“I’ve wrestled with an alligator, I’ve tussled with a whale, I handcuffed

lightning, threw thunder in jail. Last night I murdered a rock,

injured a stone, hospitalized a brick. I’m so mean, I make medicine sick.

I’m gonna show you how great I am.”-Muhammad Ali

PART 2

SIGNALMENT: 4mth old, intact female Yorkshire Terrier; history of neck pain,Inability to stand/walk

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

Atlantoaxial Joint

Atlanto-Axial Joint

Atlantoaxial instability Diagnosis

Radiographs: lateral x-ray of neck in slight ventroflexion

avoid further spinal cord damage with positioning

Atlantoaxial Instability

CT scan:dens is marked by *

Normal toy breed dog Toy breed dog with atlantoaxial subluxation

X-rays of same dogs; note separation of C1 and C2 when dog’s neck is flexed in B

Narrowed spinal canal

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

Atlantoaxial Instability: Surgical Correction

Stabilization using screws and bone cement

Stabilization using trans-articularscrews

Atlantoaxial InstabilityClient info

prognosis is fair to good for animals with mild signs

animals should not be used for breeding; may be hereditary

CASE #6

Cervical Spondylomyelopathy: Wobbler’s

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

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

Cervical Spondylomyelopathy: WobblerTreatment: 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

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

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 (>5 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

Degenerative Myelopathy

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

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

Deafnessdamage to auditory pathway

chronic otitis rupture of tympanic membrane damage to middle ear (ossicles)

damage to auditory nervehereditary 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

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

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

Laryngeal Paralysis

Laryngeal Paralysis Signs:

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

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

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

CASE #11

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

Idiopathic Facial Nerve Paralysis Etiology: unknown Occurrence

Cocker Spaniels, Corgis, Boxers, Eng Setter, DLH cats

Signs Older dogs (>5 y) Ear droop Lip paralysis Sialosis (drooling) Deviation of nose Collection of food in paralyzed side of mouth Absence of menace and palpebral reflex

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

Grey’s Anatomy Memory Center

womenwomen