- incoordination - sensory phenomenon - sensory/proprioceptive ataxia seen w/ spinal dz

- v voluntary movement - motor phenomenon - can be UMN or LMN

- abscence (complete loss) of voluntary movement

- loss of ability to fill and empty the bladder/intestines voluntariy (can be UMN or LMN)

Spinal Dz Flashcards by laura knight

What are the white and grey matter in the spinal cord?

> Grey matter
- Butterfly shape 
- nerve cell bodies
> White matter 
- axons 
- dorsal, lateral and ventral funiculus

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What is contained in the dorsal and lateral funiculi? What would damage to thee cause?

sensory and proprioceptive tracts (Ascending)

> ataxia

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What is contained in the ventral and lateral funiculi? What would damage to these cause?

motor (UMN) tracts (descending)

> UMN paresis

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What is comtained in the ventral horn of the grey matter? What would damage here cause?

LMN cell bodies

> LMN paresis

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Where do the majority of spinal diseases affect?

Most dorsal and ventral equally. Some only dorsal or ventral .

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What are the 4 functional segments of the SC?

C1-C5
C6-T2
T3-L3
L4-S4

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Do spinal cord segments = vertebral bodies?

NO!!

Spinal cord doesnt reach end of vertebral canal (cauda equina from L6/&)
so L7, S1, S2, S3 spinal cord segments exit around L5 vertebral body
then “conus medullaris” then becomes cauda equina

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What does “myelopathy” mean?

- disorder of the SC 
> extrinsic (pushes on cord) 
- extradural/intradural 
> intrinsic 
- intramedullary (diffuse or focal)

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Define ataxiA

incoordination
sensory phenomenon
sensory/proprioceptive ataxia seen w/ spinal dz

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Define paresis

v voluntary movement
motor phenomenon
can be UMN or LMN

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Define plegia

abscence (complete loss) of voluntary movement

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What do mono- para- hemi- and tetra- describe?

= one limb
= both pelvic limbs
= both limbs one side
= all 4 limbs

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Define incontinence

loss of ability to fill and empty the bladder/intestines voluntariy (can be UMN or LMN)

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Are nociception tests always indicated in the neuro exam?

NO if gait fine and no proprioceptive losses then no need (will be last tract to go)

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What postural signs may be see nwith spinal dz?

crouched, kyphosis
low head carriage
shiff-sherrington (T3-L3 lesions specifically)

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What gait abnormalaities may be seenw tih spinal dz?

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> often ataxia and paresis combination

ataxia and paresis ddx: spinal or brainstem
only paresis: consider NMJ or lumbosacral problems
only ataxia: consider cerebellar/vestibular problems

How do large breed neck problems commonly present?

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hindlimbs affected, minimal forelimb involvement (HL tracts are more superficial than FL)

What are proprioceptive deficits useful for?

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determining presence of neurological disease

- NOT useful for assessing neuro-anatomical location of disease

With compressive (extrinsic) myelopathies, what clinical signs manifest early/late in the disease?

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lost first and regained last
- proprioception (so if gait is abnormal, should have lack of proprioception)
- movement (paresis/plegia and voluntary urination)
- nociception (superficial then deep pain)
lost last and regained first

So if the gait is abnormal but there are NO propriception deficits, what can be inferred?

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not a compressive spinal dz

> eg. may be bilat cruciate rupture

What are spinal cord reflexes important for?

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ID which spinal cord segment is affected
> patella
> withdrawal
> cutaneous trunci
decreased indicate LMN signs of a lesion within the reflex arc (ie. C6-T2 or L4-S3)
increased/exagerated reflexes indicate UMN sign of lesion CRANIAL to reflex arc (ie. C1-C5 or T3-L3)

Where do UMN and LMN synapse?

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ventral horn grey matter

Action of UMN?

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facilitates and to a greater extent inhibits muscle groups (net effect = inhibition of muscle tone and reflexes)
UMN lesions -> disinhibiition -> ^ tone and reflexes

When should palapation be perfeormed within the neuro exam?

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end!! start gently

What is nociception useful for?

Determining prognosis in severe cases - not necessary to always perform - if you do perform, must be an unequivocally noxious stimulus (haemostats on periosteum) Dont go light! - do nto confuse with withdrawal REFLEX - concious nocicpetion requires behavioural response

Other than deep pain, what is prognosis based on?

- diagnosis | - function (neuro exam)

What signs do C1-C5 spinal cord lesions present with?

- tetraparesis and ataxia in all 4 limbs - proprioceptive deficits in all 4 limbs - intact or INcreased spinal reflexes in all 4 limbs - normal/increased muscle tone all 4limbs +- Horner's syndrome +- urinary dysfunction (uncommon) +- tetraplegia uncommon (respiratory distress d/t phrenic n. involvement will occour before tetraplegia)

What signs do C6-T2 spinal cord lesions present with?

- tetraparesis and ataxia in all 4 limbs - proprioceptive deficits in all 4 limbs - intact or DEcreased tone and spinal reflexes in thoracic limbs - intact or INcreased tone and spinal reflexes in pelvic limbs +- 2 engine disconnected gait +- Horner's syndrome +- urinary dysfunction (uncommon) +- tetraplegia uncommon (respiratory distress d/t phrenic n. involvement will occour before tetraplegia)

What signs do T3-L3 spinal cord lesions present with?

- normal thoracic limbs - paraparesis and ataxia of the pelvic limbs - paraplegia possible - intact or INcreased tone and spinal reflexes pelvic limbs - Urinary dysfunction common ("UMN bladder") +- Shiff-Sherrington

What is Shiff-Sherrington and when is it seen?

> Acute T3-L3 SC injury > Border cells (L1-L7 segments) affected - project to cervical intumescence - provide inhibitioin to extensory muscles thoracic limbs -> disinhibition - paraplegia with ^ extensor tone in the thoracic limbs > Ddx cervical lesion - thoracic limbs neurologically normal (reflexes and movement) > indicates localisatino not prognosis

What signs do L4-S4 spinal cord lesions present with?

- thoracic limbs normal - paraparesis and ataxia pelvic limbs - paraplegia possible - intact/decreased tone (pelvic limbs) and spinal reflexes all imbs - urinary dysfunction common ("LMN bladder") +- flaccid tail +- possible decreased perianal reflex

Clinical spinal neuro-anatomical localisation

``` > neuological? - look for proprioceptive deficits > how many limbs affected? - 4 = C1-C5 or C6-T2 - pelvic only = T3-L3 or L4-S3 > Spinal reflexes to narrow down - ^ = C1-C5 or T3-L3 - v = C6-T2 or L4 - S3 > 2 engine gait? - C6-T2 ```

2 main ways of obtaining accurate ddx ?

> Classical pathophysiological - DAMNITV | > 5 or 6 finger rule (Holger and Patricks)

What are the 6 fingers of the 6 finger rule?

1. localisation 2. signalment (cats v dogs, look up uncommon breeds, age) 3. onset (peracute/acute/chronic) 4. progression (few disorders spontaneously improve, care in 1st 24hrs) 5. symmetry (few disorders truly assymetric) 6. pain (excludes several condiitons)

Most common spinal dz in dogs

- IVDD (type 1 and 2) - Ischaemic myelopathy - Neoplasia - Syringomyelia - Immune-mediated/inflammatory

Most common spinal dz in cats

- Infectious/inflammatory (FIP) - Trauma (Fx/luxation) - Neoplasia (lymphoma if young, meningioma if older)

Look at flow chart for diagnosing spinal disease

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Spinal Dz Flashcards

(38 cards)