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

Postoperative Analgesia with Transdermal Fentanyl or Intramuscular Methadone in Dogs Submitted to Thoracolumbar Hemilaminectomy

Background: Postoperative care after thoracolumbar hemilaminectomy in dogs generally includes rest, physical therapy, and analgesics such as opioids. Currently, there is no established standard for the management of postoperative pain in patients undergoing hemilaminectomy. Ideally, an analgesic protocol should provide adequate pain relief with limited sedation, low adverse effects, and postoperative patient comfort. Therefore, this study aimed to evaluate postoperative analgesia using transdermal fentanyl or intramuscular methadone in dogs undergoing thoracolumbar hemilaminectomy associated with intervertebral disc fenestration (HT) for the treatment of intervertebral disc extrusion (IVDE).Materials, Methods &amp; Results: Eight dogs from the Department of Neurology and Neurosurgery of a veterinary teaching hospital, submitted to HT for the treatment of IVDE, were included. The dogs were randomly distributed into two groups of equal numbers, namely the transdermal fentanyl (FT) group and the intramuscular methadone (IM) group. At the end of the surgical procedure, a fentanyl adhesive patch was applied to the animals in the FT group, which remained there for 72 h. In the IM group, analgesia was induced by intramuscular administration of methadone at intervals of 6 h until 72 h after surgery. The animals were evaluated using the short form of the Glasgow Composite Pain Scale (SF-GCPS). Evaluations of physiological parameters, side effects, and pain were performed by two assessors who had experience using the pain scale and were blinded to the analgesic protocol. Pain evaluations were performed every 2 h (from T4) until 24 h after the surgical procedure. Evaluations were performed every 4 h from 24 h to 48 h after the surgical procedure and at intervals of 24 h from 48 h to 72 h.Discussion: Transdermal fentanyl provided the lowest pain scores, when evaluated by the SF-GCPS, for both assessors. These data are presented as a function of time in Figure 1, which shows the variation in pain scores by SF-GCPS over time. It should be noted that, for both assessors, animals in the FT group had lower pain scores than animals in the IM group. There was also less variation in pain scores in the FT group, indicating better analgesic quality. This can be explained by the maintenance of the drug’s plasma concentrations in a stable manner, avoiding periods of greater or lesser pain throughout the evaluation period due to the absence of increases or decreases in plasma concentration. In the IM group, three analgesic rescues were required; in the FT group, there was no rescue. Although the data indicate that IM was responsible for a greater occurrence in the number of rescues, it is worth noting that this information is based on a small group of animals. One dog needed two rescues (at T4 and T8), regarding which both assessors agreed, while another required one rescue (at T18), but there was a difference of one point between the raters. However, pain scores in all of the cases were considered to be mild, not moderate or severe, with rescues occurring on scores of 5/20. Both fentanyl used by the transdermal route and intramuscular methadone promoted analgesia in the first three postoperative days in dogs undergoing HT. Better stability in postoperative pain scores without the need for analgesic rescue and less occurrence of adverse effects were observed in dogs treated with FT.Keywords: fentanyl patch, neurosurgery, dogs, analgesia, pain.Título: Analgesia pós-operatória com Fentanil transdérmico ou Metadona intramuscular em cães submetidos à hemilaminectomia toracolombar Descritores: adesivo fentanil, neurocirurgia, cães, analgesia, dor

