Neuro junior > Spinal disorders > Flashcards

Spinal disorders Flashcards

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1
Q

Objectives (4)

A
  1. Recognize clinical signs of spinal disorders
  2. Localize spinal lesion to appropriate segment
  3. Recognize classic signalments for various disorders
  4. List appropriate ddx for neuroloc and signalment
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2
Q

Thoracic limb reflexes

A

Withdrawal is only reliable reflex

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3
Q

Pelvic limb reflexes

A

Patellars and withdrawals reliable

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4
Q

Other reliable reflexes (3)

A
  1. Panniculus
  2. Perineal
  3. Anal tone
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5
Q

Acutely down dog non-neurologic DDX (6)

A
  1. Hemoabdomen
  2. Sepsis
  3. Heart failure
  4. Arrythmia
  5. Polyarthritis
  6. Orthopedic dz
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6
Q

Acutely down dog neurologic categories (3)

A
  1. Brain
  2. Spine
  3. Motor unit (LMN)
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7
Q

Acutely down dog neuro (5)

A
  1. IVDD
  2. FCE, other vascular lesion - NON PAINFUL
  3. Inflammatory
  4. Trauma
  5. Motor unit dz
    - Nerve: Polyradiculoneuritis
    - Junction: Myasthenia gravis
    - Muscle: not often down
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8
Q

Painful spinal lesions (5)

A
  1. IVDD
  2. Meningitis/meningomyelitis (covering of cord)
  3. Diskospondylitis (disk and vertebra)
  4. Fracture/luxation
  5. Neoplasia (bone or meninges)
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9
Q

There are no nerve endings…

A

Within the cord

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10
Q

DDX signalment: Immature ~ 9 mo (4)

A
  1. trauma
  2. congenital
  3. infectious
  4. degenerative
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11
Q

DDX signalment: Mature (3)

A
  1. IVDD
  2. FCE/vascular
  3. Neoplasia
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12
Q

DDX signalment: Geriatric (3)

A
  1. IVDD
  2. Neoplasia
  3. Degenerative
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13
Q

DDX signalment Chondrodystrophoid (1)

A

IVDD

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14
Q

DDX Course of dz: Acute non-progressive (3)

A
  1. Vascular
  2. Trauma
  3. IVDD
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15
Q

DDX course of dz: Acute progressive (5)

A
  1. Trauma
  2. IVDD
  3. Neoplasia
  4. Inflammatory
  5. Infectious
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16
Q

DDX course of dz: Chronic progressive (5)

A
  1. Neoplasia
  2. Degenerative
  3. IVDD
  4. Inflammatory
  5. Infectious
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17
Q

Minimum database

A
  1. Bloodwork
    - NOVA/PCV/TS vs CBC/Chem/UA (age/hx/finances)
  2. UA/culture (chronic back dog bladder!)
    - Chronicity/concurrent dz
  3. Thoracic rads
    - Age, Motor unit dz
    - LMN - look for megaesophagus
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18
Q

Indications for spinal rads (3)

A
  1. Trauma-was it really trauma (found at stairs)
  2. Diskospondylitis (severely painful, shouldn’t be down)
  3. Osseous neoplasia - hx osteosarc
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19
Q

Indications for CT (4)

A
  1. Chondrodystrophoid (IVDD susp)
  2. Better if recent surg < 4mo (MRI hot mess)
  3. Traditionally more sens for bone
  4. Fast, safer, cheapish
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20
Q

Indications for MRI (4)

A
  1. Indramedullary dz
  2. FCE, vascular dz
  3. Neoplasia
  4. Lower risk than myelogram
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21
Q

Down cat (6)

A

VASCULAR UNTIL PROVEN OTHERWISE

  1. check pulses, then doppler flow, then paired NOVAs
  2. Not ush surgical
  3. CBC/Chem/UA
  4. BP
  5. Met check thorax +/- AUS
  6. +/- MRI
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22
Q

Cervical Spinal Diseases (6)

A
  1. AA
  2. COMS/SM
  3. CSM
  4. IVDD
  5. Neoplasia
  6. Inflammatory - SRMA/GME
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23
Q

