Page 1494 - Cote clinical veterinary advisor dogs and cats 4th

758 Parturition, Normal

Absence: may indicate embolism or • Spinal and pelvic limb radiographs to evaluate • Type I disc herniation with absent deep pain
■
degenerative myelopathy for bony lesions such as fracture, neoplasm, perception: guarded to poor prognosis (50%
VetBooks.ir ■ Increased (spasticity): lesion in T3-L3 Advanced or Confirmatory Testing within the first 24-48 hours and poor to
functional recovery) if surgery performed
○ Muscle tone
or infection
spinal cord segments
grave after 48 hours
Decreased: lesion in L4-S2 spinal cord
■
segments • Myelography, CT, or MRI (p. 1132): spinal • Type II disc herniation (chronic) with intact
deep pain perception: fair to good prognosis
cord compression secondary to IVDD,
neoplasia, and infectious or inflammatory with surgical decompression, depending on
Etiology and Pathophysiology disease process number of lesions and duration of clinical
• IVDD (p. 555) • Cerebrospinal fluid (CSF) analysis (p. 1323): signs, with the prospect of a longer recovery
○ Degenerative disc changes lead to disc evidence of infection, inflammation, exfoliat- period
herniation into the spinal canal: Hansen ing neoplasia • Nonsurgical spinal cord disease has a variable
types I, II, III • Titers and polymerase chain reaction (PCR) prognosis depending on the underlying cause.
• Fibrocartilaginous embolization (p. 336) assay of serum and CSF: to assess for
○ Herniation of disc material into vertebral infectious causes, especially if CSF analysis PEARLS & CONSIDERATIONS
body and entrance into the venous plexus suggests active inflammation
• Degenerative myelopathy (p. 241) • Blood, urine, and CSF culture if infectious Comments
○ Progressive, diffuse degeneration of spinal cause is suspected • Immediate referral to a surgeon or neuro-
cord myelin and axons • Electrodiagnostics: electromyography, motor surgeon is warranted for an animal that is
• Spinal/peripheral nerve disorders nerve conduction decompensating neurologically.
○ Cause sensory and motor dysfunction • IV glucocorticoid administration
distal to the lesion (e.g., trauma, neoplasia) TREATMENT (methylprednisolone sodium succinate,
dexamethasone) has no proven benefit for
DIAGNOSIS Treatment Overview spinal cord injuries in dogs and cats and
Treatment should address the underlying cause: may cause adverse effects: gastrointestinal
Diagnostic Overview surgical decompression if a compressive lesion disorders, infection, and immunosuppression.
A complete orthopedic and neurologic exam is found (e.g., IVDD) or medical management
(including distribution of sensory loss) is the (antibiotics, antiinflammatories, antifungals) as Technician Tips
best means of differentiating musculoskeletal indicated. The goal of treatment is pain relief Use care and rigid support when moving
disease from neural involvement. Advanced and resolution of the neurologic dysfunction. patients with acute hindlimb paresis and an
imaging (myelography, CT, or MRI) is often unknown trauma history.
required when a neurologic disease is suspected. Acute General Treatment
As dictated by the underlying cause Client Education
Differential Diagnosis • Approximately 40% of dogs treated medically
• Degenerative (e.g., IVDD [p. 555]) Possible Complications for presumptive intervertebral disc hernia-
• Neoplasia (e.g., vertebral osteosarcoma) Ascending myelomalacia from severe cord tion have a relapse of clinical signs or fail
• Infectious (e.g., discospondylitis [p. 266]) injury is somewhat unpredictable and has a to respond.
• Inflammatory (e.g., granulomatous menin- grave prognosis. • It is essential to comply with a recommended
goencephalomyelitis [p. 647]) period of cage rest/confinement.
• Trauma (e.g., spinal fracture/luxation Recommended Monitoring
[p. 369]) • Reevaluate neurologic function at 4-week SUGGESTED READING
• Vascular (e.g., fibrocartilaginous embolism intervals until satisfactory pelvic limb func- Aikawa T, et al: Long-term neurologic outcome of
[p. 336]) tion is achieved. hemilaminectomy and disk fenestration for treat-
• Orthopedic disease can cause hindlimb • A canine cart is an option for dogs that fail ment of dogs with thoracolumbar intervertebral
weakness. to regain adequate pelvic limb function. disk herniation: 831 cases (200-2007). J Am Vet
Med Assoc 241:1617-1626, 2012.
Initial Database PROGNOSIS & OUTCOME AUTHOR: Dan Polidoro, DVM, DACVS
• CBC, serum biochemistry panel, urinalysis: EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
may reflect stress or underlying infectious • Based on preoperative neurologic exam and
cause (less common) underlying disease
• Complete orthopedic (p. 1143), neurologic • Type I disc herniation with intact deep
(p. 1136), and cardiovascular evaluations to pain perception: 80%-95% have functional
rule out concurrent disease recovery with surgery.

Video
Parturition, Normal Client Education Available
Sheet

BASIC INFORMATION Synonyms Epidemiology
• Queening: parturition in the queen (female SPECIES, AGE, SEX
Definition cat) Dogs and cats: postpubertal, female
The act or process of giving birth to puppies • Whelping: parturition in the bitch
or kittens

www.ExpertConsult.com