1. General principles. Goal : 17/07/2017 INDEX: Afecções da medula espinhal de felinos

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1 Afecções da medula espinhal de felinos Gualtiero Gandini Describe the most common diseases affecting the spinal cord of the cat INDEX: 1. General principles 2. Vitamin D and feline spinal cord disorders 3. Diseases mimicking spinal cord signs Goal : 1. General principles 1

2 2002 Relevant reviews PROCEEDINGS OF THE ESFM FELINE CONGRESS, STOCKHOLM, SEPTEMBER 2002 Spinal cord disorders Richard A LeCouteur Journal of Feline Medicine and Surgery (2003) 5, Relevant reviews Brain camp Bologna Retrospective study on 205 cats with histologically confirmed spinal cord lesion 2

3 CLINICAL PRESENTATION ONSET: ACUTE: mainly associated to trauma 60% inflammatory and vascular cases characterized by subacute signs (<30gg.) all the other VITAMIN D categories have insidious onset and chronic-progressive course CLINICAL PRESENTATION LOCALIZATION: LOCALIZATION: Lumbosacral (124 cats), thoracic (118) and cervical (116); FOCAL localization (102) MULTIFOCAL localization (95) Inflammatory diseases associated to multifocal localization (FIP and cryptococcosis). TRAUMA: associated to Thoracic or LS localization NEOPLASIA: LS localization most frequent CLINICAL PRESENTATION AGE AT DEATH: YOUNG CATS (<2 years): infectious, congenital, traumatic diseases. FIP most common CATS >2<8 years: lymphosarcoma, vertebral neoplasia, FIP most common diseases; CATS >8 years: vertebral neoplasia, lymphosarcoma, ischemic diseases 3

4 prevalence:. prevalence: 205 Cats 92 Cats 1. Inflammatory 32% 2. Neoplastic 27% 3. Trauma 14% 4. Congenital 11% 5. Vascular 9% 6. Degenerative 6% 1. Neoplastic 27% 2. Inflammatory* 14% 3. Trauma 9% 4. Vascular 6.5% 5. Degenerative 5.4% 6. Congenital 3%. the ranking : 1. FIP 2. Lymphoma 3. Vertebral Neoplasms 4. Trauma 4. Ischemic Disorders 4

5 2. Vitamin D & spinal cord disorders 1 : Infiammatory/ infectious. the winner: Feline Infectious Peritonitis (FIP) NEXT LECTURE!!! 2 : Neoplastic Lymphoma : most represented (20 cases) Vertebral column neoplasia (17 cases). Osteosarcoma (8 cases). Fibrosarcoma (3 cases) meningeal tumours (7 cases) FIBROBLASTIC OSTEOSARCOMA Most frequent localization: Lumbar and sacral 5

6 Chronic ataxia and paresis : differential diagnoses V I T A M I N D Vascular Inflammatory/infectious Trauma Anomalous (Congenital) Metabolic Idiopathic Neoplastic Degenerative Intervertebral Disk Disease (Protrusion) Meningomyelitis (FIP!!) Lymphoma Osteosarcoma Meningioma, other Globoid cell luekodystrophy, Neuraxonal dystrophy Spine anomalies; subarachnoid diverticulum JAVMA, Vol 232, No. 2, January 15, 2008 LYMPHOMA Lymphoma: frequent in young adult cats (4-6y) (any age: 6m-17y) Literature: 87% extradural! Systemic involvement (kidney, Bone marrow, liver, lymphnodes) Multifocal CNS involvement Prognosis: poor 6

7 Photo: prof. Carlo CANTILE - Pisa 17/07/2017 NEUROLOGIC SIGNS: according to the localization and staging EXTRA NEUROLOGIC SIGNS: abdominal palpation; thorax x-ray according to the localization CSF EXAMINATION: - mononuclear pleocytosis (mitoses?) - increased proteins ADVANCED DIAGNOSTIC IMAGING: Magnetic Resonance Imaging NEUROPATHOLOGY LYMPHOMA DIAGNOSIS Capo Cat,DSH Mc, 11y NRN 3667 Capo Cat,DSH Mc, 11y NRN 3667 T2-W T1-W T1-W + c.e. 7

8 ."giriamo pagina". Mici, DSH, Fs, 8y; [NRN 1078] since ten days crouched stance and gait, reluctance to jump hyperalgesia on palpation of the TL region Mici, DSH, Fs, 8y; [NRN 1078] DIFFERENTIAL DIAGNOSES? BENIGN: Bone cyst Bone Sequestrum Physitis NEOPLASIA: Osteo/Chondro/fibrosarcoma Lymphosarcoma Metastases 8