Congenital AA instab def and breeds

A
  1. Hypoplasia/aplasia of dens

2. Toy/teacups - Yorkies, poms, poodles, chihuahuas

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24
Q

Acquired AA instab

A

Traumatic, rare

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25
AA med manag (3)
1. Cervical splint 2. Young dogs affected < 30 days 3. > 2mo in splint- complications (sores/airway obst/relapse)
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AA surgical cor (2)
1. Cross pinning C1-C2 kirschner wires - pot penetrations spinal cord and migration of wire 2. Screws and PMMA to vert floor - > 90% success but high risk (10% die)
27
Syringomyelia (2)
1. Fluid buildup in parencyma of spinal cord from altered CSF dynamics - fluid bright white on MR 2. secondary syringomyelia
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Secondary syringomyelia (5)
1. abn caudal fossa 2. tethered spinal cord 3. trauma 4. arachnoiditis 5. tumor
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COMS
Caudal occipital malformation syndrome
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Syringomyelia CS and TX
``` CS (King charles cavalier) 1. Phantom scratching 2. Pain 3. Lameness TX: multimodal 1. Gabapentin 2. Omeprazole 3. NSAIDS and Pred if NSAIDS don't work 4. Surgery (foramen magum decomp) -sx imp pain, not syrinx and prog is variable (worse with larger syrinx) ```
31
Classic CS cervical spondylomyelopathy
TWO ENGINE GAIT | -classical caudal cervical CS
32
Disc Assoc Wobbler synd (DAWS)
7-9 yr old dobie 1. VENTRAL SPINAL CORD COMP FROM DISC 2. Type II IVDD (Caudal cerv C5, C6, C7) 3. +/- dynamic comp 4. chronic protrusion of disk 5. Med manag - NSAIDS, pred, PT (Caution), acupuncture (pain) 6. SX - V-slot, distractoin-fusion (many complications)
33
Osseus-assoc wobbler
Young dog/giant breed 1. DORSO/DORSOLATERAL compression 2. Articular process degenerative joint dz 3. Malformations 4. Articular cysts (comp C2, C3, C4) 5. Med manag - NSAIDS, Pred, PT, acupuncture 6. SX - dorsal laminectomy/fusion (rough, prolonged recov)
34
Steroid Responsive meningitis +/- arteritis | MAIN R/O
Diskospondylosis from bact infection
35
Steroid responsive meningitis +/- arteritis (7)
1. Boxer, Bernese, Beagle, German SH pointer 2. Pembroke Welsh corgi? 3. < 2 yrs old 4. SEVERE cervical pain 5. Stiff, stilted gait, reluctant to move 6. Often febrile 7. Minimal neuro deficits
36
Painful walking on egg shell dzes (2)
1. Steroid resp meningitis +/- arteritis | 2. Immune mediated polyarthritis
37
Ster. Resp Men +/- art (exam, labs) (3)
1. PE: NSF, +/- fever 2. CBC: +/- leukocytosis 3. CSF - Acute: marked neutrophillic pleocytosis - Chronic: mixed pleocytosis, esp if steroids - Will shift to mononuclear pop (I think)
38
Ster. Resp Men +/- art TX/PX (3)
1. Immunosuppression: steroids, azathioprine, MMF - treat at least 4-6 months 2. Good prognosis - worse if recurs and older dogs with longer time to dx 3. Potential for recurrence if wean from ster. too soon
39
Granulomatous Meningoencephalomyelitis (5)
1. Females 2. Toys and terriers 3. forms: Ocular, Focal, Diffuse 4. Peracute 5. Fatal if untreated
40
GME Lesions and CS (5)
1. Caudal fossa 2. Cerebrum 3. Cervical spine 4. Any white matter 5. Can present with cervical pain as only CS
41
GME CSF (3)
1. Pleocytosis 2. Often Mononuclear 3. Can be Normal
42
GME MRI
1. Infiltrative lesions 2. Irregular margins 3. Mass effect 4. T2 and FLAIR hyperintensities
43
GME TX (7)
1. Corticosteroids 2. Radiation 3. Cyclosporine 4. Cytosine arabinoside 5. Procarbazine 6. Azathioprine 7. Mycophenolate mofetil
44
Thoracolumbar dz (5)
1. IVDD 2. Trauma 3. Congenital malformations 4. Degenerative myelopathy 5. Fibrocartilagenous Embolism
