Orit Chai

A Method for Intervertebral Space Distraction Before Stabilization Combined with Complete Ventral Slot for Treatment of Disc-Associated Wobbler Syndrome in Dogs

OBJECTIVE To evaluate the use of a modified K-wire spacer for maintaining intervertebral distraction after ventral decompression and during stabilization as a treatment for disc-associated wobbler syndrome in large breed dogs. STUDY DESIGN A retrospective study. ANIMALS Dogs (n=7) with disc-associated wobbler syndrome. METHODS Medical records (2003-2006) of dogs treated by a modified surgical method were evaluated. Data retrieved were signalment, onset and duration of clinical signs, neurologic abnormalities, diagnostic methods, surgical procedure, immediate, and long-term (>or=1 year) postoperative clinical and radiographic outcome. RESULTS Mean duration of clinical signs was 4.8 months. Neurologic signs included ataxia (2), ambulatory tetraparesis (2), and non-ambulatory tetraparesis (3). Three dogs had disc protrusion in 2 sites, 2 dogs had the procedure in 1 location and stabilization of both affected sites. All dogs improved dramatically and remained for 1-3 years. One dog had recurrence of cervical discomfort 13 months later. CONCLUSIONS Despite the limited number of dogs, overall initial successful outcome with only 1 dog having mild recurrence 13 months later supports further use and evaluation of this technique. CLINICAL RELEVANCE Distraction using a K-wire spacer after ventral decompression followed by stabilization should be considered in dogs with disc-associated wobbler syndrome to prevent collapse of the intervertebral space.

Sub-occipital Craniectomy in a Lion (Panthera leo) with Occipital Bone Malformation and Hypovitaminosis A

Abstract Neurologic dysfunction accompanied by malformation of both the skull and the cervical vertebrae has been previously described in lions kept in captivity worldwide, and this dysfunction and malformation were most often related to vitamin A deficiency. Diagnosis of the bone malformation and its effects on the neural tissue was until recently limited to postmortem examination, with characteristic thickening of the bones of the cranial vault, cerebellar herniation, compression of the foramen magnum, and enlargement of the lateral ventricles. For some mildly affected lion cubs with neurologic signs, improvement was reported with excessive vitamin A supplementation. However, definitive diagnosis was only available for those that eventually died or were euthanized. This case documents the antemortem diagnosis of the disease using computed tomographic imaging and liver biopsy. While conservative treatment failed, suboccipital craniectomy removed the thickened occipital bone and was demonstrated to be a successful surgical intervention that can be used to treat more severely affected lions.

Successful medical management of lumbar intervertebral disc prolapse in a ferret

Thoracolumbar disc herniation was diagnosed in a two-year-old ferret using a myelogram followed by a computed tomography scan. The ferret was paraplegic with no control over urination and defecation. Conservative treatment that included cage rest and passive range of motion exercises for three weeks followed by extensive physiotherapy and hydrotherapy resulted in full recovery two months after the onset of treatment. Although intervertebral disc disease has been reported previously in four ferrets, this is the first report in which a postmyelogram computed tomography was used to demonstrate the herniated disc, and physiotherapy was used as principal treatment modality.

The prognostic value of cerebrospinal fluid characteristics in dogs without deep pain perception due to thoracolumbar disc herniation.

Providing a pre-operative prognosis for dogs presented with absent deep pain perception (DPP) is extremely challenging, as the overall recovery rates widely vary. This study assesses the possible correlation between the severity of spinal cord injury and CSF cytology in 31 paraplegic dogs presented with absent DPP due to acute thoracolumbar intervertebral disc herniation (TL-IVDH). All dogs underwent surgical decompression immediately following diagnosis. CSF TNCC, macrophage percentage and macrophage to monocyte (MΦ:M) ratio were significantly higher in dogs that failed to regain DPP within 10 days post-operatively and in dogs that failed to regain ambulation at the end of the study period (P< 0.05). MΦ:M of 0.73 and higher corresponded to a sensitivity of 54% and specificity of 100% for prediction of a negative long-term outcome. CSF TNCC, macrophage percentage and MΦ:M ratio effectively predicted regaining DPP and the long-term outcome in dogs that lost DPP due to acute TL-IVDH.

Retrospective evaluation of combined mycophenolate mofetil and prednisone treatment for meningoencephalomyelitis of unknown etiology in dogs: 25 cases (2005-2011).

