Head tilt as a clinical sign of cervical spinal or paraspinal disease in dogs: 15 cases (2000-2021).

OBJECTIVES: To characterise head tilt as a rare clinical sign of cervical spinal or paraspinal disease in dogs. MATERIALS AND METHODS: Retrospective single-centre case-series study of dogs with head tilt and cervical spinal or paraspinal disease in the absence of intracranial abnormalities. Descriptive statistics were used. RESULTS: Fifteen dogs met the inclusion criteria of this study. Median age at onset was 6 years (range 2.5 to 12 years). Onset of neurological signs was mainly chronic (9/15, 60%). Most common presenting complaints included head tilt (9/15, 60%) and cervical hyperaesthesia (8/15, 53%). Most common neurological findings included head tilt (15/15, 100%), generalised proprioceptive ataxia and tetraparesis (6/15, 40%) and cervical hyperaesthesia (8/15, 53%). Diagnoses included post-operative complication of C2 spinal nerve root mass removal (2/15, 13%), C3-C4 intervertebral disc extrusion (2/15, 13%), cervical paraspinal myositis (2/15, 13%) and one of each: C2 vertebral malformation, C2 spinal nerve root mass, C1-C2 meningioma, C2 vertebral fracture, C4-C5 intervertebral disc extrusion, C4 vertebral body mass, C5-C7 osseous-associated cervical spondylomyelopathy, and concurrent C5-C6 and C6-C7 intervertebral disc protrusions. Two dogs were euthanased shortly after diagnosis and two of 15 were dogs lost to follow-up. No post-mortem examination was performed for these cases. For the 11 of 15 remaining dogs, head tilt resolved in eight of 15 (53%) dogs after treatment of the underlying condition and in three of 15 (20%) dogs, it remained static. CLINICAL SIGNIFICANCE: Head tilt can be a rare clinical sign of cervical spinal or paraspinal disease in dogs.

CT diagnosis of occipital condyle fracture in a dog presented for severe cervical hyperesthesia.

A 9-month-old male entire Doberman Pinscher presented with acute onset of severe cervical hyperesthesia after a fall. Neurological examination revealed a normal gait with low head carriage and severe cervical hyperesthesia. A CT scan of the cervical vertebral column revealed the presence of a comminuted fracture at the dorsomedial aspect of the right occipital condyle and sclerosis of the underlying bone. Medical management was initiated consisting of an external bandage, strict rest, and pain medication. Due to the lack of clinical improvement, the dog was euthanized 2 months after diagnosis. Histopathology of the lesion was compatible with a healing fracture.

Clinical features, treatment and outcome of discospondylitis in cats.

OBJECTIVES: There is a paucity of information on feline discospondylitis. This study aimed to describe the signalment, clinical and laboratory findings, aetiological agents, treatment and outcome in cats affected by discospondylitis. METHODS: This was a retrospective review of the medical records of cats diagnosed with discospondylitis at four referral institutions. RESULTS: A total of 17 cats were identified. Most were domestic shorthair cats (76.5%) and male (58.8%), with a median age of 9 years (range 0.9-14) and a median duration of clinical signs of 3 weeks (range 0.3-16). All cats presented with spinal hyperaesthesia; 3/17 had pyrexia. Neurological dysfunction was found in 64.7% of cats, which was indicative of a T3-L3 or L4-S2 spinal segment, associated nerve root or associated nerve neurolocalisation. Haematology, serum biochemistry and urinalysis revealed occasional inconsistent non-specific changes. All cats underwent urine culture; 9/17 cats also had a distinct tissue cultured. Positive bacterial cultures were obtained in two cats (11.8%) for Staphylococcus species (urine, blood and intradiscal fine-needle aspirate) and Escherichia coli (urine); both presented with multifocal discospondylitis. Treatment was non-surgical in all cats, with sustained antibiotic therapy for a median of 3 months (range 1-9). Analgesia provided included non-steroidal anti-inflammatory drugs, alone or in combination with gabapentin. Restricted exercise was advised for a minimum of 4 weeks. Outcome information available in 12 cats was excellent in terms of pain control and neurological function in 10 cats (83.3%) at the time of stopping antibiotics. Recurrence occurred in one case, which had received a single antibiotic for 6 weeks, and relapsed 4 months after presentation. One other case failed to improve and was euthanased during the course of hospitalisation. CONCLUSIONS AND RELEVANCE: Feline discospondylitis is uncommon and no obvious signalment predisposition was found in this study. Spinal hyperaesthesia was universally present, with neurological dysfunction also highly prevalent. Bacterial culture was unrewarding in most cases. Amoxicillin-clavulanic acid or cephalosporins are reasonable choices for first-line antibiotics. Prognosis was favourable, with no long-term evidence of recurrence in cats on sustained antibiotic therapy, for a mean duration of 3 months.

