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Basics of Neurology:
Spinal Cord and Peripheral Nerve Diseases
Matt Brunke, DVM, CCRP, CVPP, CVA Diplomate,
American College of Veterinary Sports Medicine and Rehabilitation

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Ross University
IVAPM
Chi Institute
IAVRPT
American College of Veterinary Sports Medicine and Rehabilitation

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Lecture outline – Neuro in an hour
– Quick review –Basics
– Central Nervous System
– Spinal Cord Injuries
– Peripheral Nervous System
– What do we do?

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Definitions

- Myelopathy – any dz process affecting the spinal cord
-paresis - weakness
- -plegia – paralysis
- Tetra – all 4 limbs affected
- Para – two limbs affected, usually pelvic
- Mono – one leg
- Hemi – one side
- Ataxia - incoordination
- Neuropraxia
- Temporary conduction loss, nerve intact
- Axonotmesis
- Axon & myelin damaged, but nerve intact
- Neurotmesis
- Totally severed nerve

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Functional anatomy
– Spinal cord
– Begins at caudal extent of the medulla
– Continues into lumbar region
– Terminates with nerve roots that extend into the tail (cauda equina)
• Vertebrae
– Cervical (7), Thoracic (13), Lumbar (7), Sacrum (3),
Caudal (1-20)

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Spinal cord
- Cervical (C1-C5)
- Cervical Intumescences (C6-T2)
- Thoracolumbar (T3-L3)
- Lumbar intumescences (L4-S3)
– L4-L6 and L6-S3
- 2 Basic Neurons
– Upper Motor Neuron (UMN) Brain ? White Matter
– Lower Motor Neuron (LMN) Grey Matter? Target Tissue

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A Complete Rehab Exam
- Visual, Gait, Standing and Recumbent
- Cardiovascular, Orthopedic, Neurologic
- Is it neuro or ortho in origin? (both??)
– Mimics: hip dysplasia, CCL disease
- Which limbs are affected?
- Neuro exam – Postural reactions, spinal reflexes, muscular tone, muscle atrophy
- Is the problem UMN, LMN or both?

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UMN vs. LMN
UMN lesion LMN lesion
Gait Long strided, stiff, spastic Short strided, looks lame, support issues
Postural Reaction Slow to hop and place Normal if supported
Spinal Reflexes Normal to increased (hyper) Decreased to absent (hypo)
Muscle Tone Normal to increased Decreased to absent
Muscle Atrophy Minimal to none Moderate - severe

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Anatomic Diagnosis
Site of Injury Thoracic Limb Deficit Pelvic Limb Deficit
C1-C5 UMN UMN

C6-T2 LMN UMN
“Two-engine gait”

T3-L3 NORMAL UMN

L4-S3 NORMAL LMN

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T3 is the key!
- If forelimbs are normal and hindlimbs abnormal – lesion must be CAUDAL to T3
- If both the fore limbs and hind limbs are abnormal - lesion is CRANIAL to T3
- When you get radiographs – include the ENTIRE spinal column
- One exception...Schiff-Sherrington Syndrome!

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Schiff-Sherrington Syndrome
- Severe acute lesion in the TL segments
- Increased tone in the forelimbs that is obvious when patient in lateral
- DOES NOT affect motor function, postural reactions or reflexes in forelimbs
- Commonly confused with a cervical lesion

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Spinal Cord Dysfunction
- Pain (root signature) ? Proprioceptive Loss ? Ambulation? Motor function? Pain perception
- Gain them back in reverse order
- Grading
– 0-4 (Normal, Pain only, Ataxia/paresis, loss of motor function, loss of pain sensation)
– Normal, mild, moderate, severe

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What’s the cause?
- Degenerative
- Developmental
- Anomalous (congenital)
- Autoimmune
- Metabolic
- Nutritional
- Neoplastic (cancer)
- Inflammatory
- Infectious
- Immune-mediated
- Idiopathic
- Trauma
- Toxic
- Vascular

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Central Nervous System – Spinal Cord
- Degenerative/Developmental
– Atlanto-axial subluxation
– Wobbler’s Syndrome
– Intervertebral Disk Disease
– DISH/Spondylosis
– Degenerative Myelopathy (DM)
– Lumbosacral Disease (LS)

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CNS– Spinal Cord – Degen/Develop
– Atlanto-axial Luxation
– Toy/Small Breeds
- Yorkies, Pug, CKCS, Chihuahua, Dachshund
– Acute or progressive neck pain to weakness
– Tetraparesis/plegia
– SURGERY
– Be gentle

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CNS– Spinal Cord – Wobblers
- Cervical
Spondylomyelopathy
- Cervical Malformation-
malarticulation
- Young Great Danes, Mastiffs, Rottis
- Middle Aged Dobermans
- Neck pain to plegia
- Needs MRI to confirm

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CNS– Spinal Cord – Degen/Develop
- Intervertebral Disk Disease (IVDD) – Type 1
- Chondrodystrophic – usually...
– Nucleus and anulus rupture
- Research – born this way
- Rapid onset
- Pain to paralysis
- Meds or surgery

