Extradural Synovial Cyst of the Cervical Spine in a Saint Bernard

Background: Extradural synovial cysts (ESC) originate from an extrusion of the synovium in unstable or degenerated joints. In the spine, this condition can cause neurological signs such as hyperesthesia, proprioceptive ataxia and paresis. Since extradural presentations of synovial cysts are unusual in dogs, the aim of this manuscript is to report a case of extradural synovial cyst of the cervical spine, as well as the clinical findings, diagnosis, surgical treatment and clinical evolution after therapy.Case: A 3-year-old spayed Saint Bernard weighing 60 kg was presented to a Veterinary Medical Teaching Hospital with a history of acute paraparesis that evolved to non-ambulatory tetraparesis five days after the appearance of the first clinical signs. Neurological examination revealed non-ambulatory tetraparesis, normal muscle tone and segmental spinal reflexes in the thoracic and pelvic limbs, as well as cervical pain associated with limited neck movement. According to the neurological examination, the likely lesion location was the C1-C5 spinal cord segment. The differential diagnosis list included intervertebral disc disease, caudal cervical spondylomyelopathy, neoplasm, infectious or noninfectious inflammatory disease, and cystic diseases. Complete blood (cell) count and serum biochemistry tests were within reference limits. The cerebrospinal fluid analysis revealed 35 mg/dL of protein (< 30 mg/dL) and 27 cells (up to 5 cells/mm3) with a predominance of lymphocytes. In plain radiography, bone proliferations of the C4 (caudal) C5 (cranial) articular processes were observed and, in myelography, extradural spinal cord compression was evident between C4-C5 on the right side. The animal underwent dorsal laminectomy for spinal cord decompression. An extradural synovial cyst and proliferated articular processes were removed. At 1,281 days after surgery, the dog was clinically normal and presented no neurological deficits.Discussion: The etiology of synovial cysts has not been well established. However, it is believed that osteoarthritic degeneration associated with joint mobility could cause a rupture in the articular capsule, leading to a synovial membrane protrusion, which would fill with synovial fluid and compress spinal structures. ESC in the cervical region have been reported, often associated with cervical neoplasm. The case we report had no evidence of bone or intervertebral disc compression in myelographic and radiographic exams, abnormalities that would appear in cervical neoplasm. The patient underwent dorsal laminectomy to confirm the presumptive diagnosis and decompress the spine. In the histopathological exam, the cystic material consisted of connective fibrous tissue with a synovial cell lining layer, compatible with synovial cysts. The fluid drained during surgery was also analyzed, showing similarities to synovial fluid drained from other conventional joints. Cerebrospinal fluid analysis revealed mononuclear pleocytosis, a common finding in ESC. The ESC should be included in the differential diagnosis of dogs with cervical myelopathy, especially in young animals and large breeds. A myelographic exam is an important but not definitive auxiliary tool for diagnosis and the therapeutic plan. Dorsal laminectomy is an effective technique for treating ESC

Avaliação de um suplemento para animais idosos no tratamento de cães com sinais clínicos sugestivos da Síndrome da Disfunção Cognitiva Canina

O alto nível de relação entre humanos e animais de companhia intensificou a preocupação de alguns tutores com as desordens relacionadas ao envelhecimento. Durante a velhice, além de mudanças fisiológicas, alterações patológicas como a Síndrome da Disfunção Cognitiva Canina (SDCC) são comuns. Essa doença é caracterizada por processos degenerativos que culminam em perda gradual da função cognitiva, sendo frequentemente confundida com o processo natural de envelhecimento. Neste contexto, objetivou-se avaliar a ação de um suplemento nutricional à base de aminoácidos, prebióticos e ácidos graxos para cães idosos na evolução clínica da SDCC. Foram avaliados 67 cães em idade sênior (&gt; 7 anos) para positividade aos sinais clínicos da SDCC. Posteriormente, os animais positivos (n=15 / 22%) foram alocados em dois grupos experimentais, controle (C) e tratamento (T- utilização do suplemento nutricional). Observou-se melhora, relatada pelos tutores, de sinais clínicos associados à SDCC em 80% dos animais tratados, no entanto mais estudos são necessários para elucidar o efeito de suplementos nutricionais na regressão da sintomatologia clínica de cães com sinais clínicos sugestivos da doença