Clinical reasoning in canine cervical hyperaesthesia: which presenting features are important?

BACKGROUND: To evaluate whether clinical features from the history, presentation, physical and neurological examination of dogs with cervical hyperaesthesia are statistically predictive of the underlying diagnosis. METHODS: Two hundred and ninety-eight dogs presenting with cervical hyperaesthesia between January 2010 and October 2018 were investigated. Only neurologically normal dogs with cervical hyperaesthesia on examination were included, while those with concurrent neurological deficits including gait abnormalities and proprioceptive deficits were excluded. Univariate analysis of clinical variables was performed, and those associated with each diagnosis were retained for multivariable binary logistic regression models. RESULTS: Ninety-five per cent of cervical hyperaesthesia presentations were represented by eight conditions that included steroid-responsive meningitis arteritis (SRMA; n=100), intervertebral disc extrusion (n=78), syringomyelia (SM; n=51), intervertebral disc protrusion (n=30), neoplasia (n=8), cervical spondylomyelopathy (n=7), immune-mediated polyarthritis (n=5) and meningoencephalomyelitis of unknown aetiology (n=5). Younger age (P=0.003), pyrexia (P=0.003) and haematology abnormalities (P=0.03) comprising leucocytosis, neutrophilia or monocytosis were associated with a diagnosis of SRMA. CONCLUSIONS: Easy-to-recognise clinical features can be used to identify the most likely differential diagnosis in neurologically normal dogs with cervical hyperaesthesia, which may aid the decision making of veterinary surgeons evaluating dogs with this presentation.

Distemper Encephalomyelitis Presenting with Lower Motor Neuron Signs in a Young Dog.

A 4 mo old spayed female mixed-breed dog was presented for focal lower motor neuron signs of the right forelimb and marked hyperesthesia on axillary palpation. Her signs progressed rapidly over the following days to diffuse lower motor neuron signs in all limbs and a seizure. MRI demonstrated a focal, slightly right-sided, 2.5 cm region of noncontrast-enhancing T2 hyperintensity and T1 isointensity at C4-C5 spinal cord segments. Imaging of the brain was unremarkable. The dog was euthanized as a result of poor prognosis. Polymerase chain reaction on cerebrospinal fluid and immunohistochemistry of brain tissue were both positive for canine distemper virus. This report documents an atypical presentation of canine distemper encephalomyelitis causing lower motor neuron signs and hyperesthesia.

Cervical hyperaesthesia in dogs: an epidemiological retrospective study of 185 cases.

OBJECTIVES: To describe the prevalence, clinical findings and predictors of disease in dogs with cervical hyperaesthesia. MATERIALS AND METHODS: Medical records of dogs referred for neurological investigation of cervical hyperaesthesia between 2009 and 2013 were retrospectively reviewed. Dogs were assigned to one of the following groups according to the final diagnosis: Non-Neurologic, Brain, Cervical Spine, Multifocal, and Chiari-like Malformation/Syringomyelia. Demographic data, clinical and neurological signs and laboratory findings were compared between groups using univariate analysis; predictors of disease location were assessed by multivariate analysis. RESULTS: Final diagnostic allocations of the 185 records included in the study were as follows: 2.7% Non-Neurologic, 2.2% Brain, 63.2% Cervical Spine, 22.2% Multifocal and 9.7% Chiari Malformation/Syringomyelia. Intervertebral disc extrusion and steroid-responsive meningitis arteritis were the most common diseases. Compared to Multifocal dogs, those allocated a Cervical Spine diagnosis were older, heavier, more frequently ataxic and lame on a thoracic limb; furthermore, they were less frequently depressed or hyperthermic at presentation. Leucocytosis, neutrophilia and monocytosis were more frequent in dogs allocated a Multifocal diagnosis. Dogs with cervical hyperaesthesia older than 36 months and non-hyperthermic at presentation were more likely to have a lesion of the cervical region rather than a multi-focal disease. CLINICAL SIGNIFICANCE: Although non-specific, these results may be useful to guide clinicians in management of dogs presenting with cervical hyperaesthesia. Animal age and body temperature may support the suspicion of either focal or multi-focal cervical spinal disease.

Dermoid sinus type VI associated with spina bifida and tethered cord syndrome in a French Bulldog.