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Congenital Spinal Malformations (3) 1. breed 2. presenting compl 3. age onset
1. Breed predilections - frenchies, pugs, english bulldogs, bostons, screw tails 2. Presenting complaint - progressive ataxia, paresis - Ush non-painful 3. Age of onset is variable
46
Congenital Spinal Malformations TX
``` Med manage 1. Strict rest 2. Pred: 0.5-1 mg/kg/day 3. pain control SX 4. Decompressive sx w/ stabilization (poor prog) ```
47
Congenital Spinal Malformations Pathology (2)
1. Compression from canl stenosis | 2. microinstability - wedge shaped vertebrae
48
IVDD Compressive extrusion
1. Acute IVD extrusion with mass of nucleus causing cord compression
49
IVDD Concussive extrusion
1. Acute IVD extrusion w/ no residual compression | 2. ANNPE - acute non-compressive nucleus pulposus extrusion
50
IVDD Contraindications for Med ther.
1. Non-ambulatory | 2. absent pain perception
51
When to image and cut (7)
1. Progression in 24-48 2. Progression/lack of response in 1-2 weeks med manag 3. relapse off meds 4. Cervical pain with ANY DEFICIT 5. Recurrent pain, multiple episodes 6. Lower motor neuron deficits 7. non ambulatory status
52
Scan all little white fluffy dogs b/c
possibility of inflammatory dz
53
Things that may look like IVDD....?!?!?! Don't cut....?!?!?!
1. Young, small breed dogs with cervical pain and no other obvious signs - Concern for inflammatory brain disease - Not uncommon presentation - Yorkies, pugs, poms, malteses, shih tzus
54
Degenerative Myelopathy
1. GSD, Husky, Corgi, Boxer, Chessie, Rhodesians - mean age 9 and 11 yrs old 2. Non-painful, slowly progressive 3. Diagnosis of exclusion 4. No tx, PT may slow progression PX 1 yr
55
DM work-up (6)
1. Neuro exam 2. CBC/Chem 3. UA/urine culture 4. Thoracic rads 5. MRI/CT/myelogram T3-L3 6. CSF
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DM testing (3)
1. SOD-1 mutation - homozygous at risk or diseased 2. can support dx with imaging 3. not replacement for imaging
57
Myelomalacia
1. Clinical dx 2. rapid progression of T3-L3 parapersis UMN -> LMN 3. Imaging and CS supportive 4. Ascending panniculus, loss of PL reflexes, anal tone, TL paresis, loss of ventilatory fxn 5. NO TX -> Euthanasia
58
Non-compressive myelopathies
1. Fibrocartilagenous embolic myelopathy - these get better 2. Acute non-compressive nucleus pulposus extrusion-ANNPE, Type III IVDD, COncussive/traumatic disc 3. Ischemic infarction
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Evaluating non-compressive myelopathies
1. peracute-acute - can progress w/in first 24 hours 2. Non-painful - distinguish from anxiety 3. Often assymmetrical 4. Intramedullary spinal cord disease - non-surgical (generally improve on own)
60
Typical FCE HX
young, large-breed dog, possible vigorous activity, animal jumps and screams and goes down
61
Work up FCE, ANNPE, infarcs b/c
1. If there is an underlying cause (for a stroke) want to treat underlying cause 2. CBC/Chem - endocrinopathies, hepatopathy 3. UA/UPC/TEG - Proteinuria, hypercoagulability
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FCE, ANNPE, Infracts TX
1. Physiotherapy - only thing shown to help 2. Great prog unless.... - loss of pain, LMN localizations (lack muscle tone) - Intramedullary hemorrhage on MRI
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Diskospondylitis (5)
1. Radiographic dx 2. Usually multifocal 3. Crosses joints/takes out endplates 4. VERY PAINFUL 5. rarely neuro deficits
64
Disko common bact (4)
1. Staph 2. Strep 3. E. coli 4. Brucella - zoonotic, reportable
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Disko diagnostics/TX (3)