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

Encephalic Meningioma in Dogs

Background: Meningioma is the most common brain tumor in dogs. These extra-axial tumors originate in one of the meninges, and arachnoid is the most common. Several retrospective studies of brain tumors are found in the international literature. However there are few researches in the national literature. The purpose of this study is to report twelve dogswith brain meningioma. The breed, gender, age, neurological signs, the brain location, the clinical evolution, the tumor classifcation and diagnostics tests were investigated.Cases: Twelve dogs were attended at Veterinary Hospital of Santa Maria University: six mixed-breeds; four Boxer; a Dachs hund; and a Poodle. The age ranged from eight to 14 years, with average of ten years and nine months old. The clinical signs observed were generalized seizures (9/12); behavioral changes (6/12); walk in circle (5/12); swallowing diffculty (2/12 [16%]); hypermetria (2/12); central vestibular syndrome (1/12); and amaurosis (1/12). The presumptive diagnosis was brain neoplasm in all dogs. Six dogs were underwent symptomatic treatment with corticosteroids and anticonvulsants; two dogs were underwent corticosteroids; and four were euthanized without performing treatment. After starting treatment,four dogs (50%) showed clinical improvement in the frst week, however, the clinical signs worsened after two weeks. The thalamus-cortex region was affected in seven cases (59%), followed by cerebellar-pontine region (25%), brainstem (8%) and cerebellum (8%). In the histological classifcation of meningiomas, the meningothelial variant was observed in six dogs, three psammomatous, two transitional and a fbroblast.Discussion: The average age of initiation of clinical signs was ten years and nine months, similar result found in a large study about brain tumor. Female dogs were most affected (n = 8), although some authors did not report sexual predis position. The neurological signs of dogs with brain meningiomas occur through adjacent structures compression, directinvasion of tissues, interruption of circulation, edema, inflammation and necrosis. The thalamus-cortex region was the most affected and the seizures were the most common clinical signs observed in dogs, according to the international literature. The meningiomas canine are histologically classifed into two groups: benign tumors (meningothelial, fbroblast,transitional, psammomatous, angiomatous, papillary, myxoid and granular cells); and malignant tumors (anaplastic). The meningothelial variant was found most frequently in this stud (50%), according to the others authors. The clinical course of time was determined from the onset of signs found in neurological examination until the time of death or euthanasia of dogs, being progressive in all patients. In this study, encephalic neoplasms showed slow evolution of signals between fve to 180 days (mean 58 days). This time is longer compared to other study in which the mean survival of 86 dogs was 30 days. In the present study, there was only symptomatic treatment with corticosteroids and/or anticonvulsant. The conclusion of this study is that brain meningioma is a common tumor; occur in adult and older dogs of different breeds; the clinical signs more frequent were seizures, behavioral changes and walk in circle to the side of the lesion. The palliative treatment with corticosteroids and anticonvulsants may be effcient in controlling the clinical signs, however the long-term prognosis is adverse.Keywords: neoplasm, brain, neurology, dog

Biofilm formation by Rhodococcus equi and putative association with macrolide resistance

Abstract: Rhodococcus equi is a facultative intracellular pathogen, which cause severe pyogranulomatous pneumonia in foals and tuberculosis-like lesions in humans. Its ability to form biofilm was described in strains isolated from chronic diseases associated to treatment failures in humans. This study aimed to verify the biofilm formation by 113 R. equi isolated from equine samples (clinical and fecal) using two different methods (biofilm-culturing with and without additional glucose and epifluorescence microscopy). We also aimed to determine the efficacy of azithromycin, clarithromycin and erythromycin on R. equi in established biofilm. We found 80.5% (26/41) and 63% (58/72) biofilm-positive isolates, in fecal and clinical samples, respectively. The additional glucose increased the biofilm formation by R. equi fecal samples, but not by clinical samples. The antimicrobials tested herein were not able to eradicate R. equi in biofilm even at higher concentrations. This is the first study showing the biofilm formation by R. equi isolated from equine samples. Our findings indicate that R. equi biofilm-producers may be more resistant to the antimicrobials evaluated. Further studies are warranted to test this hypothesis

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

Susceptibility profile of Brazilian Rhodococcus equi isolates against azithromycin, clarithromycin and erythromycin

Rhodococcus equi infection treatment is usually a macrolide (azithromycin - AZM, clarithromycin - CLR and erythromycin - ERY) and rifampicin combination. However, resistance cases have been reported, especially for ERY. In view of the need of a study about Brazilian isolates susceptibility profile, this study aimed to characterize the minimum inhibitory concentration (MIC) of the macrolides - AZM, CLR and ERY - against 44 R. equi isolates. It was found all isolates CLR and AZM sensitive; however, for ERY, 27% (12/44) were classified as intermediate sensitivity. R. equi Brazilian isolates used here showed a large susceptibility profile, except against ERY, for which it was observed some resistance evidence. In order to avoid failures in the equine rhodococcosis therapy it was highlighted the importance of microbiological culture and antimicrobial susceptibility testing in vitro before beginning treatmen

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

Biofilm formation by Rhodococcus equi and putative association with macrolide resistance

Abstract: Rhodococcus equi is a facultative intracellular pathogen, which cause severe pyogranulomatous pneumonia in foals and tuberculosis-like lesions in humans. Its ability to form biofilm was described in strains isolated from chronic diseases associated to treatment failures in humans. This study aimed to verify the biofilm formation by 113 R. equi isolated from equine samples (clinical and fecal) using two different methods (biofilm-culturing with and without additional glucose and epifluorescence microscopy). We also aimed to determine the efficacy of azithromycin, clarithromycin and erythromycin on R. equi in established biofilm. We found 80.5% (26/41) and 63% (58/72) biofilm-positive isolates, in fecal and clinical samples, respectively. The additional glucose increased the biofilm formation by R. equi fecal samples, but not by clinical samples. The antimicrobials tested herein were not able to eradicate R. equi in biofilm even at higher concentrations. This is the first study showing the biofilm formation by R. equi isolated from equine samples. Our findings indicate that R. equi biofilm-producers may be more resistant to the antimicrobials evaluated. Further studies are warranted to test this hypothesis