LAM- Spinal Cord

Spinal cord disease we will have varying degrees of ?

Paresis

ATAXIA

Hypalgesia

Main differentials for tetraparesis?

Cervical vertebral stenotic myopathy

Equine degenrative myelopathy/neuroaxonal dystrophy

Equine protozoal myelitis

What injuries are most common with spinal cord trauma?

Cervical injuries

What fractures are most common in foals?

Dens

And atlas in general

Foal are prone to thoracolumbar fractures, are adults too?

No

How do you treat unstable cervical fracture?

Surgically stabilize

What is the prognosis for recumbent horses with unstable/complete fractures?

Guarded

Scientific name for wobbler syndrome?

Cervical stenotic myopathy

Most common non-infectious neurologic disease of horses

CSM leads to cervical cord compression resulting in?

Tetraparesis and ataxia

Osteochondrosis is a developmental disease of ?

growing cartilage

How does osteochondrosis manifest in cervical vertebrae?

OCD of facet joints

Physeal dysplasia of vertebral bodies

Leading to instability and potential narrowing of vertebral canal

What is type 1 of CSM?

Dynamic instability between cervical vertebrae

Presents at younger age and occurs between C3-C6

What is type 2 of CSM?

Static compression of spinal cord

Generally occurs at C5-T1 (low)

Older horses

What is a good method to determine CSM?

Cervical myelogram

Young horse with CSM will likely have what signs on neuro exam?

Spastic tetraparesis and ataxia

Occipital-atlanto-axial malformations are congenital malformations in what breeds?

Arabians, Quarter horses and draft horse as well as others

With occipital-atlanto-axial malformations do they have to have chord compression?

No

Some have no to minimal chord compression but limited range of motion

Clinical signs of OAA?

tetraparesis and ataxia (long tract signs) present at birth

How to diagnose OAA?

Rads/MRI/CT

What is a developmental disease involving neuraxonal degeneration of spinal cord proprioceptive long tracts`

Equine neuroaxonal dystrophy/ degenerative myelopathy

eNAD may have been caused by what during fetal development?

Vitamin E deficiency

Pregnant mares without access to green grass or quality hay

Is there a genetic component with eNAD?

Strongly suspected

eNAD presents just like?

Wobblers

Young clumsy horse

Will horses with eNAD have normal cervical imaging?

Yes

No antemortem test for these guys

Neurologic changes in eNAD are irreversible however...?

Early recognition and supplementation can stop progression

What disease is a syndrome of acute spinal ataxia and often sacral signs caused by neurotropic strains of EVH-1

Equine herpes virus-1 myeloencephalopathy

Who does EHM affect?

adults older than 3 yrs

Is EHM reportable

yes

How is EHM transmitted?

Resp route but minimal to mild resp signs

EHM results in diffuse _____________ ________________ of the spinal cord with edema hemorrhage and sometimes infarction

regional vasculitis

Clinical presentation for horses with EHM?

Acute onset of ataxia

Hind-limb ataxia

Urinary retention/bladder paralysis loss of tain and anal tone/penile prolapse

T or F? EHM can vary from milk ataxia to recumbent

True

Transient ____________ may be your best clinical sign indicating EHM

fever

How to diagnose EHM?

Clinical presentation and signs

CSF may have pleocytosis, increased protein and xanthochromia

In febrile phase, what test can you take for nasal secretions or blood?

PCR

Four-fold rise in SN titer

Treatment for EHM?

Supportive care

Anti-inflammatory drugs to counteract spinal cord vasculitis and edema

Abx for urinary tract

What is prognosis for EHM?

20-40% mortality, 40-50% have residual deficits

Does vaccination protect from CNS disease of EHM?

No

Helps reduce shedding in youngsters

Who is post anesthesia myelomalacia seen in?

Young draft breeds

What is PAM?

Fail to rise after general anesthesia or show bilateral hind-limb paresis progressing to paralysis and recumbence

Where is PAM?

It is hemorrhage and malacia of the spinal cord gray matter primarily lumbo-sacral segments

Ischemic in nature

Ingestion of what causes sorghums toxicosis?

Sudan/johnson grass

What does sorghum toxicosisi cause?

Hind limb ataxia

Urinary retention

Cystitis

Unique presentation

How to treat sorghum toxicosis?

Remove from source and supportive treatment

With atlanto-occipital CFS tap where do you aim the needle?

To the chin

What are some clinical signs of vestibular disease?

Head tilt

Drifting or listing to one side

Resting nystagmus

When vestibular disease is central, what does it involve?

Medulla, pons or cerebellum

When vestibular disease is peripheral, what does it involve?

Vestibular branch of CN 8, peripheral vestibular disease is common in horses

With peripheral vestibular disease, The signs of disequillibrium are _________________ to the lesion

ipsilateral

Resting horizontal nystagmus is _________ from the side of the lesion, sometimes rotary

away

If you blindfold a horse with vestibular disease will it get better or worse

worse

What may cause peripheral vestibular disease?

trauma, infections, inflammatory or degenerative conditions of petrous temporal bone

There is a close anatomic relationship of CNs ___&____ so that disease in this area may result in vestibular signs, facial nerve paralysis or both

7 8

Cause for temporohypid osteoarthropathy are likely idiopathic but could be related to what?

Chronic changes initiated by otitis media, maybe GP disease

Cribbing

Primary degenerative process

Temporohyoid osteoarthropathy can lead to __________ ______________ of petrous temporal bone

spontaneous fracture

This would result in acute vestibular ataxia/facial paralysis

How do you manage THO?

Abx and anti-inflammatory drugs

With facial paralysis with THO, it is very important to protect what?

The eye on the affected side with topical antiobiotic

_______________ intervention can prevent the fracture

surgical

What is the definitive diagnosis for otitis media- interna

Tympanocentesis, cytology and culture

Abx will resolve mild cases