ClinNeuro- Cervical Pain

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  1. Differential diagnoses for neck pain. (4)
    cervical IVDD, atlantoaxial subluxation, steroid-response meningitis-arteritis, cervical spondylomyelopathy
  2. Describe the classic neck pain posture.
    kyphosis (arched back), head hung low, reluctance to flex neck/turn head
  3. What are the 3 main structures involved in spinal pain?
    meninges, nerve roots, vertebrae (periosteum)
  4. In what animals are you most likely to see cervical IVDD?
    small breeds >2 years old
  5. What are the most commonly affect discs with cervical IVDD in small dogs? In large dogs?
    • small dogs- C2,C3
    • large dogs- C6,C7 (caudal cervical)
  6. Clinical signs of cervical IVDD. (5)
    neck pain**, +/- proprioceptive ataxia, +/- tetraparesis, +/- root sign, [RARELY] non-ambulatory tetraparesis/tetraplegia
  7. With C-IVDD, hyperesthesia is associated with mainly disease in the ___________; neurologic deficits are associated with disease in the __________.
    cranial discs; caudal discs
  8. How do you diagnose C-IVDD? (5)
    signalement, history, neurologic findings (neck pain), CT scan, +/- MRI
  9. Describe the medical treatment of C-IVDD. (3)
    confinement for 4 weeks, NSAIDs, restricted activity for additional 4-6 weeks
  10. What surgical approach is usually used to treat C-IVDD?
    ventral slot for ventral decompression
  11. Why does atlantoaxial subluxation occur?
    failure of structural support ligaments or processes in the C1 and C2 region
  12. 75% of the structural support in the C1, C2 region comes from the __________; therefore, ...
    dens; anything that affects/compromises the dens will cause atlantoaxial subluxation.
  13. 2 types of etiologies of atlantoaxial subluxation  and what they cause.
    • congenital- aplasia or hypoplasia of the dens, absence of ligaments
    • acquired (trauma)- dens fracture, ligament rupture
  14. In what animals do you usually see atlantoaxial subluxation?
    toy breeds, < 2 years old
  15. Clinical signs associated with atlantoaxial subluxation. (3)
    cervical hyperesthesia, proprioceptive ataxia, tetraparesis
  16. How do you diagnose atlantoaxial subluxation?
    radiographs (lateral and VD views), +/- MRI
  17. Describe the medial treatment of atlantoaxial subluxation. (4)
    [always try medical management first] neck brace for 3 months (removes dynamic cord compression), confinement for 3-8 weeks, steroids, physical therapy
  18. Describe surgical treatment of atlantoaxial subluxation [only in certain cases].
    ventral fusion....very high mortality rate, even with the best surgical technique
  19. What are indicators of good prognosis with atlantoaxial subluxation? (3)
    < 2 years old, signs for <30 days, ambulatory
  20. What is steroid-responsive meningitis-arteritis?
    immune-mediated response against meninges and arteries in the CNS from excessive productions of IgA in CSF and serum (unknown cause)
  21. What breeds are predisposed to SRMA?
    BBB-GP- boxers**, beagles, bernese mountain dogs, golden retrievers, pointers
  22. What age dogs usually present with SRMA?
    6 months- 2 years
  23. Clinical signs associated with SRMA. (5)
    acute onset of pain and neck rigidity, reluctance to walk, stiff gait, fever, +/- diffuse spinal pain
  24. Dogs with SRMA typically present with __________ without _________.
    severe neck pain; neurologic deficits
  25. How do you diagnose SRMA? (4)
    neutrophilic leukocytosis on CBC, severe neutrophilic pleocytosis in CSF, cloudy/hemorrhagic CSF, detection of high IgA in CSF or serum
  26. How do you treat SRMA? (2)
    0.25mg dexamethasone right after spinal tap dx, immunosuppressive prednisone (decreasing dose slowly) for 4-6 months
  27. What is the prognosis for SRMA?
    good prognosis
  28. Cervical spondylomyelopathy is commonly known as ___________.
    Wobbler's syndrome
  29. Cervical Spondylomyelopathy (CSM) is characterized by...
    variable degrees of spinal cord and nerve root compression, leading to neurological deficits and/or cervical hyperesthesia
  30. CSM is a common disease of ____________.
    large and giant breed dogs
  31. Describe the pathogenesis of CSM. (6)
    intervertebral disc protrusion, congenital/acquired osseous malformation, ligamentous compression, vertebral tipping, canal stenosis, dynamic compression
  32. What are the clinical signs of CSM? (4)
    cervical hyperesthesia, proprioceptive ataxia (worse in pelvic limbs), 2 engine gait, [RARE] non-ambulatory tetraparesis
  33. What kind of CSM do Dobermans get?
    disc-associated CSM
  34. What kind of CSM do Great Danes get?
    osseous-associated CSM
  35. What animals are usually affected by CSM?
    Great Danes and giant breeds <3 years, Dobermans and large breed ~6 years (>3yr)
  36. CSM is accompanied by ____________ signs; the lesion is localized to __________.
    chronic, progressive; C1-C8 SC segments
  37. How do you diagnose CSM?
  38. Describe medical txt of CSM. (3)
    exercise restriction, body harness/NO NECK COLLAR, Prednisone for 2-4weeks
  39. Describe surgical txt of CSM. (2)
    ventral slot for disc-associated CSM, Dorsal laminectomy for osseous-associated CSM
  40. What is the prognosis for CSM?
    medical and surgery- 36 months survival
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ClinNeuro- Cervical Pain
vetmed ClinNeuro
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