Intradural Disc Extrusion in a Dog

Background: Intervertebral disc extrusion is an important cause of spinal cord dysfunction in dogs. Intradural localization of the extruded disc material is rare, and is generally associated with a traumatic event or with recurrence of disc extrusion at a previously affected site. We report the clinical presentation, diagnostic workup, and treatment of a dog with intradural intervertebral disc extrusion not preceded by a traumatic event.Case:  A 6-year-old male Dachshund was referred for neurological evaluation due to acute onset of hind-end paralysis preceded by claudication of the left hindlimb. The patient had been receiving conservative treatment to no effect. Neurological examination revealed asymmetric non-ambulatory paraparesis, absence of postural reactions and decreased muscle tone in both hindlimbs, a bilaterally diminished patellar reflex, and a hindlimb withdrawal reflex which was normal on the right and greatly diminished to absent on the left. The lower back was tender to epaxial palpation. Plain radiographs of the lumbar spine in the lateral projection showed calcified material within the spinal canal between the third and fourth lumbar vertebrae. Myelography was suggestively abnormal at the same level, with epidural leakage of contrast at L3-L4. Considering the clinical history, breed, age, neurological signs, and radiographic findings, intervertebral disc disease was suspected despite the inconclusive myelography findings. A dorsolateral lumbar hemilaminectomy was performed. Intraoperatively, the diagnosis was confirmed by visualization of a discolored spinal cord and absence of extradural material. The intradural space was accessed via durotomy. A firm, straw-yellow material was seen compressing the spinal cord and removed. Subsequent histopathological examination confirmed that this material consisted of extruded intervertebral disc contents. Postoperatively, the patient underwent physiotherapy and achieved a satisfactory recovery.Discussion: The most common cause of paraparesis in chondrodystrophic dog breeds is intervertebral disc extrusion. Intradural extrusion of the intervertebral disc is a rare phenomenon, often associated with vigorous exercise that causes laceration of the dura mater, allowing penetration of disc material into the intradural space. Although there were no classic signs of intervertebral disc disease on plain radiography, radiopaque material was visible within the spinal canal, which can occur in cases of calcified intervertebral disc extrusion. Myelography was inconclusive, but the decision was made to operate nevertheless, considering that the patient had not responded to conservative treatment and that surgicaltreatment is the most suitable approach for dogs with non-ambulatory paraparesis or paraplegia secondary to intervertebral disc extrusion. The surgical technique consisted of a hemilaminectomy and durotomy. Our diagnostic suspicion was confirmed intraoperatively, as in most cases of intradural disc extrusion in humans. Intradural disc extrusion is anuncommon phenomenon in dogs, and the diagnosis is usually only established intraoperatively. This unusual variant of intravertebral disc disease should be included in the differential diagnosis of spinal cord dysfunction in chondrodystrophic breeds, even in the absence of a history of trauma or preexisting intervertebral disc disease. Clinical treatment appears ineffective in these cases. Conversely, surgical treatment can yield good outcomes, and even functional recovery

