ClinNeuro- Chronic Paraparesis

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Mawad
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311794
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ClinNeuro- Chronic Paraparesis
Updated:
2015-11-20 10:38:12
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vetmed clinneuro
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vetmed ClinNeuro
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  1. Partial paralysis of the limbs due to neurologic dysfunction.
    paresis
  2. What are your main differentials for chronic spinal paraparesis? (5)
    type II IVDD, degenerative myelopathy, spinal tumors, lumbosacral stenosis, discospondylitis
  3. How does type II (chronic) IVDD differ from type I (acute)?
    type II is characterized by nucleus degeneration and replaced by fibrocartilage, progressive, and slow disc bulging and compression of SC
  4. What animals are usually affected by type II IVDD?
    large breed dogs, pugs, middle-aged to older
  5. What are the clinical signs associated with type II IVDD? (4)
    proprioceptive deficits**, progressive, hind limb ataxia/paraparesis, +/- pain
  6. Type II IVDD may improve with __________ because...
    corticosteroids; there is usually vasogenic edema in the spinal cord.
  7. How do you diagnose type II IVDD?
    definitive- MRI (do rads to rule out osteomyelitis, discospondylitis, spinal neoplasia)
  8. What are indications for medically managing type II IVDD? (5)
    ambulatory, stable/non-progressive deficits, non-painful, SC compression is mild, multiple disc sites affected** (sx risk greater than benefit)
  9. Describe medical management of type II IVDD. (3)
    restricted activity- strict confinement, physical therapy, NSAIDs/steroids
  10. What are indications for surgical treatment of type II IVDD? (4)
    progressive neurologic deficits, pain, lack of response to medical management, significant spinal cord compression
  11. What is the surgical approach to type II IVDD?
    hemilaminectomy +/- lateral corpectomy
  12. Describe degenerative myelopathy.
    degenerative disease of the white matter of the spinal cord
  13. What causes degenerative myeopathy?
    genetic disease- superoxide dismutase 1 gene mutation (autosomal recessive)
  14. What is the most common signalment of degenerative myelopathy?
    > 5 years old, GSD, boxers, corgis, huskies, others
  15. Degenerative myelopathy is a ___________ disease.
    slowly progressive
  16. What are early clinical signs of degenerative myelopathy? (3)
    proprioceptive ataxia (UMN paraparesis), bilaterally symmetrical, non-painful
  17. Describe clinical signs of degenerative myelopathy in advanced disease. (5)
    non-ambulatory paraparesis, LMN signs, urinary incontinence, tetraparesis, dyspnea/dysphagia
  18. How do you diagnose degenerative myelopathy?
    diagnosis of exclusion- MRI/CT normal; can do DNA testing but not all + dogs get this disease (incompletely penetrant)
  19. How do you treat degenerative myelopathy?
    no effective treatment, exercise and physical therapy can increase survival
  20. What is the prognosis for degenerative myelopathy?
    6 months- 2 year survival
  21. Describe degenerative lumbosacral stenosis.
    degenerative process causing spinal canal stenosis at lumbosacral space
  22. What are the 3 processes that can contribute to lumbosacral stenosis?
    type II IVDD b/w L7-S1, proliferation of interarcuate ligament, articular facet bone proliferation
  23. What is a common signalment of animals with degenerative lumbosacral stenosis?
    large breed dogs, GSDs, >3 years old
  24. History associated with degenerative lumbosacral stenosis. (5)
    progressive course, lower back pain, difficulty rising, low tail carriage, incontinence
  25. Describe the signs associated with cauda equina syndrome associated with degenerative lumbosacral stenosis. (3)
    urine retention and leaking, fecal incontinence, decreased anal/tail tone
  26. Describe the signs associated with sciatic weakness associated with degenerative lumbosacral stenosis. (5)
    paraparesis without ataxia, decreased flexor reflex in PL, dropped hocks/plantigrade, N to increased patellar reflex/pseudohyperreflexia, decreased caudal thigh muscle mass/tone
  27. Clinical signs associated with degenerative lumbosacral stenosis. (5)
    cauda equina syndrome, sciatic weakness, root signature, LS pain, paresthesias (chew on foot or tail)
  28. How do you diagnose degenerative lumbosacral stenosis?
    MRI/CT but there is a known poor correlation b/w imaging findings and clinical signs, electrodiagnostics (non-specific)
  29. Describe medical management of degenerative lumbosacral stenosis. (3)
    exercise restriction for 4 weeks, NSAIDs or steroids, gabapentin
  30. Describe surgical management of degenerative lumbosacral stenosis.
    [dogs that fail medical management] lumbosacral stabilization
  31. What are indications for surgical management of degenerative lumbosacral stenosis? (3)
    dogs that fail medical management, urinary retention, painful even with medical management
  32. What is the prognosis for degenerative lumbosacral stenosis?
    guarded to poor with neurologic deficits
  33. What are some extradural spinal neoplasias? (5)
    osterosarcoma, lymphoma, plasma cell tumor/multiple myeloma, nerve sheath tumor, metastases
  34. What are some intradural-extramedullary spinal neoplasia? (3)
    meningioma** (most common primary spinal neoplasia), nerve sheath tumor, lymphoma
  35. What are some intramedullary spinal neoplasias? (3)
    glial tumors, ependymoma, metastases
  36. What animals commonly get spinal neoplasia?
    any breed (esp goldens, rotts, boxers), usually >5 years
  37. How do you diagnose spinal neoplasia? (5)
    first-met check radiographs, US, survey radiographs (bony tumors), MRI/CT, FNA/biopsy
  38. What are common bacterial etiologies of discospondylitis? (4)
    staph aureus/intermedius, strep, E. coli, Brucella canis
  39. What is discospondylitis?
    infection of the intervertebral disc and end plates
  40. What are common fungal etiologies of discospondylitis? (2)
    Aspergillus, Coccidioides immitus
  41. How do animals get discospondylitis? (2)
    usually hematogenous spread, sometimes exogenous extension from trauma/surgery
  42. What animals are usually affected by discospondylitis?
    large breed dogs (GSD), purebreds, males, young to middle-aged
  43. What are common locations for discospondylitis?
    lumbosacral disc space, mid-to-caudal thoracic and lumbar spine
  44. Clinical signs associated with discospondylitis. (3)
    systemic signs (fever, lethargy, anorexia), severe spinal pain, +/- neurologic deficits
  45. How do you diagnose discospondylitis?
    rads (takes 7-14 days to become apparent)- concentric lysis of end plates, widened/collapsed disc space, pathologic fractures, CT/MRI- more sensitive
  46. How do you treat discospondylitis?
    empiric (often don't ID organism)- cephalosporin 6-8 weeks
  47. What is the prognosis with discospondylitis?
    pain alone- good, guarded if neurologic deficits or poor response to atb

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