HAVE CONFIDENCE!

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HAVE CONFIDENCE!

• Ive wrestled with an alligator, Ive tussled
  with a whale, I handcuffed lightning, threw
  thunder in jail. Last night I murdered a rock,
• injured a stone, hospitalized a brick.
• Im so mean, I make medicine sick.
• Im gonna show you how great I am.
• -Muhammad Ali

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DISEASES OF THE NERVOUS SYSTEM

• PART 2

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CASE 5
SIGNALMENT 4mth old, intact female Yorkshire
Terrier history of neck pain, Inability to
stand/walk
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CASE 5 Atlantoaxial Instability

• Signs
• Toy and miniature breeds
• Reluctance to be patted on head
• Neck pain
• May have tetraparesis (weakness in all 4 limbs)
  or tetraplegia (paralysis in all 4 legs)
• Sudden death due to respiratory paralysis

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Atlantoaxial Joint
Atlanto-Axial Joint
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Atlantoaxial instability

• Diagnosis
• Radiographs lateral x-ray of neck in slight
  ventroflexion
• avoid further spinal cord damage with positioning

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Atlantoaxial Instability
Normal toy breed dog Toy breed dog with
atlantoaxial subluxation
Narrowed spinal canal
CT scan dens is marked by
X-rays of same dogs note separation of C1 and C2
when dogs neck is flexed in B
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Atlantoaxial Instability (Subluxation)

• Treatment
• Medical
• splint neck in extension with cage confinement x
  6 w
• treat like other spinal cord trauma
• Surgical (if unresponsive to medical Rx)
• stabilize/decompress
• attach dorsal process of axis to arch of atlas
• fuse atlas and axis joint with pins and bone
  graft
• hemilaminectomy to relieve spinal cord compression

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Atlantoaxial Instability Surgical Correction
Stabilization using trans-articular screws
Stabilization using screws and bone cement
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Atlantoaxial Instability

• Client info
• prognosis is fair to good for animals with mild
  signs
• animals should not be used for breeding may be
  hereditary

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CASE 6
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Cervical Spondylomyelopathy Wobblers

• Cervical spinal cord compression as a result of
  caudal vertebral malformation or
  misarticulation.
• Large breed dogs (Great Danes and Dobermans)
• Signs
• Progressive hind-limb ataxia (wobbly gait)
• Pelvic limbs cross each other when walking
• Abduct widely/tend to collapse
• May drag toes (wears dorsal surface of nails)
• Impaired proprioception
• Signs may also be present in front limb
• Crouching stance with downward flexed neck
• Rigid flexion of neck may have neck pain

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Cervical Spondylomyelopathy Wobbler

• Diagnosis
• Radiographs to show malalignment and narrowing of
  spinal canal
• Myelogram is essential to locate the region of
  compression
• CT and MRI if available

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Cervical Spondylomyelopathy Wobbler

• Treatment without treatment, prognosis is poor
• Medical
• Anti-inflammatory doses of corticosteroids
• Neck brace
• Cage confinement
• Surgical
• Decompression of spinal cord by laminectomy
• Stabilize vertebral column
• screws and wire dorsally
• spinal fusion ventrally

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Cervical Spondylomyelopathy Wobbler

• Client info
• Prognosis is guarded
• Most likely a hereditary disease
• Multiple levels of compression less favorable
  prognosis than a single area of compression
• Surgery is risky and costly

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CASE 7
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Degenerative Myelopathy

• Etiology unclear
• May be autoimmune response to antigen in nervous
  sys
• Degeneration of white matter in ascending and
  descending tracts
• Signs
• Mainly in German Shep and Shep mixes (gt5 yr)
• Progressive ataxia and paresis of hind limbs
• Loss of proprioception is first sign
• Dog falls down when trying to defecate
• Muscle wasting of back muscles along caudal
  thoracic and lumbosacral areas
• Symptoms progress until animal is unable to
  support weight on hind limbs

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Degenerative Myelopathy
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Degenerative Myelopathy

• Diagnosis
• Neurologic Exam
• ? proprioception
• N-? patellar reflexes
• Lack of pain
• Normal sphincter tone normal panniculus (pin
  prick) reflex
• Radiographs usually normal
• Treatment none - symptoms will progress to
  paralysis

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Degenerative Myelopathy

• Client info
• Degenerative myelopathy is a progressive,
  incurable disease
• Although symptoms are similar at early stages, it
  is a different disease from hip dysplasia
• When dog cannot support weight, quality of life
  should be evaluated

