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PEOPLE. “The man who smiles in the face of trouble… Has found someone to blame it on.”. Anatomy. Supratentorial: better prognosis Infratentorial . forebrain is responsible for "thinking," behavior, and final integration of sensory information. Brain: Neoplasia.

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people

PEOPLE

“The man who smiles in the face of trouble…

Has found someone to blame it on.”

anatomy
Anatomy

Supratentorial: better prognosis

Infratentorial

forebrain is responsible for "thinking," behavior, and final integration of sensory information

brain neoplasia
Brain: Neoplasia

Enlarging mass in brain; causes compression of healthy tissue or replacement with cancerous tissue

  • Primary: meningioma, glioma, choroid plexus papilloma, pituitary adenoma or adenocarcinoma (cushing’s), and others.
  • Secondary (metastasis): hemangiosarcoma, mammary carcinoma and melanoma
  • Dogs most common meningiomas and gliomas
  • Sagittal MRI of the brain of an 8 year old female German Shepherd dog.
  • Seizure
  • Well encapsulated mass in the olfactory bulb and frontal cortex of the brain
  • Meningioma (histopathology)
  • TX: surgical removal of the tumor followed by radiation
  • PX: Good not touching brain (unlike gliomas: radiation therapy)
brain neoplasia1
Brain: Neoplasia
  • Forebrain
    • Behavior
      • Depression, loss of learned behavior
    • Seizures: acute onset, 5-6 yrs old
    • Pacing and circling (Vestibular signs)
    • Ipsilateral vision: bump
    • E.g. Glioma’s and new treatments
      • Brachycephalic breeds: such as the Boxer, the Boston terrier, and the French and English bulldog
brain neoplasia2
Brain - Neoplasia
  • The Brainstem
    • motor function (the ability to walk, CV and resp function), consciousness and balance
    • 1st signs: loss of balance (vestibular signs) and paresis of one side of the body
    • Dysphagia, change in voice and inability to move the eyes
    • Progresses into paralysis, coma and death.
  • Vestibular signs:
  • Head tilt
  • Leaning and falling to the side of the head tilt
  • Drunken gait with loss of balance (ataxia)
  • Circling to the side of the head tilt
  • nystagmus
  • Anorexia and vomiting
  • Strabismus
slide7

Kasey, a 10-year-old female Golden retriever

  • trigeminal nerve root tumor
  • sensation to the face and motor function to the muscles of mastication
  • 15 months
brain neoplasia3
Brain - Neoplasia
  • The Cerebellum - coordination of movements and interacts closely with the vestibular system to control balance and posture.
    • Uncoordinated gait characterized by dramatic goosestepping (hypermetria)
    • Intention tremors: Head tremors that are worst when the animal is intent on something (i.e., food) but disappear when the animal is relaxed Swaying of the trunk
    • Wide based stance
    • Sometimes there can be vestibular signs such as a head tilt
    • The animal's strength remains normal
brain neoplasia4
Brain: Neoplasia
  • Dx
    • Systematic screening for tumors in other organs
    • CBC, chem panel
    • Radiographs: metastasis
    • CSF tap to assess increased cerebral spinal pressure
    • Ophthalmic exam may indicate optic nerve edema
    • Computed tomography (CT) scanning or magnetic resonance imaging (MRI) to locate tumor
ct or mri
CT or MRI
  • MRI
    • shows the brain in more detail than CT
    • the test of choice when assessing for brain tumors
    • more expensive test and less widely available
    • CT images (more artifacts for brainstem/ cerebellum): meningiomas, choroid plexus papillomas
    • MRI: gliomas, brainstem or cerebellar disease or Boston Terrier.
brain neoplasia5
Brain: Neoplasia
  • Rx— surgical removal, radiation therapy,

chemotherapy, and palliative treatment of the symptoms

    • Surgical removal of superficial single lesions
      • Tumors of the brainstem pose problems
      • Forebrain: you can resect certain parts of the forebrain without long-term effects.
      • Meningiomas tend to be located on the surface of the brain and are therefore the best candidates for surgical removal.
      • Gliomas are more difficult to remove because they lie deep within the substance of the brain.
brain neoplasia6
Brain: Neoplasia
    • Radiation therapy
    • Chemotherapy; efficacy varies with tumor

type (lymphomas respond well; other less so)