OBJECTIVE To evaluate the use of a combined protocol of prednisone and mycophenolate mofetil (MMF) for the treatment of meningoencephalomyelitis of unknown etiology (MUE) and to describe response, adverse effects, and outcome. DESIGN Retrospective study (2005-2011). SETTING University teaching hospital. ANIMALS Twenty-five client-owned dogs with clinical signs, neuroimaging, and cerebrospinal abnormalities consistent with MUE. Five dogs whose MMF treatment was discontinued after 7-14 days due to gastrointestinal clinical signs were evaluated only for adverse effects. INTERVENTIONS Dogs were initially treated with prednisone 2 mg/kg PO every 12 hours and with MMF 20 mg/kg PO or IV every 12 hours. Prednisone was tapered after 4 days to 1 mg/kg every 12 hours for 14 days, then to every 24 hours for 30 days, and again reduced by half every 2-4 months thereafter. When prednisone was tapered completely or to 0.5 mg/kg every 24-48 hours without clinical relapse, MMF was tapered in a similar manner. MEASUREMENTS AND MAIN RESULTS Partial or complete clinical response was achieved in 95% (19/20) of the dogs. Median survival time by the end of the study was 250 days (range 6 to >1,679) with 40% (8/20) of the dogs still alive (336-1,679 days after diagnosis). All Pug dogs (4/20) included in the study died with a median survival time of 14 days. Adverse effects attributed to MMF, which included hemorrhagic diarrhea within the first 2 weeks of treatment, were recorded in 20% (5/25) of the dogs. CONCLUSIONS MMF can be used as an adjunctive treatment for dogs with MUE. This protocol enables reduction of prednisone treatment or, in some cases, its complete withdrawal. The possibility of intravenous administration is advantageous in cases with severe neurological abnormalities and mentation changes, often seen in MUE. Attention is warranted for gastrointestinal adverse effects, especially in the first 2 weeks of treatment.

Reversible Paralysis and Loss of Deep Pain Sensation After Topical Intrathecal Morphine Administration Following Durotomy

Objective To report 2 dogs that developed temporary pelvic limb paralysis with loss of deep pain sensation after topical intrathecal morphine administration during spinal surgery. Study Design Clinical report. Animals Dogs (n = 2). Methods A 5-year-old castrated male French Bulldog with a subarachnoid diverticulum at T9–T10 and a 9.5-year-old castrated male Belgian Shepherd dog with a herniated disc at T12–T13 and intradural component, had Gelfoam soaked with morphine placed over the dura mater defect. Results Pelvic limb paralysis and loss of deep pain sensation was noticed immediately after recovery from anesthesia. After intravenous naloxone administration, both dogs immediately regained ambulation and normal pain sensation; however the effect was temporary lasting only a few hours. Permanent resolution of clinical signs occurred 24 hours after surgery. Conclusions Topical intrathecal morphine administration resulted in temporary pelvic limb paralysis and loss of deep pain sensation. This route of administration should be used cautiously until further determination of the efficacy and adverse effects associated with topical intrathecal morphine administration.OBJECTIVE To report 2 dogs that developed temporary pelvic limb paralysis with loss of deep pain sensation after topical intrathecal morphine administration during spinal surgery. STUDY DESIGN Clinical report. ANIMALS Dogs (n = 2). METHODS A 5-year-old castrated male French Bulldog with a subarachnoid diverticulum at T9-T10 and a 9.5-year-old castrated male Belgian Shepherd dog with a herniated disc at T12-T13 and intradural component, had Gelfoam soaked with morphine placed over the dura mater defect. RESULTS Pelvic limb paralysis and loss of deep pain sensation was noticed immediately after recovery from anesthesia. After intravenous naloxone administration, both dogs immediately regained ambulation and normal pain sensation; however the effect was temporary lasting only a few hours. Permanent resolution of clinical signs occurred 24 hours after surgery. CONCLUSIONS Topical intrathecal morphine administration resulted in temporary pelvic limb paralysis and loss of deep pain sensation. This route of administration should be used cautiously until further determination of the efficacy and adverse effects associated with topical intrathecal morphine administration.

TAENIA MULTICEPS BRAIN CYST REMOVAL IN TWO WILD NUBIAN IBEX (CAPRA NUBIANAS)

Abstract: Two wild adult Nubian ibex (Capra nubiana) were captured and admitted to the Hebrew University Veterinary Teaching Hospital with various neurologic signs, including alerted mentation, head tilt, and pathologic nystagmus. The lesion in the central nervous system was localized to the forebrain in one ibex and to the cerebellum of the other. Both ibexs were diagnosed with brain cyst using computed tomography (CT). Craniectomy was performed to remove the cysts, and both animals returned to their natural environment after a rehabilitation period. Parasitologic examination revealed cysts of Taenia multiceps coenurus. This is the first report to describe the neurologic signs, CT findings, surgical procedure, and follow-up postsurgery information in wild Capra nubiana.