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What a difference a week makes

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CNS– Spinal Cord – Degen/Develop
- Intervertebral Disk Disease (IVDD)
– Hansen Type 2 -chronic
- Anulus bulges
– Acute Non-compressive Nucleus Pulposus
Extrusion – “type 3” – similar to FCE

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CNS– Spinal Cord – Degen/Develop
- Spondylosis deformans
- 25-70% of 9 year old dogs are affected
- Especially BOXERS
- Usually not clinical, rarely causing back pain

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CNS– Spinal Cord – Degen/Develop
- DISH – Diffuse Idiopathic Skeletal Hyperostosis
- May not be clinical, may cause some spinal pain
- BOXERS

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CNS– Spinal Cord – Degen/Develop
- Degenerative Myelopathy (DM)
- Chronic degenerative radiculopathy
- German Shepherd Dogs, Pembroke Corgis, Boxers, Rhodesian Ridgebacks, others
- Degeneration of axons and myelin
- Usually older than 8, NON PAINFUL, usu T3/L3
- Genetic test
- New research – Digital Tensor Imaging MRI – pick up changes in cord (otherwise need necropsy)

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CNS – Spinal Cord - DM

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CNS – Spinal Cord - DM

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CNS– Spinal Cord – Cauda Equina
- Lumbosacral Disease (LS)
- Compression of nerve roots
- German Shepherds
- 3-7 years old
- Back pain, LAMENESS
- Research – epidural injection series with methylprednisone – improved 79% of cases
- #1 reason MWD are retired

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CNS– Spinal Cord - Anomalous

- Spina bifida
– Incomplete fusion of dorsal vertebral arches
– Wedge vertebrae
– LS area usually
– Manx cats and Screw-tail dogs (bulldog, pug)

- Hemivertebrae
– Half thoracic/half lumbar
– Pugs, Frenchies
– Cause cord compression?

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CNS– Spinal Cord - Neoplasia
- Primary – usu chronic
– Extradural – similar to IVDD
– Intradural, extramedullary
– Intramedullary

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C1-C5 Intramedullary tumor

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CNS – Spinal Cord - Neoplasia
- Osseous neoplasia
– Primary (rare) – Osteosarcoma
– Systemic/Metastases – Multiple myeloma, other tumors (adenocarcinoma) that met to bone

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CNS – Infectious/Inflammatory
- Infectious
– Bacterial – Diskospondylitis
– Rickettsial
– Fungal
– Protozoal
– Parasitic
- Inflammatory
– GME

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CNS – Infectious
- Diskospondylitis
- Inflammation/infection between the end plates- sclerosis, narrow, sometimes bridged
- Spinal pain, fever, depression, neuro signs
- RADIOGRAPHS
- Blood and urine cultures
- 8-12 weeks of antibiotics

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CNS – Spinal Cord - Rickettsial
- Rocky Mountain Spotted Fever (RSMF)/Ehrlichiosis
- Blood and CSF samples, antibiotics for 2-4 weeks
- Varying degrees of issues, and recovery

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CNS – Spinal Cord - Fungal
Cryptococcus neoformans
- CNS, lungs, eyes, skin, bones
- Total paralysis, or spinal pain
- Blood and CSF samples
Blastomyces, Histoplasma
- Difficult to treat
- Uncertain recovery

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CNS – Spinal Cord -Protozoal
Neospora caninum
• Young puppy paralysis
• Muscle rigidity
• Poor prognosis
Toxoplasma gondii
• Puppies – fever, diarrhea, respiratory, seizures
• Treatment can be effective

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CNS – Spinal Cord - Parasitic
• Verminous myelitis
• Baylisacrais procyonis – raccoon roundworm
• Sudden and severe – one sided
• Full recovery uncertain

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CNS – Spinal Cord – Inflamm/Idiopathic
• Granulomatous Meningoencephalomyelitis (GME)
• Worldwide in dogs, maybe virus?
• Neck pain, tetraparesis
• Female, small breed at highest risk
• Sudden or chronic
• MRI, CSF
• Uncertain prognosis

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Central Nervous System – Spinal Cord
- Trauma
– HBC/RTA
– Fractures
- Pathologic fractures

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Trauma (Gun shot wound)

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CNS – Spinal Cord - Vascular
- Fibrocartilagenous embolism (FCE/FCEM)
– Pieces of cartilage block blood flow
– Adult large/giant breeds, also Mini Schn. and Shelties
– NON-PAINFUL
– Acute (after jumping or running) – agility dogs
– 85-99% regain function
– Usually T3/L3
– No medications – just REHAB!