    • Palliative: Anti-seizure medication (Phenobarbital PO 2-3 times/day), Corticosteroids—prednisone
  • Client info
    • The more severe the signs, the worse the outcome
    • The larger the tumor, the worse the outcome
    • Supratentorial tumors (tumors of the forebrain) have a better prognosis than infratentorial tumors (tumors of the brainstem and cerebellum)
    • Radiation therapy does prolong lifespan in most cases
    • Meningiomas have a better outcome than tumors that lie within the brain (e.g. gliomas)
epilepsy
Epilepsy
  • MOA: balance within

the brain shifts too far

toward excitation,

too many cells may

become too excited and a seizure can result

epilepsy1
Epilepsy
  • Generalized/ tonic (stiff muscle) - clonic (rhythmic movements: grand mal)
  • Grand mal (motor)
    • Prodrome
    • Ictus: the seizure itself
    • post-ictal(post-seizure)
  • Petit mal (absence seizure): little movement, animals?
  • Focal/ Partial
  • focal seizure may stay localized
  • may spread and affect the whole brain causing a classic, generalized, tonic-clonic seizure
  • brain tumor or infection
  • Simple: motor, twitching or blinking to one side of the face
  • Complex: sensory. Senseless repetitive behavior: imaginary fly biting,
seizures
Seizures

When the seizure begins, the dog stiffensand falls; They then begin jerking movementsThey are not in pain during the seizureand cannot control their bladder or bowels.

epilepsy2
Epilepsy
  • Signs of seizure
    • short aura (stare into distance,

seek comfort/protection from

someone, vocalize)

    • seizure lasts 1-2 min; may consist of total body muscle twitching with extended arms and legs and arching of neck dorsally (opisthotonus)
    • dog will be disoriented/blind for a few minutes

Click for video

slide19

http://www.thepetcenter.com/gen/epilepsy.html

    • may be incited by certain events
    • normal at other times
epilepsy3
Epilepsy
  • Dx
    • CBC, chem panel—r/o metabolic diseases causing seizures
      • hypoglycemia
      • hypocalcemia
      • hepatic encephalopathy (failure to detox blood)
        • Shunt
        • Cirrhosis
      • Pb poisoning
    • Radiographs—r/o head trauma or hydrocephalus
    • CT scan or MRI—r/o space-occupying lesion in brain
  • Rx—directed at cause if one can be found
    • treat if >1 every mo or two (Rx will not completely stop seizures)
    • Phenobarbital is TOC
status epilepticus
Status Epilepticus
  • Signs—prolonged, uninterrupted seizures (>5-10 minutes) or cluster of seizures
  • Rx
    • Diazepam (2-10 mg to effect); can be repeated over several minutes
  • Phenobarbital -
    • Time to steady state blood levels: 10-14 days
    • Side effects: sedation, ataxia, PU/PD/PP, hepatotoxicity, blood dyscrasias (Rare)
    • Establish an open airway
    • IV cath with IV fluids to keep an open vein
    • Monitor blood Ca and glucose; treat is needed
    • Monitor body temp; if elevated, treat appropriately
    • If cerebral edema is suspected, treat with mannitol (IV)
    • Phenobarbital—IV or IM
status epilepticus1
Status Epilepticus
  • Client info—
    • Epilepsy is an incurable disease
    • Even with treatment, animal may still seize;
      • goal is to reduce frequency and intensity of seizures
    • Spaying/neutering will remove any hormonal influence on seizures
    • Medications will probably be required for life
    • Most animals that seize can live a normal life
    • If seizure free for 6-9 mo, may reduced or discontinued Rx
slide24

LIFE

“Life is the art of drawing without an eraser.”

-John w. Gardner

spinal cord
Spinal Cord
  • Function
    • Nerve fibers carry signals between brain - rest of body
  • Anatomy
    • Like brain, protected by hard covering – dura
    • Intervertebral disk (cushion):
      • between vertebral body
      • increases range of motion
      • prevents vertebrae rubbing
spinal cord anatomy
Spinal Cord: Anatomy

Like brain, spinal cord enclosed in hard covering

IVDD problem in both humans and canine

Anatomical differences—cervical same; lumbar—human bears weight, canine doesn’t

Attached rib (thorax) helps stabilize the IV joint; worse at T-L junction (dogs)

degenerative disc disease humans
Degenerative Disc Disease: Humans

Degeneration of disk occurs with age

Dries out, shrinks (we get shorter as we age)

iv disk disease anatomy
IV Disk Disease: Anatomy

Normal spinal column and disk Prolapsed disk

1/3 thickness

nucleus fibrosus

intervertebral disk disease
Intervertebral Disk Disease
  • Etiology
    • IVD dries out with age → hardened, less compliant
    • ↑Pressure from jumping
    • Occurs most commonly in cervical, caudal thoracic, and lumbar vertebrae
    • Most common spinal cord disorder in companion animals
intervertebral disk disease1
Intervertebral Disk Disease
  • Hansen TYPE I: Nucleus pulposus herniates upward; narrowest part of annulus fibrosus
    • TYPE I: Most common in chondrodystrophic (“faulty development of cartilage”) breeds
      • Dachshunds, shih tzus, Lhasa apsos, beagles, basset hounds (poodles also affected)
      • Acute onset
      • Can occur at any age, but generally younger dogs
intervertebral disk disease2
Intervertebral Disk disease
  • Hansen TYPE 2: dorsal protrusion of the annulus into the spinal canal
    • Common in older dogs and nonchondrodystrophic breeds
      • Occurs over a longer period of time
      • Clinical signs may be less severe
      • Generally older dogs
intervertebral disk disease3
Intervertebral Disk Disease
  • Signs:
    • Pain
    • Paresis/paralysis; nerve function is lost in this order:
      • Proprioception—largest fibers; most susceptible to pressure; signs are ataxia
      • Motor fibers—next smallest fibers; signs are weakness/paresis
      • Cutaneous sensory fibers—small; require a lot of pressure to disrupt function; decreased panniculus reflex
      • Deep pain fibers—smallest fibers; require the most pressure to disrupt; loss is associated with poor prognosis
  • Severity of clinical signs depends on:
      • Speed at which disk material is deposited
      • Degree of compression
      • Duration of compression
ivdd dx spine x rays
IVDD Dx: Spine X-Rays