9 Mici, DSH, Fs, 8y; [NRN 1078] Mici, DSH, Fs, 8y; [NRN 1078] Diagnosis Neoplasia vertebral body L2 Treatment Decompressive surgery Outcome One year later: recurrence, second CT and decompressive surgery two years later: further recurrence, CT and euthanasia Aetiologic Diagnosis Osteoblastic osteosarcoma OSTEOSARCOMA Bone primitive tumors are quite rare in the cat Osteosarcoma is the most common bone neoplasia in the cat Osteosarcoma affects more frequently the appendicular skeleton less reported in axial skeleton Prognosis more favourable in the cat than in the dog Treatment: surgical palliative treatment Axial: shorter survival time than appendicular osteosarcoma 9

10 ."giriamo pagina". «Chronic presentation» 4 : anomalous/hereditary Storage diseases: - gangliosidosis - glycogenosis - sphyngomyelinosis - mucopolysaccharidosis type VI Neuraxonal Dystrophy Globoid Cell leukodystrophy (Krabbe disease) FeLV-associated degenerative myelopathy Subarachnoid diverticulum Hydrosyringomyelia DIAGNOSIS CLINICAL PRESENTATION young age, chronic progressive course EXCLUSION OF OTHER DISEASE blood work, MRI, CSF POST MORTEM CONFIRMATION Globoid cell Leukodystrophy «Tommy» DSH, M, 4m NRN

11 Globoid cell Leukodystrophy «Flash» DSH, MC, 9 m NRN 5145 Globoid cell Leukodystrophy CORTESIA DR. CARLO CANTILE «Goldrake» Maine Coon, MC, 18 m NRN

12 «Goldrake» Maine Coon, MC, 18 m NRN 5519 upside down??? Acute ataxia and paresis: differential diagnoses V I T A M I N D Vascular Inflammatory/infectious Trauma Anomalous (Congenital) Metabolic Idiopathic Neoplastic Degenerative Fibrocartilaginous Embolic Myelopathy Trauma Aortic thromboembolism Intervertebral Disk Disease (extrusion; ANNPE) 12

13 higher incidence? Trauma EXOGENOUS ENDOGENOUS Vertebral trauma: - car accidents - falls - penetrating wounds - gunshots concomitant injuries (30-83%)! Intervertebral disk disease: - acute non-compressive nucleous pulpous extrusion (ANPPE) - disk extrusion Cat DSH, Fs, 3 years (the cat of my boss!) Trauma PRESENTATION: Acute paraplegia Nrad 9024 L1 L2 L3 13

14 Intervertebral disk disease sporadic disease dogs incidence ,12 2% dogs median age: 8years Both acute and chronic herniation T13-L1; L4-5; L7-S1 most common sites Fibrocartilagineous Embolic Myelopathy (CEM) Occlusion of the spinal vasculature by fibrocartilaginous material histologically and histochemically identical to the nucleus pulposus of the intervertebral disc, causing ischemic necrosis of dependent regions of spinal cord parenchyma. VASCULAR ANATOMY dorsal and ventral radicular arteries dorsal spinal artery central artery spinal branches of the vertebral artery, intercostal arteries and lumbar arteries ventral spinal artery C. Botteron Bern Fibrocartilagineous Embolic Myelopathy (CEM) Overall quite similar to the canine FCEM Older cats (median age 10 y[6m-17y]) Typically non-progressive after 6 hours Lateralization less common 58% Good outcome 79% cases Cortesia di C. Botteron Berna «Samuele» DSH, MC, 3 years 14

15 Tired? 3. Diseases mimicking spinal cord signs acute onset of pain and severe paraparesis???? Cortesia dr.ssa Gianni - Milano 15

16 Ischemic Neuromyopathy consequence of arterial thromboembolism (ATE): - endotelial lesion (i.e. neoplasia, heart valve) - blood stasis - hypercoagulable state Thromboembolism Occlusion of the aortic trifurcation : ischemia of the tributary area CLINICAL SIGNS proportional to: extension of the ischemic damage presence of collateral network circulation Courtesy dr. Gianni - Milan PAIN (sometimes dramatic!) Flaccid Paresis/paralysis Absent spinal reflexes distal limbs cold and cyanotic nail beds Absence of the femoral pulse Ischemic neuromyopathy and neoplasia where do you localize? 16

17 1. Cats are.. cats! 2. Spinal cord diseases differ greatly from those of dogs 3. Cats spinal diseases carry a poorer prognosis compared to dogs 4. Most frequent disease: FIP 5. Most frequent tumor: Lymphoma 6. Acute onset disease: trauma; FCEM, IVDD 7. Subacute/Chronic onset disease: FIP, neoplasia 8. Consider age for your differential: younger cats: FIP; Lymphoma older cats: Neoplasia; FCEM; IVDD.. Questions? 17