Facial Paralysis Secondary to Hypothyroidism in a Dog

Background: Secondary neurological disorders hypothyroidism is unusual in dogs, especially when compared with other clinical signs, such as lethargy, weight gain and dermatological alterations. When manifested, these signals refer to the peripheral or central nervous system and the most common include: vestibular disease, seizures, laryngeal paralysis, poly­neuropathy and paralysis of the facial nerve. Several reports of neurological disorders associated with hypothyroidism are found in literature, basically international. In the national literature, however, there are few reports on the subject. Thus, the aim of this study was to report a case of facial paralysis associated with hypothyroidism in a dog.Case: A male canine, the boxer race, with 7-year-old were referred to the Veterinary Medical Teaching Hospital of the UFSM with a history of difficult water and food intake and asymmetry of the face for seven days. On neurological ex­amination, the animal found itself alert and locomotion, postural reactions and segmental reflexes without changes. In the evaluation of the cranial nerves, there was a menace response absent the right side, however with preserved vision, palpebral and lip ptosis of the right side and reflection palpebral absent on the same side. Opposite the historical, clinical, neurological and laboratory test findings, the diagnosis was facial paralysis secondary to hypothyroidism. As differential diagnoses were listed, inner otitis neoplasm in inner ear, trauma and idiopathic facial paralysis. After the diagnosis, clini­cal treatment was instituted with levothyroxine sodium, at a dose of 0.02 mg kg orally every 12 h, being observed total improvement of clinical signs (no changes for water intake and food, menace response and reflection palpebral normal and symmetry of the face) in 32 days.Discussion: The diagnosis of facial paralysis associated with hypothyroidism was based on the history, clinical and neurological examination findings, laboratory assessment of thyroid function by observing low serum free T4 and high concentrations of TSH, the therapeutic response after supplementation levothyroxine sodium, and exclusion of other pos­sible causes, such as otitis interna and traumatic. The pathogenesis of this change associated with hypothyroidism is not completely understood, although it is believed that cranial nerve paralysis (trigeminal, facial and vestibulocochlear) may result from the resulting compression of myxedema deposit nerve or in the tissues of the head and neck, demyelination caused by disordered metabolism of Schwann cells, decreased blood perfusion of the inner ear secondary to hyperlipidemia and increased blood viscosity or metabolic defects ranging from change in axonal transport to severe axonal loss. Treatment consists of supplementation of levothyroxine and most dogs with neurological disorders associated with hypothyroidism will present partial or total improvement of clinical signs between two and four months, generally being observed improve­ment within the first week of treatment. In the dog this report, after the beginning of treatment, improvement was observed partial and total clinical signs in 15 and 32 days, respectively. Therefore, with appropriate treatment, hypothyroidism is a disease with an excellent prognosis. The report brings to clinical relevance, the importance of hypothyroidism in the dif­ferential diagnosis of facial paralysis in dogs with face asymmetry history, the laboratory evaluation of thyroid function and response to therapy with levothyroxine sodium supplementation essential for definitive diagnosis. Keywords: neurology, facial nerve, peripheral neuropathy, dogs

Neurological and Orthopedic Diseases in Dogs and Cats Submitted to Physiotherapy

Background: The goals of physical therapy are to maximize functional recovery, improve mobility, and restore well-being and quality of life. In the veterinary literature, there is a dearth of data on physical therapy in small animal practice. Therefore, this study aimed to identify the main neurological and orthopedic diseases in canine and feline patients seen at the physical therapy service of an animal hospital. Concomitantly, we collected demographic and clinical information on patients, including sex, breed, physical therapy modalities, number and frequency of physical therapy sessions, duration of treatment, and rate of functional recovery.Materials, Methods & Results: The records of animals with neurological and orthopedic diseases seen at the Physical Therapy department of a university-affiliated animal hospital were reviewed. The animals were divided into two groups: I) dogs and cats with neurological diseases and II) dogs and cats with orthopedic diseases. Both groups were distributed according to species, age, sex and race. Dogs and cats were classified into three age groups: puppies (≤ 1 year old), adults (> 1 year and ≤ 10 years old) and elderly (> 10 years old). A total of 384 records were retrieved, of which 370 (96.4%) were of dogs and 14 (3.6%) of cats. Neurological cases accounted for 66% of the total (n = 253), with 243 cases in dogs (96%) and 10 in cats (4%). Among orthopedic cases (n = 131, accounting for the remaining 34%), 127 were in dogs (97%) and only 4 in cats (3%). In the neurological dysfunction group, intervertebral disc disease (72.4%) was the most common diagnosis. Among the orthopedic disorders, femur fracture (23.1%) was most prevalent. In group I (neurological), 66.7% of outcomes in canine patients and 44.4% in felines were considered satisfactory. In group II (orthopedic), 61% of outcomes in dogs and 66.7% in cats were considered satisfactory.Discussion: Physical therapy has many applications in small-animal practice. After spinal cord decompression surgery in dogs with IVDD, for instance, it helps maintain and recover motor and sensory function, and is considered safe and well-tolerated in dogs after thoracolumbar hemilaminectomy with disc fenestration. Physical therapy also plays an important role after surgical repair of fractures and dislocations, aiding recovery of range of motion and return to functional activity. The most probable explanation for the wide variation in number of physical therapy sessions can be explained by owners’ satisfaction with the level of recovery achieved by the animal, often leading to discontinuation of physical therapy. The high rate of unsatisfactory outcomes in feline patients can be explained by the type of injury (spinal trauma) and the degree of neurological dysfunction. Adult female dogs were most likely to be referred to the physical therapy sector, and the Dachshund and Poodle breeds were most prevalent. Patients in the neurological dysfunction group had the highest average duration and number of sessions. Massage, stretching, passive joint mobilization, and neuromuscular electrical stimulation (NMES) were the most commonly used modalities in all physical therapy protocols. Satisfactory functional recovery was achieved in more than 60% of cases in both groups. The absence of a control group and the lack of standardization of physical therapy modalities precluded a more definitive confirmation of the results obtained in terms of functional recovery

