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Paresis, Hindlimb 757

TREATMENT • Central ○ Nerve sheath tumors
○ Intervertebral disc herniation ■ Guarded to poor because local recur-
VetBooks.ir Short-term treatment is dictated by the ■ Guarded to poor with absent deep pain PEARLS & CONSIDERATIONS Diseases and Disorders
Treatment Overview
rence is common
Fair to excellent with intact deep pain
■
perception
cause, anatomic localization, and severity of
sensation if addressed in 24-48 hours
the lesion/injury. Long-term treatment may
involve medical therapy, physical rehabilitation, ■ Poor to grave if absent deep pain sensa- Comments
protection of affected limb from trauma, and an tion and addressed after 24-48 hours Brachial plexus avulsions with severe traction
adequate duration of supportive care to allow ○ Fibrocartilaginous embolism on the nerve roots may cause damage to the
for recovery/reinnervation. ■ Poor to excellent based on magnitude/ spinal pathways, resulting in pelvic limb deficits
distribution of spinal cord lesion and that are usually ipsilateral but can be bilateral.
Acute General Treatment nociception status
As indicated by underlying cause and its ○ Neoplasia Technician Tips
effects ■ Guarded to poor based on surgical • Use caution when manipulating patients
accessibility and follow-up care with suspected fractures or luxations to avoid
Possible Complications • Peripheral secondary injuries to peripheral or spinal
• Failure to regain adequate function of affected ○ Brachial plexus avulsion nerves.
limb ■ Generally poor; often requires • Use sling support and/or a protective boot
• Local recurrence of nerve root tumors amputation to prevent trauma to the foot when walking
• Persistent trauma, self-mutilation, or ■ Guarded to fair if there is deep pain a patient with a paretic limb(s).
contracture of paretic limb, necessitating sensation
amputation ○ Brachial plexus neuritis Client Education
■ Guarded but recovery is possible • Inform clients about prognosis, expected
Recommended Monitoring ○ Peripheral nerve injuries duration of forelimb paresis, and potential
• Monitoring of limb daily for signs of trauma ■ Fair to good for mild neurologic deficits, for failure to regain adequate function of
or self-mutilation sharp lacerations with prompt surgical limb, which necessitates amputation.
• Serial neurologic exams for up to 6 months repair and short distance from site of • Perform or recommend physical rehabilita-
to evaluate limb for reinnervation injury to end organ tion techniques.
• Serial electrodiagnostics to monitor recovery ■ Guarded to poor for severe neurologic
• Monitoring for evidence of recurrence of deficits; stretching, crushing, and avul- SUGGESTED READING
nerve root tumor by physical exam and MRI sion injuries; contaminated wounds de Lahunta A, et al: Lower motor neuron: spinal
or CT if indicated with delayed surgical repair; and large nerve, general somatic efferent system. In de
distance from site of injury to end organ Lahunta A, et al, editors: Veterinary neuroanatomy
PROGNOSIS & OUTCOME (>30 cm) and clinical neurology, ed 4, St. Louis, 2015,
○ Ischemic thromboembolic neuromyopathy Elsevier, pp 102-161.
• Largely depends on the neurologic exam at ■ Prognosis more favorable for forelimb AUTHOR: Dan Polidoro, DVM, DACVS
presentation and response to treatment emboli EDITOR: Leah A. Cohn, DVM, PhD, DACVIM

Paresis, Hindlimb Client Education
Sheet

BASIC INFORMATION • German shepherds are overrepresented in • Orthopedic examination (p. 1143) to rule
cases of degenerative myelopathy. out orthopedic causes of weakness
Definition • Palpation of the bones of limbs, pelvis
Paraparesis is defined as partial loss of motor Clinical Presentation (including rectal exam in dogs), and vertebral
function in the pelvic limbs. Paraparalysis or DISEASE FORMS/SUBTYPES column for fractures/luxations
paraplegia is a complete loss of motor function Hindlimb paresis or paralysis is the difficulty • Fundic exam: evidence of multifocal/diffuse
in the pelvic limbs. or inability to use the hindlimbs due to central nervous system (CNS) inflammation
weakness, ataxia (incoordination), or spastic- • Neurologic exam (p. 1136) findings depend
Epidemiology ity (limb stiffness) caused by a neurologic on location and severity of lesion.
SPECIES, AGE, SEX lesion. Weakness suggests a lower motor ○ Gait varies from mild pelvic limb lameness
Any dog or cat can be affected. neuron or neuromuscular lesion. Spasticity to complete loss of sensory and motor
and ataxia suggest an upper motor neuron function.
GENETICS, BREED PREDISPOSITION lesion. ○ Spinal reflexes (e.g., patellar)
• Young to middle-aged chondrodystrophoid ■ Hyporeflexia: lesion in L4-S2 spinal
dogs (e.g., dachshunds) are predisposed to HISTORY, CHIEF COMPLAINT cord segments
intervertebral disc disease (IVDD), especially Weakness, lameness, or inability to use ■ Hyperreflexia: lesion in T3-L3 spinal
Hansen type I. hindlimb(s) cord segments
• Middle-aged to older nonchondrodystro- ○ Spinal hyperpathia (back pain on palpation)
phoid dogs (e.g., German shepherds) are PHYSICAL EXAM FINDINGS ■ Presence: may indicate IVDD, neopla-
predisposed to IVDD, especially Hansen • Assessment of the femoral pulse; if absent, sia, trauma, infectious or inflammatory
type II. consider aortic thromboembolism myelopathy

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