1. urine culture; +/- blood culture 2. Cephalexin, Clavamox, Baytril 3. NSAIDS, Tramadol * if you've chosen correct abx will be less painful within days
66
Disko Prog (3)
1. good prog 2. Requires long-term tx 3. do rads every 2-3 months - monitor all the lesions * Avoid surgery
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Sequelae Disko
Pathologic fracture/luxation
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Lumbosacral dz (3)
1. Working dogs - GSD/malinois 2. Congenital - malformations 3. Acquired - IVDD/proliferative
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Lumbosacral dz CS (5)
1. Pain - reluctance to jump/climb 2. Decreased withdrawal reflex 3. +/- proprioceptive deficits 4. Flaccid tail 5. Urinary and fecal incontinence
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Lumbosacral dz TX - med - sx
1. Med management - NSAIDS/prednisone - Gabapentin/tramadol - PT/acupuncture 2. Surgical managment - dorsal laminectomy - foraminotomy - stabilization
71
Lumbosacral dz prog (4)
1. if only pain - attempt medical management 2. If only pain and mild deficits - good with sx 3. If severe deficits - fecal & urinary incontinence - poor prognosis
72
Feline Spinal Diseases (6)
1. Degenerative: IVDD (uncommon) 2. Neoplasia: LSA, Meningioma 3. Immune mediated/Inflammatory (uncommon) 4. Infectious: Toxo, Crypto (COMMON) 5. Trauma: traction inj/tail pull, fx/luxation 6. Vascular: hemorrhagic/ischemic infarctions (common)
73
Remember cats have no
nuchal ligament
74
The down cat (5)
1. Check for pulses, then doppler flow then paired novas 2. CBC/Chem/T4/UA 3. BP 4. Met check thorax +/- AUS 5. +/- MRI and CSF
75
Feline IVDD (6)
1. Extremely rare 2. Older cats ~ 10 yrs old 3. LUmbar L4-L5 most common 4. Mineralized discs on rads 5. Extrememly painful and fractious 6. Very good px with sx
76
Feline spinal Neoplasia (6)
1. Spinal cord LSA 2. Spinal cord Glial (cervical) 3. Spinal cord fibrosarc (Thoracic) 4. Vertebral column OSA 5. Meningeal neoplasia 6. Non-vertebral extradural neoplasia - plasma cell tum
77
Feline Spinal infections (5)
1. FIP: < 2 years old 2. Bacterial myelitis 3. Cryptococcus 4. Toxoplasma 5. Idiopathic inflammatory
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Recumbent care (3)
1. Urine scald 2. Decubital ulcers 3. Muscle atrophy
79
Bladder management (2)
1. Acutely: indwelling u cath or express q6, or intermit cath if male 2. Pharm: - Prazosin (1mg/15 kg PO q8h) - diazepam (0.5-1 mg/kg IV q8h)
80
IVDD summary and can't R/O.... (6)
1. Can't R/O GME 2. Chondrodystrophoid breeds 3. PEracute to acute onset 4. Often painful 5. Concussion vs compression 6. CT/myelogram
81
Vascular summary (6)
1. FCE 2. Ischemic/hemorrhagic event 3. 3 yr old lab, frisbee, screams, down 4. Can progress w/in 24 hrs 5. Often assymetrical 6. Non-painful - very anxious
82
Chronic/slowly down dog summary (4)
1. IVDD 2. Wobbler-type lesions 3. Degenerative: degenerative myelopathy 4. LMN: polyneuropathy
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Wobbler-type Disorders IVDD, Type II (6)
1. Caudal cervical 2. Dobies, Weims 3. Middle-aged 4. Ventral compression 5. Maybe dynamic 6. chronic disorders
84
Wobbler-type Disorder Dorsolateral compression (5)
1. Osseus 2. Articular proliferation, synovial cysts 3. Malformed vertebrae/lamina 4. Young giant breed dogs 5. Cronic disorders
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Stereotypes 1. IVDD 2. FCE 3. DM 4. Other
1. IVDD - Dachshund, beagle, shih tzu, Boston terrier - German Shepherd, Doberman, Labrador 2. FCE - Lab, young-middle aged, active large breed dog 3. DM - German shepherd, boxer, corgie, rhodesian ridgeback 4. Other - Great dane, rottie, frenchie
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