Intradural Disc Extrusion in a Dog

Background: Intervertebral disc extrusion is an important cause of spinal cord dysfunction in dogs. Intradural localization of the extruded disc material is rare, and is generally associated with a traumatic event or with recurrence of disc extrusion at a previously affected site. We report the clinical presentation, diagnostic workup, and treatment of a dog with intradural intervertebral disc extrusion not preceded by a traumatic event.Case:  A 6-year-old male Dachshund was referred for neurological evaluation due to acute onset of hind-end paralysis preceded by claudication of the left hindlimb. The patient had been receiving conservative treatment to no effect. Neurological examination revealed asymmetric non-ambulatory paraparesis, absence of postural reactions and decreased muscle tone in both hindlimbs, a bilaterally diminished patellar reflex, and a hindlimb withdrawal reflex which was normal on the right and greatly diminished to absent on the left. The lower back was tender to epaxial palpation. Plain radiographs of the lumbar spine in the lateral projection showed calcified material within the spinal canal between the third and fourth lumbar vertebrae. Myelography was suggestively abnormal at the same level, with epidural leakage of contrast at L3-L4. Considering the clinical history, breed, age, neurological signs, and radiographic findings, intervertebral disc disease was suspected despite the inconclusive myelography findings. A dorsolateral lumbar hemilaminectomy was performed. Intraoperatively, the diagnosis was confirmed by visualization of a discolored spinal cord and absence of extradural material. The intradural space was accessed via durotomy. A firm, straw-yellow material was seen compressing the spinal cord and removed. Subsequent histopathological examination confirmed that this material consisted of extruded intervertebral disc contents. Postoperatively, the patient underwent physiotherapy and achieved a satisfactory recovery.Discussion: The most common cause of paraparesis in chondrodystrophic dog breeds is intervertebral disc extrusion. Intradural extrusion of the intervertebral disc is a rare phenomenon, often associated with vigorous exercise that causes laceration of the dura mater, allowing penetration of disc material into the intradural space. Although there were no classic signs of intervertebral disc disease on plain radiography, radiopaque material was visible within the spinal canal, which can occur in cases of calcified intervertebral disc extrusion. Myelography was inconclusive, but the decision was made to operate nevertheless, considering that the patient had not responded to conservative treatment and that surgicaltreatment is the most suitable approach for dogs with non-ambulatory paraparesis or paraplegia secondary to intervertebral disc extrusion. The surgical technique consisted of a hemilaminectomy and durotomy. Our diagnostic suspicion was confirmed intraoperatively, as in most cases of intradural disc extrusion in humans. Intradural disc extrusion is anuncommon phenomenon in dogs, and the diagnosis is usually only established intraoperatively. This unusual variant of intravertebral disc disease should be included in the differential diagnosis of spinal cord dysfunction in chondrodystrophic breeds, even in the absence of a history of trauma or preexisting intervertebral disc disease. Clinical treatment appears ineffective in these cases. Conversely, surgical treatment can yield good outcomes, and even functional recovery