Signalment and history 3 year old male entire Boxer

Acute onset non ambulatory paraparesis

Schiff Sherrington posture

No history of trauma

Physical and neuro Exam Physical Exam: unremarkable Neurological Exam:

Hands off: Mental status and behaviour: Normal Posture and body position at rest – Schiff Sherrington Evaluation of gait – non ambulatory paraparesis L>R No Abnormal involuntary movements

Hands on: CN assessment: WNL Postural reaction testing: prop. Deficits on both HLs Spinal reflexes: muscle tone and size – decreased withdrawal on Left

Hind limb Sensory evaluation: appropriate (expected as presence of voluntary

movements) Rem: clinically worse the following day: paraplegia: no voluntary

movements

Paraparesis differentials Spinal Pain No Spinal Pain

D: intervertrebral disc, calcinosis cincumscripta, spinal extrasynovial cyst, mucopolysaccharidos

D: Degenerate myelopathy, lysosomal storage diseases, spondylosis deformans, dural ossifiation

A: intra-arachnoid cysts, spinal dysaphism, syringomyelia, vertrebral malformations, spinal stenosis

A:

M: hyperchylomicronaemia M:

N: Primary: extradural and intradural-extramedullarySecondary: Metastatic

N: Primary: Astrocytoma, Ependymoma, Oligodendroglioma

I: diffuse idiopathic skeletal hyperostosis, calcinosiscircumscripta (idiopathic)I: meningitis, myelitis, discospondylitis, vertebral physitis, GME, SRMA, vascultis

I:

T: Traumatic disc herniation, verterbral fractures/luxations T:

V: epidural haemorrhage V: Fibrocartilagenous Embolism, Thrombosis, Infarction

From: BSAVA Neurology Manual

Clinical Signs of FCE Often yelp once – ass with trauma/exercise

Para or Tetra Paretic/Plegic

May have schiff sherrington posture

Often lateralized signs – hemiparesis

May be urinary/faecal incontinent

Usually gradual improvement in neuro deficits

ACUTE, NON PAINFUL, ASSYMETRICAL AND NON PROGRESSIVE myelopathy

Schiff Sherrington posture

Extensor rigidity in the front legs BUT normal proprioception suggest severe SC injury

Pathogenesis Disc derived fibrocartilage acts like an emboli and

blocks blood vessels supplying the spinal cord

Infarction to this area

Gets gradually better as neovascularisation occurs in areas of infarction

Spinal Shock was also suspected

Diagnosis Based on History, Clinical signs and signalment

Full physical exam and neuro exam – Diagnosis of exclusion often

Could do radiography (myelogram)/CSF tap/Bloods to rule out other conditions

MRI : expect lateralised lesion within the spinal cord parenchyma ( brightness on the T2 sequence called T2 hyperintensity)

Buddy’s MRI Extensive T2-hyperintense intramedulary lesion, from

T11/12 to L3.

T2 weighted image of the thoraco-lumbar portion of the spinal cord

1.Abnormal: Brightness within the spinal cord

2.Normal: spinal cord: uniform grey color

1

2

Treatment Good nursing

Rehabilitation: Physiotherapy & hydrotherapy (VIDEO) (+/- lazer)

Urinary catheter (if no evident voluntary movements) or expressing of the bladder

HYDRO VIDEO

Buddy’s progress in the under water treadmill

Prognosis Overall: Generally good with good nursing and

physio– get increasingly better of weeks – months

Deep pain? If absent poorer prognosis

Full recovery may not occur if severe damage caused to the SC

Won’t get worse after first 24 hours

Buddy Today – 8 days later Urinary catheter removed once good movement in the

legs was observed

Physio every day and getting stronger every time

RHL back to almost normal

LH still dragging but making some effort to move it, starting at hip as seen in video

Still needs sling to support him on short walks but is getting there

Gone home!!!

With thanks to the neurology team for helping me understand Buddy’s case

Any questions?