Page 1913 - Cote clinical veterinary advisor dogs and cats 4th

Tail Paralysis 957

as possible, with an awareness that pain may • Many dogs live normal lives after the AUTHOR: Michael Stone, DVM, DACVIM
cause them to be uncooperative or aggressive diagnosis. EDITOR: Jonathan E. Fogle, DVM, PhD, DACVIM
VetBooks.ir Client Education SUGGESTED READING Diseases and Diseases and Disorders Disorders
even with normal handling.
Stone MS. Systemic lupus erythematosus. In Ettinger
• Routine monitoring should be scheduled to
detect relapse of disease and adverse effects SJ, et al, editors: Textbook of veterinary internal
medicine, ed 8, St. Louis; 2017, Elsevier, pp
of immunosuppressive medications. 861-866.

Tail Paralysis

BASIC INFORMATION • Concurrent fractures of the axial skel- whether or not treatment is likely to require
eton, pelvis, pelvic limbs, and/or thoracic tail amputation.
Definition limbs
Severe impairment or loss of tail motor function • Urinary and/or fecal incontinence, urine- or Differential Diagnosis
feces-soiled tail and/or perineum • Anomalous (spina bifida, hemivertebra,
Epidemiology • Pain originating from the pelvic area or the sacrocaudal dysgenesis, dermoid sinus)
SPECIES, AGE, SEX base of the tail • Degenerative lumbosacral stenosis (stenosis
Depends on underlying cause • Shock if massive trauma of vertebral canal, type II disc at L7-S1
• Tachycardia, heart murmur, gallop, weak or space, sacral osteochondrosis, instability
GENETICS, BREED PREDISPOSITION absent pulses, cyanosis/cold extremities of the and misalignment of L7-S1, articular facet
• Pugs, bulldogs (spina bifida, sacrocaudal pelvic limbs, possibly with signs of congestive arthritis)
dysgenesis) heart failure (if feline cardiomyopathy- • Intervertebral disc disease (type I or type II)
• Chondrodystrophic breeds (disc herniation) associated thromboembolism) • Spinal trauma/fracture/avulsion
• Working dogs (limber tail, cold tail syn- • Transverse myelopathy (T3-L3 or L4-S3 or • Vascular (feline thromboembolism, fibrocar-
drome, or acute caudal myopathy) Cd1-Cd5 only) tilaginous embolism)
○ Large, distended bladder • Neoplasia
RISK FACTORS ○ Easy to empty if spinal lesion involves • Discospondylitis
• Outdoor cats (trauma) lumbar intumescence (lower motor neuron • Limber tail/cold tail syndrome or acute
• Free-roaming dogs bladder) caudal myopathy
• Cardiomyopathies in cats (aortic thrombo- ○ Difficult to empty if spinal lesion is cranial
embolism [p. 74]) to lumbar intumescence (upper motor Initial Database
• Type I disc herniation with severe paraparesis neuron bladder) • Rectal exam to document pain, swelling,
• Degenerative lumbosacral stenosis (cauda • Rectal exam: painful and might induce instability, mass effect
equina syndrome) sacrocaudal instability if associated with • Complete neurologic exam to localize the
trauma lesion (p. 1136)
ASSOCIATED DISORDERS • Radiographs of the spine, including sacro-
• Cutaneous wounds of the tail Etiology and Pathophysiology caudal region (malformations, fracture/
○ Self-inflicted if sensation altered by Musculoskeletal: trauma/avulsion, discospondylitis, osteolytic/
neurologic disease • Spinal/coccygeal fracture osteoproliferative tumor, intervertebral disc
○ Secondary to external trauma (e.g., hit • Degenerative lumbosacral stenosis disease)
by car, falls) • Coccygeal muscle injury (suspected in limber • CBC, serum biochemistry panel, urinalysis
• Tail fracture tail syndrome) depending systemic involvement
• Feline cardiomyopathy Neurologic: • Thoracic radiographs
• Spinal malformations ○ To assess for lesions secondary to trauma
Clinical Presentation • Spinal fracture ○ To assess for metastases if neoplasia is
HISTORY, CHIEF COMPLAINT • Nerve root avulsion (lumbar intumescence/ suspected
• Trauma involving the hindquarters (e.g., hit coccygeal) • Ultrasound
by car, falls, stepped on) • Disc herniation (with or without paraparesis) ○ Thoracic (for feline cardiomyopathy)
• Trauma involving traction injury on the tail • Tumor of the spine/spinal canal/cord ○ Abdominal (suspected pelvic canal tumor
(e.g., malicious, caught in door) Cardiac/vascular: or aortic thromboembolus)
• Unwillingness to jump up (e.g., lumbosacral • Feline thromboembolic disease
diseases) • Vascular compromise secondary to trauma Advanced or Confirmatory Testing
• Acute-onset vocalization and hindlimb (arterial avulsion or thrombosis) • Advanced imaging modalities: myelog-
paresis/paralysis (aortic thromboembolism) • Fibrocartilaginous embolism raphy, CT, MRI (p. 1132) may be
• Painful partially limp tail, generally after indicated for assessing underlying spinal
intense activity (limber tail syndrome) DIAGNOSIS abnormalities
• Electromyography (rare instances of neuro-
PHYSICAL EXAM FINDINGS Diagnostic Overview muscular disease, also reported in limber tail
• Impaired tail motility with or without Tail paralysis is apparent on physical exam. syndrome)
hindlimb paresis A complete neurologic exam helps identify • Fine-needle aspiration if possible for cytologic
• Skin wounds (limbs, trunk, abdomen, and/ the extent of the causative lesion, which evaluation (masses, discospondylitis)
or tail) contributes to determining the prognosis and • Ultrasound-guided biopsy (masses)

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