Clinical reasoning in canine cervical hyperaesthesia: which presenting features are important?

Abstract

Background To evaluate whether clinical features from the history, presentation, physical and neurological examination of dogs with cervical hyperaesthesia are statistically predictive of the underlying diagnosis. Methods Two hundred and ninety-eight dogs presenting with cervical hyperaesthesia between January 2010 and October 2018 were investigated. Only neurologically normal dogs with cervical hyperaesthesia on examination were included, while those with concurrent neurological deficits including gait abnormalities and proprioceptive deficits were excluded. Univariate analysis of clinical variables was performed and those associated with each diagnosis were retained for multivariable binary logistic regression models. Results Ninety-five percent of cervical hyperaesthesia presentations were represented by eight conditions which included steroid-responsive meningitis arteritis (SRMA, n=100), intervertebral disc extrusion (IVDE, n= 78), syringomyelia (SM, n= 51), intervertebral disc protrusion (IVDP, n= 30), neoplasia (n=8), cervical spondylomyelopathy (CSM, n=7), immune mediated polyarthritis (IMPA, n= 5) and meningoencephalomyelitis of unknown aetiology (MUA, n=5). Younger age (p=0.003), pyrexia (p=0.003), and haematology abnormalities (p=0.03) comprising leucocytosis, neutrophilia or monocytosis, were associated with a diagnosis of SRMA. Conclusions Easy-to-recognise clinical features can be used to identify the most likely differential diagnosis in neurologically normal dogs with cervical hyperaesthesia, which may aid the decision making of veterinary surgeons evaluating dogs with this presentation