off legs SA

History

·    When did this happen? Did it happen suddenly or over a period of time?

o  Acute onset – IVDD, FEC, spinal luxation, idiopathic polyradiculoneuritis

o  Progressive – Neospora, dry FIP, degenerative myelopathy, cervical spondylopathy

·    Were they in pain before they went down?

·    Did they see any signs before they went down?

·    Are they systemically unwell? – FIP

·    Ever happened before?

·    Vaccinated and parasite treatment?

Signalment

·    IVDD – dachsunds, bassets

·    Dry FIP – young cat, multi-cat housefold, male

·    Spinal luxation – young toy breeds

·    SRMA – beagles, bernese, boxers

o  Young dogs with neck pain – SRMA = top differential

·    Syringomyelia – CKCS

Investigations

·    Hands off examination

o  Ataxia

o  Asymmetry

o  Gait – stiff gait = Neospora, polymyositis, cervical spondylopathy

·    Clinical exam

o  Pyrexia – MUO, SRMA, discospondylosis

o  Pain – MUO, SRMA, discospondylosis, syringomyelia, IVDD

o  Weakness – botulism, idiopathic polyradiculoneuritis, polymyositis, syringomyelia

·    Neurological exam – mentation? Reflexes?

·    Exclude trauma – history from O, signs of crepitus, swelling, tail pull

·    Imaging – radiography for basic fractures, MRI/CT for IVDD, spinal trauma, etc.

·    CSF tap – pleucocytosis = MUO, neutrophils + protein = SRMA, FIP

Lesion localisation:

·    LMN = paresis, reduced tone/flaccid, reduced/absent reflexes

·    UMN = paresis, retained/increased tone, retained/increased reflexes

Causes and management

·    Degenerative

o  IVDD – MRI to diagnose

§ Extrusion – acute, compression and bruising – treatment: NSAIDs and cage rest

§ Protrusion – chronic, compression affecting shape of disk – treatment: surgery

o  Degenerative myelopathy – proprioceptive defects and weakness, HL initially, then FL

§ Progressive and chronic, rule out IVDD with MRI to dx

·    Infectious

o  Protozoal – Neospora – stiff/rigid HLs, eosinophilia on haematology

o  Clostridia: botulism – weakness, tetanus – rigid paralysis

o  FIP – systemically unwell, granulomas in spinal cord

·    Inflammatory

o  MUO – chronic progressive, diagnose with CSF and MRI, treatment: IS dose of corticosteroids, +/- cyclosporin

o  SRMA – painful neck, diagnose with CSF, treatment: 6w of IS dose of corticosteroids

o  Discospondylitis – very painful, progressive, CT to diagnose, treatment: broad spec abx

o  Polymyositis – auto-immune inflammation of muscles

·    Idiopathic

o  Idiopathic polyradiculoneuritis – rapid onset, diagnose with MRI, should self resolve

·    Trauma

o  Spinal trauma – acute pain, bilateral paresis, CT to diagnose 

o  Sciatic nerve injury – recent vaccination or IM injection?

·    Vascular

o  FCE – non-painful spine, diagnose with MRI, conservative treatment