Tumor Necrosis Factor-α and Interleukin-6 Concentrations in Cerebrospinal Fluid of Dogs After Seizures

Background Idiopathic and acquired epilepsy are common in dogs. Up to 30% of these dogs are refractory to pharmacological treatment. Accumulating experimental evidence indicates that brain immune response and presence of inflammatory mediators decrease the threshold for individual seizures and contribute to epileptogenesis. Hypothesis Dogs with seizures have higher cerebrospinal interleukin‐6 (IL‐6) and tumor necrosis factor‐α (TNF‐α) concentrations compared to dogs with no seizures. Methods A prospective double blinded study; cerebrospinal fluid (CSF) and serum IL‐6, TNF‐α and total protein (TP) concentrations were measured by a blinded investigator for the study group and CSF IL‐6 and TNF‐α levels and TP concentrations were measured in the control group (CG). Animals Dogs presented with seizures that had enough CSF collected to allow analysis were included in the study group. Twelve apparently healthy, quarantined, stray dogs served as control (CG). Results Cerebrospinal fluid TNF‐α and IL‐6 concentrations were significantly higher (P = .011, P = .039) in dogs with seizures (0 ± 70.66, 0.65 ± 10.93 pg/mL) compared to the CG (0 ± 19, 0.73 ± 0.55 pg/mL). When assessing cytokine concentrations of specifically the idiopathic epilepsy (IE) dogs compared to the CG, only TNF‐α concentrations (8.66 ± 62, 0 ± 19 pg/mL) were significantly higher (P = .01). CSF TP concentrations were not significantly higher in the study dogs compared to the CG. Conclusions and Clinical Importance Higher TNF‐α and IL‐6 concentration in the CSF of dogs with naturally occurring seizures. The higher supports the hypothesis that inflammatory processes through certain mediators play a role in the pathogenesis of seizures in dogs.

Clinical characteristics of Spirocerca lupi migration in the spinal cord

Spirocerca lupi is a nematode infecting dogs mostly in tropical and subtropical areas. Although its typical target is the esophageal wall, aberrant migration is not uncommon, including migration of unknown incidence into the spinal cord. While successful treatment of intraspinal S. lupi (ISSL) infection depends on early diagnosis, tools for definitive ante-mortem diagnosis are unavailable. We therefore aimed at characterizing clinical signs and clinical pathology findings of ISSL in dogs. For that, we analyzed medical records of dogs hospitalized in 2005-2016 presenting with neurological signs consistent with ISSL, which were diagnosed definitively post-mortem. Retrieved information included signalment, medical history, chief complaint, physical and neurological evaluation, neuroanatomical localization at presentation, clinical pathology, imaging findings, treatment, outcome and post-mortem findings. Ten midsize to large breed dogs were included, 7 of which had received prophylactic treatment. In all 10 dogs, onset was acute and neurological deterioration until presentation (2 h-6 d) was fast. Neurological examination localized the lesions within the spinal cord and paresis or paralysis was asymmetric in all dogs. Spinal pain was documented in 9/10 dogs. Cerebrospinal fluid (CSF) analysis was abnormal in all dogs and was characterized by pleocytosis in 8/10, whereas cytology revealed the presence of eosinophils in all dogs. Advanced imaging excluded spinal cord compression in all dogs tested. Post-mortem examination detected spinal cord migration tract in all cases. Nematodes were found in the spinal cord parenchyma (8/10) or adjacent to it (2/10) in all dogs. A larva was found in the subarachnoid space of one dog and an adult nematode in the thoracic intervertebral artery of another. Esophageal nodules were found in 5/10 dogs. These findings suggest that the combination of sudden onset of acute asymmetric paresis accompanied by pain, presence of eosinophils in the CSF and lack of compressive lesion may serve as sufficient evidence for tentative diagnosis of ISSL in endemic areas.

Fibrosis of the masseter leading to trismus and dysphagia in a mare

TRISMUS, defined as the inability to adequately open the mouth ([O’Leary 1990][1]), can be caused by tetanus, temporomandibular joint disease, mandibular fracture, eclampsia and neurological disease ([Pearson and others 2005][2]). This short communication reports trismus in a horse resulting from