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Peripheral Nervous System
- Degenerative/Developmental
– GOLPP (Lar Par and Polyneuropathy)
– Dancing Doberman Disease
– Distal denervating disease
– Distal polyneuropathy of Rottweilers

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PNS – Degen/Develop - GOLPP
- Geriatric Onset Laryngeal Paralysis and Polyneuropathy
- (Chronic axonal degeneration)
- 8-13 years, Labs, Newfies, GSD
- BARK CHANGE
- Loud breathing, increased airway resistance – vagus nerve
- Hind end weakness (sciatic nerve)
- Muscle atrophy
- Not painful

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PNS – Degen/Develop
- Dx – Laryngeal exam, rads, other
- Rehab therapy – before and after surgery
- Doxepin???
- Sx – “tie back”
– Risk of aspiration

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PNS – Degen/Develop
- Dancing Doberman Disease
- >6 months old, flex/extend hip when standing
- Prefer to sit than stand
- Front legs fine
- Stagnant disease
- Non painful

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PNS – Degen/Develop
- Distal denervating disease
- Common in UK, nowhere else
- Any dog, any age. Unknown cause
- Sensory intact
- Supportive treatment, excellent prognosis
- 4-6 week recovery

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PNS – Degen/Develop
- Distal polyneuropathy of Rottweilers
- Weakness on one side (hemi) that progresses to tetra
- Male, female, age 1-4. Unknown cause
- Electro diagnostics needed
- Poor prognosis
- Steroids?

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Peripheral Nervous System
- Metabolic
– Hypothyroidism
– Partial paralysis, weakened reflexes, CP deficits, lar par, regurgitation
– Blood test
– Easy, cheap treatment (thyroxine)
– And REHAB

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PNS - Neoplasia
Peripheral Nerve Sheath Tumor
- PNST
- Usually front legs
- Weakness, pain
- Paresis, ATROPHY
- Difficult at times to catch on MRI
- Surgery/radiation
Paraneoplastic Neuropathy
- Cancer outside the nervous system
- Insulinoma!
- Immune system response to tumor?
- Para or tetra paresis
- FIND and TREAT the tumor

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Insulinoma – tetaparesis

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Peripheral Nervous System
- Inflammatory
– Acquired Myasthenia Gravis
– Acute Idiopathic Polyradiculoneuritis
– Chronic Inflammatory demyelinating polyneuropathy
– Trigeminal Neuritis
- Idiopathic
– Facial paralysis

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PNS - Inflammatory
- Acquired Myasthenia Gravis
- Neuromuscular Junction Dz (NMJ)
- GSD, Golden, Labs
- Stiff after exercise, tremors, weakness
- Dysphagia, megaesophagus
- Testing and treatment available, rehab after
- Fulminant – sudden resp. paralysis (rare)

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PNS - Inflammatory
- Acute Idiopathic Polyradiculoneuritis
- “Coonhound paralysis”
- 7-14 days AFTER raccoon bite or scratch, or a vaccine
- Hind legs weak, then progresses to front, face, throat
- Pain, bladder, bowel intact
- REHAB
- 3 week to 6 month recovery

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PNS - Inflammatory
- Chronic Inflammatory demyelinating polyneuropathy
- Gradual weakness in all limbs, decreased reflexes
- Unknown cause
- Needs steroids – usually for life

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PNS - Inflammatory
- Trigeminal Neuritis
- SUDDEN onset jaw paralysis
- Can’t close mouth, dysphagia
- Unknown cause
- Resolve in 3-4 weeks, needs rehab

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PNS - Idiopathic
- Facial Paralysis
- Weakness or paralysis
- Cockers, Pempbroke Corgi, Boxers, DLH
- Can’t blink, drooping ears, upper lip,
- Facial sensation (trigeminal) is normal

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Peripheral Nervous System - Toxin
- Tick Paralysis
- Tetraparesis/plegia progressive in 24-72 hours
- Sensory and consciousness NORMAL
- Cranial nerves affected as well
- REMOVE THE TICK

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PNS - Trauma
Brachial Plexus Avulsion
- Radial nerve?
- Partial vs. complete
- Loss of extensors ? carpal contracture
- Rehab, amputate if needed
Sciatic Nerve Damage
- Injections
- Hip fractures
- Femur fx repair

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Peripheral Nervous System - Vascular
- Ischemic myoneuropathy
- Blood clots cause damage to nerve/muscle
- Seen in hypothyroidism, Cushing’s, renal, heart and cancer
- Usually hind limbs
- SUDDEN painful weakness or paralysis, loss of reflexes
- Can take 3 weeks to 6 months to recover

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What Do We Do???
• Complete Physical Exam
• Lesion localization/anatomic diagnosis
• Minimum database
– CBC/Chemistry/UA/Thyroid Panel/Tick Testing – SURVEY RADIOGRAPHS
- Fractures, luxations, disk calcification, collapsed disk spaces, spondylosis, DISH, Osseous neoplasia, Osteomyelitis, Diskospondylitis, pathologic fracture

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What Do We Do???
- Treat for pain, stabilize, inform, be practical
- REFER – CT myelogram/MRI, CSF tap, electro diagnostics, surgery
- Wait for the neurologist to turf it back for rehab

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Paralyzed?

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His first day with me

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Neuro, with a little ortho

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All on his own

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IAVRPT2020.org

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Contact info
• DrMattBrunke@gmail.com
• DrBrunke.wordpress.com