ClinNeuro- Acute Paralysis

  1. What are the 3 main differentials for acute paralysis?
    acute disc extrusion (herniation), acute spinal cord injury, fibrocartilaginous embolic myelopathy
  2. What are 2 less common differentials for acute paralysis?
    discospondylitis, spinal neoplasia
  3. Why does disc disease cause more severe signs in dogs than in humans?
    herniation usually occurs in the lumbosacral region; in dogs, there is spinal cord compression... in humans, the spinal cord ends much more cranially, so only the cauda equina is compressed
  4. What is Hansen Type I disc disease?
    acute- extrusion
  5. What is Hansen Type II disc disease?
    chronic- protrusion
  6. What animals are usually affected by acute thoracolumbar IVDD? (3)
    chondrodystrophic dogs (dachshund, pekingese), avg. 6 years old, small breed
  7. Where does acute thoracolumbar IVDD usually occur?
    discs b/w T11-L3
  8. Clinical signs of acute IVDD. (5)
    TL pain, proprioceptive ataxia/deficits, paresis/plegia, urinary incontinence, absence of nociception [late stage]
  9. What is the exception to dogs>2 yrs old getting acute IVDD?
    French bulldogs have congenital vertebral anomalies
  10. How does acute IVDD usually present? (3)
    usually on an emergency basis, episodes of pain, sudden onset of paralysis or paresis
  11. How do you diagnose acute IVDD?
    survey radiographs to rule out trauma, CT scan, MRI
  12. Txt of dogs with TL pain (only sign) as a result of acute disc disease.
    conservative txt- confinement and analgesics
  13. Txt for dogs with ambulatory paresis from acute disc disease.
    usually recover with medical/conservative txt- confinement and analgesics
  14. Txt for dogs with non-ambulatory paraparesis as a result of acute disc extrusion.
    surgical txt is recommended
  15. Describe conservative treatment for acute disc extrusion. (4)
    STRICT CONFINEMENT for a minimum of 4 weeks, anti-inflammatory drugs, bladder care, +/- physical therapy
  16. NEVER combine NSAIDs with _________.
  17. What are the goals of surgical txt of acute disc extrusion? (2)
    decompression and disc removal
  18. What surgical techniques are used to treat acute disc extrusion? (3)
    hemilaminectomy, pediculectomy, fenestration
  19. Describe hemilaminectomy.
    dorsal approach- remove lamina (dorsolateral wall + articular process) and pedicle
  20. Describe a pediculectomy.
    lateral approach- remove pedicle (lateral wall of vertebral body)
  21. Describe fenestration surgical technique.
    make a hole in the disc and remove the nucleus pulposus
  22. What is the prognosis for IVDD?
    surgery--> 95% success; conservative txt--> 80% recovery, takes longer; paraplegic with absent nociception--> guarded to poor prognosis
  23. Concussive injuries to the SC are _________ severe than compressive injuries.
  24. What are clinical signs of acute spinal cord injury (ASCI)?
    acute onset; localized based on motor function, posture, tone, reflexes; assess (absence of) motor function [broken leg--> animal should still be able to walk on 3 legs], +/- nociception
  25. What tests should you avoid when assessing ASCI because they may cause unneeded pain/worsen condition? (2)
    postural reactions, spinal cord palpation
  26. What is the most important prognostic indicator with ASCI?
    absence or presence of nociception
  27. In what cases does progressive myelomalacia occurs, and what is it?
    ~10% of ASCI cases with absent nociception; progressive liquefactive necrosis of the spinal cord
  28. How do you diagnose progressive myelomalacia? How is it handled clinically?
    loss of cutaneous trunci reflex moves cranially every day; euthanasia (when it reaches C5, respiratory paralysis occurs...terrible death)
  29. How do you diagnose ASCI? (6)
    history, PE, neuro exam, rads (miss 25% of fractures and luxations.....NOT A GREAT STANDARD OF CARE), CT for bone lesions, MRI for cord changes
  30. ASCI lesions caudal to ________ almost always recover because...
    L%; there is no spinal cord involvement, only cauda equina.
  31. Describe treatment of acute SC injury. (7)
    treat emergency problems first, immobilize vertebral column, supportive care, analgesia (opioids), confinement, surgery if warranted, physical therapy
  32. What opioids do we often use for analgesia in patients with ASCI? (2)
    fentanyl, oxymorphone [CRI]
  33. In what ASCI patients indicate non-surgical treatment?
    patients with voluntary movement--> cage confinement 4-6 weeks
  34. In what ASCI patients is surgery indicated? (2)
    paralyzed patients, patients with an unstable vertebral column
  35. What is FCEM?
    spinal cord infarct cause by a fragment of fibrocartilaginous material from the nucleus pulposus
  36. FCEM is often associated with _________.
    intense exercise
  37. Describe the pathogenesis of FCEM.
    non-traumatic ischemic lesion/infarct- spinal stroke
  38. FCEM is the only acute SC injury that is not associated with _________; this is due to the fact that...
    pain; it affects only the spinal cord parenchyma, which does not have nociception.
  39. What are clinical signs of FCEM? (6)
    acute onset, non-progressive, focal, strong asymmetrical myelopathy, NO SPINAL PAIN, +/- asymmetric cutaneous trunci reflex
  40. Where is the most common location for FCEM?
    L4-S3 (therefore commonly has LMN PL)
  41. How do you diagnose FCEM? (5 criteria)
    • acute onset, non-progressive myelopathy
    • large breed, schnauzer, sheltie
    • asymmetric neuro signs (check cutaneous trunci)
    • absence of spinal pain after 6-12hr
    • clinical improvement within 3-7 days
  42. How do you treat FCEM?
    you don't....they get better on their own (if they don't, assume your diagnosis was incorrect and look for other causes)
  43. What are you main differentials for acute asymmetric neurologic deficits? (3)
    FCEM, myelitis/meningomyelitis, intervertebral disc extrusion
  44. How do you differentiate myelitis/meningomyelitis from FCEM?
    myelitis- dx by CSF tap; meningomyelitis is progressive and accompanied by pain
  45. How do you differentiate disc extrusion from FCEM?
    pain, usually not asymmetric
  46. __________ is contraindicated in FCEM.
  47. What is the prognosis for FCEM?
    excellent; unless: no improvement in 14 days, absence of nociception, located in C6-T2
  48. What are your top differentials (in order) from small dogs presenting with acute paralysis.
    • 1- IVDD
    • 2- trauma, FCEM (schnauzers)
    • 3- meningomyelitis
  49. What are your top differentials (in order) for large dogs presenting with acute paralysis?
    • 1- IVDD
    • 2- FCEM
    • 3- neoplasia, trauma
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ClinNeuro- Acute Paralysis
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