ClinNeuro- Cervical Pain
Card Set Information
ClinNeuro- Cervical Pain
Differential diagnoses for neck pain. (4)
cervical IVDD, atlantoaxial subluxation, steroid-response meningitis-arteritis, cervical spondylomyelopathy
Describe the classic neck pain posture.
kyphosis (arched back), head hung low, reluctance to flex neck/turn head
What are the 3 main structures involved in spinal pain?
meninges, nerve roots, vertebrae (periosteum)
In what animals are you most likely to see cervical IVDD?
small breeds >2 years old
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)
Clinical signs of cervical IVDD. (5)
, +/- proprioceptive ataxia, +/- tetraparesis, +/- root sign, [RARELY] non-ambulatory tetraparesis/tetraplegia
With C-IVDD, hyperesthesia is associated with mainly disease in the ___________; neurologic deficits are associated with disease in the __________.
cranial discs; caudal discs
How do you diagnose C-IVDD? (5)
signalement, history, neurologic findings (neck pain), CT scan, +/- MRI
Describe the medical treatment of C-IVDD. (3)
confinement for 4 weeks, NSAIDs, restricted activity for additional 4-6 weeks
What surgical approach is usually used to treat C-IVDD?
ventral slot for ventral decompression
Why does atlantoaxial subluxation occur?
failure of structural support ligaments or processes in the C1 and C2 region
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.
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
In what animals do you usually see atlantoaxial subluxation?
toy breeds, < 2 years old
Clinical signs associated with atlantoaxial subluxation. (3)
cervical hyperesthesia, proprioceptive ataxia, tetraparesis
How do you diagnose atlantoaxial subluxation?
radiographs (lateral and VD views), +/- MRI
Describe the medial treatment of atlantoaxial subluxation. (4)
[always try medical management first]
for 3 months (removes dynamic cord compression), confinement for 3-8 weeks, steroids, physical therapy
Describe surgical treatment of atlantoaxial subluxation [only in certain cases].
ventral fusion....very high mortality rate, even with the best surgical technique
What are indicators of good prognosis with atlantoaxial subluxation? (3)
< 2 years old, signs for <30 days, ambulatory
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)
What breeds are predisposed to SRMA?
, beagles, bernese mountain dogs, golden retrievers, pointers
What age dogs usually present with SRMA?
6 months- 2 years
Clinical signs associated with SRMA. (5)
acute onset of pain and neck rigidity, reluctance to walk, stiff gait, fever, +/- diffuse spinal pain
Dogs with SRMA typically present with __________ without _________.
severe neck pain; neurologic deficits
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
How do you treat SRMA? (2)
0.25mg dexamethasone right after spinal tap dx, immunosuppressive prednisone (decreasing dose slowly) for 4-6 months
What is the prognosis for SRMA?
Cervical spondylomyelopathy is commonly known as ___________.
Cervical Spondylomyelopathy (CSM) is characterized by...
variable degrees of spinal cord and nerve root compression, leading to neurological deficits and/or cervical hyperesthesia
CSM is a common disease of ____________.
large and giant breed dogs
Describe the pathogenesis of CSM. (6)
intervertebral disc protrusion, congenital/acquired osseous malformation, ligamentous compression, vertebral tipping, canal stenosis, dynamic compression
What are the clinical signs of CSM? (4)
cervical hyperesthesia, proprioceptive ataxia (worse in pelvic limbs), 2 engine gait, [RARE] non-ambulatory tetraparesis
What kind of CSM do Dobermans get?
What kind of CSM do Great Danes get?
What animals are usually affected by CSM?
Great Danes and giant breeds <3 years, Dobermans and large breed ~6 years (>3yr)
CSM is accompanied by ____________ signs; the lesion is localized to __________.
chronic, progressive; C1-C8 SC segments
How do you diagnose CSM?
Describe medical txt of CSM. (3)
exercise restriction, body harness/NO NECK COLLAR, Prednisone for 2-4weeks
Describe surgical txt of CSM. (2)
ventral slot for disc-associated CSM, Dorsal laminectomy for osseous-associated CSM
What is the prognosis for CSM?
medical and surgery- 36 months survival