Normal

horse’s head

consistent IV space

Subluxation L2-3

(old lesion)

cervical ivdd1
Cervical IVDD

Myelogram: Disk herniation at C2-3 (narrowed IV space, narrowed spinal canal)

slide40
IVDD
  • Rx TYPE I, acute onset
      • Medical Rx is recommended for animals, with deep pain intact, with or w/o neuro deficit
        • High levels of corticosteroids is CONTROVERSIAL
      • Strict confinement—2 wk minimum (easy when dog hurts; not so easy after steroids/other pain medications take effect)
      • Nursing care
        • Soft padded cage
        • Urinary cath or express bladder several times/day
      • Surgery is recommended for
        • repeat offenders
        • No voluntary motor function
        • loss of deep pain (needs to be done QUICKLY!)
        • worsening neuro signs (poor Prognosis)
ivdd rehabilitation
IVDD - rehabilitation

http://www.youtube.com/watch?v=7AkNVDc4lig&feature=related

ivdd alternative optional treatment
IVDD – Alternative/Optional Treatment
  • Methocarbamol (muscle relaxant)15-20 mg/kg q 8hr
  • High-dose Methylprednisolone sodium succinate (CONTROVERSIAL!) and should be given within 8 hours
    • Although there is proven benefit in humans, results have not been proven in dogs
  • Low dose prednisone – various regimens
  • NSAIDS
    • Carprofen, deracoxib, etodolac
  • Gastroprotectants
  • Acupuncture
veterinary acupuncture
Veterinary Acupuncture
  • http://www.youtube.com/watch?v=Z-JjZPnk_Mw&feature=related
  • http://www.youtube.com/watch?v=vJIJDUQyOmw&feature=fvw
slide47
IVDD
  • Client info
      • Do not let susceptible breeds get overweight
      • Encourage animals to keep spine parallel to ground
        • No jumping on/off couch
        • No begging on hind legs
        • No stair climbing
      • Loss of deep pain >24 h has poor prognosis
      • If surgery is done soon enough, there is a good Px of recovery
      • Almost half of animals treated medically will have recurrence
      • Extensive home care is required for medical and surgical patients
      • Severe damage to spinal cord is not reparable
atlantoaxial joint
Atlantoaxial Joint

Atlanto-Axial Joint

atlantoaxial instability subluxation
Atlantoaxial Instability (Subluxation)
  • Signs
    • Toy and miniature breeds (<1 yr)
    • Reluctance to be patted on head
    • Neck pain
    • May have tetraparesis (weakness in all 4 limbs) or tetraplegia (paralysis in all 4 legs)
    • Sudden death due to respiratory paralysis
  • Diagnosis—
    • Radiographs: lateral x-ray of neck in slight ventroflexion
      • avoid further spinal cord damage with positioning
atlantoaxial instability subluxation1
Atlantoaxial Instability (Subluxation)

Normal toy breed dog Toy breed dog with atlantoaxial subluxation

Narrowed spinal canal

CT scan:

dens is

marked

by *

X-rays of same dogs; note separation of C1 and C2 when dog’s neck is flexed in B

atlantoaxial instability subluxation2
Atlantoaxial Instability (Subluxation)
  • Treatment—
    • Medical
      • splint neck in extension with cage confinement x 6 weeks
      • treat like other spinal cord trauma
    • Surgical (if unresponsive to medical Rx)
      • stabilize/decompress
      • attach dorsal process of axis to arch of atlas
      • fuse atlas and axis joint with pins and bone graft
      • hemilaminectomy to relieve spinal cord compression
  • Client info—
    • prognosis is fair to good for animals with mild signs
    • animals should not be used for breeding; may be hereditary
atlantoaxial instability surgical correction
Atlantoaxial Instability: Surgical Correction

Stabilization using trans-articular

screws

Stabilization using screws and bone cement

references
References
  • Alleice Summers, Common Diseases of Companion Animals
  • http://cvm.ncsu.edu/vhc/tc/clinical_services/neuro/brain_tumor.html
  • http://www.canine-epilepsy.net/basics/basics_index.html