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Deafness

• damage to auditory pathway
• chronic otitis
• rupture of tympanic membrane
• damage to middle ear (ossicles)
• damage to auditory nerve
• hereditary or congenital
• bull terriers, Dobes, Rotts, Pointers, blue-eyed
  white cats, Dalmations, Aust Heelers, Aust
  shepherds, Eng setters, Catahoula
• related to drug therapy
• aminoglycosides (gentamicin, streptomycin,
  kanamycin
• topical polymyxin B
• Chloramphenicol
• Chlorhexidine w/ centrimide
• normal old age usually due to atrophy of nerve
  ganglia or cochlear hair cells

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CASE 8
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Deafness

• Diagnosis
• Inability to rouse sleeping animal with loud
  noise (e,g,. blast from air horn) is diagnostic
• Treatment No treatment is available in most
  cases
• Hearing aids are available for animals, but most
  will not tolerate something in ear canal
• Client info
• Hearing loss is permanent
• If hereditary, do not breed
• Animals can be taught to hand signals rather than
  words
• Animals should not be off leash when outside
• Hearing aids are available for dogs but are
  usually not tolerated would only be appropriate
  for hearing impaired

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Laryngeal Paralysis

• 3 types (always be cautious of laryngeal
  paralysis because of the chance of rabies)
• Hereditary seen in Bouvier des Flandres and
  Siberian Huskies
• Seen at 4-6 mo of age
• Acquired can occur from lead poisoning, rabies,
  trauma, inflammation of vagus nerve
• 1.5 to 13 yr of age
• Idiopathic seen in middle-age to old large- and
  giant-breed dogs castrated dogs and cats have a
  higher incidence than female and non-neutered
  males

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CASE 9
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Laryngeal Paralysis
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Laryngeal Paralysis

• Signs
• Inspiratory stridor
• Resp distress
• Loss of endurance
• Voice change
• Dyspnea/cyanosis/complete resp collapse

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Laryngeal Paralysis

• Diagnosis laryngoscopy will show laryngeal
  abductor m. dysfunction
• Treatment surgical intervention including
• Arytenoidectomy
• Removal of vocal folds
• Client info prognosis is guarded to good do not
  breed if hereditary

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CASE 10
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Coonhound Paralysis (Polyradiculoneuritis )

• thought to be an immune response to an unknown
  etiologic factor in raccoon saliva
• some dogs will get it 1-2 wk after exposure,
  others exposed to same raccoon will not
• Signs similar to tick paralysis and rabies
• Weakness begins in hind limbs with paralysis
  progressing rapidly to a flaccid tetraplegia
• Alert, afebrile animal
• Loss of spinal reflexes (patella tap, etc)
• Loss of voice labored breathing inability to
  lift head
• May die of respiratory failure
• May last for 2-3 mo (usually good Px)
• Rx supportive nursing care
• Client info
• Dogs can be affected without exposure to raccoon
• May require long-term nursing care
• Some animals will regain total function, while
  more severely affected animals may not

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CASE 11
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Tick Paralysis

• Cause female tick (Dermacenter variablis, D.
  andersoni) ? salivary neurotoxin
• Neurotoxin interfered with Ach at neuromuscular
  jct
• Not seen in cats humans are affected
• Signs
• Gradual onset of voice changes and hind-limb
  ataxia (motor deficit) progressing to a flaccid,
  ascending paralysis (1-3 d)
• Sensation is intact
• Ticks on the dog
• Treatment
• Remove ticks (manually or with dip)
• Usually resolves in 1-3 d
• Supportive care until dog recovers
• Ventilation required for resp paralysis

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CASE 12
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Idiopathic Facial Nerve Paralysis

• Etiology unknown
• Occurrence
• Cocker Spaniels, Corgis, Boxers, Eng Setter, DLH
  cats
• Signs
• Older dogs (gt5 y)
• Ear droop
• Lip paralysis
• Sialosis (drooling)
• Deviation of nose
• Collection of food in paralyzed side of mouth
• Absence of menace and palpebral reflex

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Idiopathic Facial Nerve Paralysis

• Treatment efficacy of corticosteroids unknown
• Artificial tears to prevent corneal ulcers
• Keep oral cavity clear of food
• Client info
• Cause is unknown
• Complete recovery does not usually occur
• May develop keratoconjunctivitis sicca (dry eye)
• Animals may require life-long maintenance

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Greys Anatomy Memory Center
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