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1264 Paresis, Forelimb

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VetBooks.ir Erythrocytosis Flushing Neurologic Manifestations of Cancer
Mast cell tumor
Myasthenia Gravis
Renal tumors (increased erythropoietin)
Pheochromocytoma
Lymphoma
Thymoma
Others
Nasal fibrosarcoma
Osteosarcoma
TVT
Hepatic tumors Nodular Dermatofibrosis Biliary carcinoma
Others
Renal cystadenoma/cystadenocarcinoma
Neutrophilic Leukocytosis Necrolytic Migratory Erythema/Superficial Peripheral Neuropathy
Lymphoma Necrolytic Dermatitis Insulinoma
Multiple tumors Others
Glucagonoma
Thrombocytopenia/Coagulopathies/DIC Cutaneous Necrosis of the Hind Paws Miscellaneous Manifestations of Cancer
Lymphoma Lymphoma (cat) Hypertrophic Osteopathy
Mast cell tumor Primary lung tumor
Hemangiosarcoma Pemphigus Vulgaris Urinary bladder rhabdomyosarcoma
Thyroid tumors Lymphoma (dog and horse) Esophageal tumors
Mammary tumors Renal Manifestations of Cancer Metastatic tumors
Nasal tumors Glomerulonephritis/Nephrotic Syndrome Others
Inflammatory carcinomas Multiple myeloma Fever
Others Polycythemia vera Multiple tumors
Cutaneous Manifestations of Cancer Lymphocytic leukemia
Alopecia Others
Pancreatic carcinoma (feline)
Others
ACTH, Adrenocorticotropic hormone; DIC, disseminated intravascular coagulation; TVT, transmissible venereal tumor.
From Withrow S, et al: Withrow & MacEwen’s Small animal clinical oncology, ed 5, St. Louis, 2013, Saunders.
Paresis, Forelimb

Differential Diagnosis Item Key Feature(s)
Intervertebral disc disease Variable pain on spinal palpation, paresis, ataxia, proprioceptive deficits; clinical signs often asymmetrical;
forelimb lameness/monoparesis may indicate nerve root entrapment (nerve root signature); MRI, CT,
myelogram or CT/myelogram for confirmation
Cervical spondylomyelopathy Chronic progressive cervical pain and proprioceptive ataxia; short-strided, spastic thoracic limb gait and
pelvic limb ataxia are characteristic; forelimb lameness or paresis may indicate nerve root entrapment
(nerve root signature). MRI reveals signal changes in the spinal cord parenchyma.
Vertebral anomaly (hemivertebra, block vertebra, butterfly Screw-tailed dog breeds most commonly affected; kyphosis, lordosis, scoliosis, and/or spinal cord and
vertebra) nerve root compression possible; Dx with survey spinal radiography, MRI to determine degree of spinal
cord compression
Vertebral, spinal cord, or meningeal neoplasia (lymphoma, Chronic, progressive paresis and/or ataxia, less commonly acute (hemorrhage, ischemia); focal pain on
meningioma, osteosarcoma, nephroblastoma, metastatic spinal palpation; often asymmetrical and variable clinical signs relating to neuroanatomic location of lesion.
neoplasia) Canine: middle-aged to older large breeds. Feline: young; lymphoma common. MRI is imaging modality
of choice. Histopathologic evaluation for definitive diagnosis; FNA or biopsy obtained by fluoroscopic or CT
guidance vs. open surgical approach.
Nerve root or peripheral nerve neoplasia (primary Chronic progressive unilateral lameness (nerve root signature), localized muscle atrophy, and variable
peripheral nerve sheath tumor or secondary tumor) neurologic deficits. Mass may only be palpable in advanced stage; MRI is imaging modality of choice.
Uncommon in cats.
Bacterial infection (discospondylitis, meningitis) Discospondylitis: acute to subacute, rapidly progressive, symmetrical or asymmetrical signs; focal
spinal pain is common. Variable fever, anorexia, lethargy, and reluctance to exercise. CT is superior to
radiographs for evaluation of vertebral lysis; blood, urine, +/− disc aspirate C&S indicated +/− Brucella
titer. Meningitis: cervical pain, low head carriage, fever, vomiting, lethargy, anorexia are common. Urine/
blood culture, CSF analysis/culture, +/− eubacteria PCR recommended.
Viral meningomyelitis (canine distemper virus, feline Distemper: flexor spasms of the limbs and neck strongly suggestive. Immunohistochemical staining of skin
infectious peritonitis, rabies) biopsy, viral inclusion bodies seen on postmortem CNS histopathology for definitive diagnosis. FIP: spinal
cord deficits possible; Dx supported by CSF analysis/PCR; periventricular/meningeal contrast enhancement
on MRI. Definitive diagnosis obtained histologically +/− immunohistochemical staining.
Fungal meningomyelitis (Cryptococcus, Coccidioides, Cryptococcus: dog/cat, regional, uncommon cause of paresis.
Blastomyces, Histoplasma) Coccidioides/Blastomyces/Histoplasma: dog, regional, rare causes of paresis.
Protozoal meningomyelitis (Neospora caninum, Young (<1 year) or immunocompromised dogs. Multifocal neurologic signs; predominantly pelvic limb LMN
Toxoplasma gondii) deficits and muscle wasting due to myositis-polyradiculoneuritis; serial increases in IgG titers > 1 : 64
support active infection; Dx with a combination of serum/CSF serology and CSF PCR.

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