1. Dan Hicks, DVM, MS, DACVIM (Neurology/Neurosurgery) Veterinary Neurology & Neurosurgical Specialists

2. 1. Clinical features 2. Anatomic localization 3. Differential diagnosis 4. Plan Clinical Neurology: A B

3. Differential Diagnoses: dependent on where, when (acuity), what (signalment) Exam tells us where not what!

4. T3 L3S1 C1-C5 Infratentorium Supratentorium Peripheral Nervous system/individual nerve

6. 1. Paresis/Paralysis – hopping is normal (brisk) if voluntary movement remains 2. Hypo to atonic 3. Hypo to areflexic 4. Neurogenic mm atrophy

7. Ability to support wt decreased Short stride (step-distance) Bunny-hopping Collapsing Fine mm tremors (orthostatic tremors) Not ataxic (not proprioceptive disorder)

8. Paresis: delays in gait generation, hopping is particularly slow Spasticity: release of antigravity mm from inhibition Hypereflexia/tonia/crossed extensor: release of inhibition Basis for decrebrate rigidity (lesion b/n rostral and caudal colliculi

11. Signs explained by focal lesion? Think “structural” problem – compression or inflammation Generalized lower motor neuron? Think botulism, tick paralysis, or Coon hound paralysis

13. “Structural” lesions - Imaging MRI CT

14. Radiographs: Osseous lesions Fracture/luxations Diskospondylitis Osteoproliferation/osteolytic diseases “In-direct” evaluation Chest films in older dogs? Screening for metallic objects

16. Invasive Seizures

17. On CT, bone is ALWAYS WHITE Bone is black or dark on MR In bone window CT, trabecular pattern of bone is evident In soft tissue window CT, bone is bright white In a T1-weighted MRI image, fat is WHITE. CSF is dark In a T2-weighted image, CSF is WHITE

18. Normal cord Herniated Disk Great bone detail Soft-tissue detail: moderate

22. Disk rupture Spinal lymphoma

28. Age of advanced imaging Advancement in neurosurgery Great, but… $$$$ Concomitant illness

29. Consider neurologic score Less severe signs = higher success rate 50% improve or recovery without surgery Warning for deep pain negative

30. 1.“Pain and Pee” pain control speeds healing times, improves efficacy of cage rest and rehab 2. CAGE REST Allows injury annulus fibrosus to heal and inflammation to subside Minimizes additional trauma Minimizes volume of extruded disk material Try sedative if pet is anxious Rehab Focal spinal injections

31. Length of cage rest not well studied Traditionally, 4-6 weeks (time for ligamentous healing) Shorter times may be just as good Early controlled movement (rehab) may promote healing

32. Prevent bed sores Monitor of UTI Home rehab exercises Most owners enjoy participating in pet’s recovery Profession rehab

33. PAIN Opioids NSAIDS Gabapentin Amantidine Focal injections Prazosin Phenyoxybenzamine Diazepam **Bladder expression or catheterization may be needed BLADDER

34. Possible benefits: Reducing inflammation of injured cord Altering propagation of inflammatory mediators Side effects: GI ulceration Pneumonia UTI Longer hospital stays (Levine, 2007)

35. One study: Dogs receiving steroids had lower “quality of life” index scores than those not receiving steroids (Levine 2007) Currently no scientific evidence supporting use in IVDD True answer still remains