Mechanisms of injury and emergency care of acute spinal cord injury in dogs and cats.

OBJECTIVES: To review the literature in regards to the pathophysiology of acute spinal cord injury, and to describe current concepts in regards to patient assessment, diagnostic, and therapeutic measures with a special emphasis on emergency and critical care considerations. ETIOLOGY: Acute spinal cord injury occurs in 2 phases. The primary injury occurs at the time of initial injury and may include intervertebral disk herniation, vertebral fracture or luxation, penetrating injury, and vascular anomalies such as fibrocartilaginous embolic myelopathy. Secondary injury occurs following primary injury and is multifactorial encompassing numerous biochemical and vascular events that result in progression of injury. DIAGNOSIS: The diagnosis is based on history and physical examination findings. A neurologic examination should be performed following initial patient assessment and stabilization. Further diagnostics to characterize acute spinal injury include radiographs and advanced imaging modalities such as myelography, computed tomography, or magnetic resonance imaging. THERAPY: Initial treatment should focus on addressing the patient's cardiovascular and respiratory system. Supportive measures to support systemic perfusion are vital to minimizing secondary injury. Specific therapy toward minimizing secondary injury in veterinary medicine remains controversial, especially in regards to the utilization of methylprednisolone. Other therapies are either in need of additional research or have failed to document clinical difference. PROGNOSIS: The prognosis for acute spinal injury is varied and is dependent upon the presence of concurrent trauma, location, and type of primary injury sustained, and extent of neurologic impairment at the time of initial presentation. The etiology of the underlying trauma is of great importance in determining prognosis and outcome. Loss of deep pain is generally accepted as a poor prognostic indicator; however, even these patients can recover depending on their response to treatment.

Survival of a suspected case of central nervous system cuterebrosis in a dog: clinical and magnetic resonance imaging findings.

A 3-year-old, spayed female rat terrier was evaluated for acute onset of stupor, disorientation, and tetraparesis. Clinical signs progressed over 3 weeks to eventual right-sided hemiparesis and circling to the left. A Cuterebra spp. larva was discovered in the vomitus of the dog 2 weeks after the onset of clinical signs. Cerebrospinal fluid analysis showed chronic inflammation, and magnetic resonance imaging supported a diagnosis of a parasitic tract through the left cerebral hemisphere. Medical management included a tapering anti-inflammatory dose of prednisone. Clinical signs improved slowly over time. This is the first description of a presumptive antemortem diagnosis of canine cuterebrosis in the central nervous system.