A 4-mo-old French bulldog was presented with acute onset pain and reluctance to move. A tubular structure arising in the dorsal thoracic midline and extending from a cutaneous orifice into deeper tissues was palpated on physical examination. Computed tomography with sinography revealed a dermoid sinus associated with spina bifida at the level of T3-T4. On surgical exploration, the dermoid sinus was found to communicate with the dura. Histology confirmed the diagnosis and classification as a type VI dermoid sinus. The pain response and hyperesthesia were suspected to be the result of tethered cord syndrome. Complete resolution of clinical signs was appreciated post-surgery, with the patient still free of clinical signs 3 mo later.

Feline hyperaesthesia syndrome with self-trauma to the tail: retrospective study of seven cases and proposal for an integrated multidisciplinary diagnostic approach.

CASE SERIES SUMMARY: This was a retrospective study on the clinical features and response to treatment in seven cats with feline hyperaesthesia syndrome (FHS) and tail mutilation. FHS is a poorly understood disorder characterised by skin rippling over the dorsal lumbar area, episodes of jumping and running, excessive vocalisation, and tail chasing and self-trauma. The majority of the cats were young, with a median age of 1 year at the onset of clinical signs, male (n = 6) and with access to the outdoors (n = 5). Multiple daily episodes of tail chasing and self-trauma were reported in five cats, with tail mutilation in four cats. Vocalisation during the episodes (n = 5) and rippling of lumbar skin (n = 5) were also reported. Haematology, serum biochemistry, Toxoplasma gondii and feline immunodeficiency virus/feline leukaemia virus serology, MRI scans of brain, spinal cord and cauda equina, cerebrospinal fluid analysis and electrodiagnostic tests did not reveal any clinically significant abnormalities. A definitive final diagnosis was not reached in any of the cats, but hypersensitivity dermatitis was suspected in two cases. A variety of medications was used alone or in combination, including gabapentin (n = 6), meloxicam (n = 4), antibiotics (n = 4), phenobarbital (n = 2), prednisolone (n = 2) and topiramate (n = 2); ciclosporin, clomipramine, fluoxetine, amitriptyline and tramadol were used in one cat each. Clinical improvement was achieved in six cases; in five cats complete remission of clinical signs was achieved with gabapentin alone (n = 2), a combination of gabapentin/ciclosporin/amitriptyline (n = 1), gabapentin/prednisolone/phenobarbital (n = 1) or gabapentin/topiramate/meloxicam (n = 1). RELEVANCE AND NOVEL INFORMATION: This is the first retrospective study on a series of cats with FHS. The diagnostic work-up did not reveal any significant abnormalities of the central or peripheral nervous system; dermatological and behavioural problems could not be ruled out. We propose an integrated multidisciplinary diagnostic pathway to be used for the management of clinical cases and for future prospective studies.

Magnetic resonance imaging muscle lesions in presumptive canine fibrocartilaginous embolic myelopathy.

This retrospective cohort study reports the observation of magnetic resonance imaging (MRI) epaxial muscle hyperintensity in dogs diagnosed with presumptive fibrocartilaginous embolic myelopathy (FCEM) (n = 61). It further reports the observation of vertebral column hyperesthesia lasting > 12 hours. The hypothesis tested was that the finding of MRI epaxial muscle hyperintensity correlated with dogs presenting with hyperesthesia. Client-owned dogs diagnosed with presumptive FCEM by specific MRI criteria were included. Statistical analysis was performed using Fisher's exact test. Twenty-three percent (14/61) of MRIs displayed abnormal muscle hyperintensity and 43% (26/61) exhibited vertebral column hyperesthesia. No relationship was found between muscle hyperintensity and pain persisting beyond 12 hours. The muscle hyperintensity remains of unknown significance. That 43% of presumptive FCEM cases have prolonged signs of pain is a higher prevalence than previously reported, and may affect clinical differential diagnoses. This is especially significant in cases in which MRI is not possible and a presumptive diagnosis must be based on the clinical signs.

Imagerie par résonance magnétique des lésions des muscles dans la myélopathie embolique fibrocartilagineuse canine présumée. Cette étude rétrospective de cohorte signale les observations de l'imagerie par résonance magnétique (IRM) pour l'hyperintensité du muscle épaxial chez les chiens diagnostiqués avec une myélopathie embolique fibrocartilagineuse (MEFC) présumée (n = 61). Elle signale aussi l'observation de l'hyperesthésie de la colonne vertébrale durant > 12 heures. L'hypothèse qui a été testée était qu'il y avait une corrélation entre l'observation de l'hyperintensité du muscle épaxial par IRM et les chiens présentés avec de l'hyperesthésie. Les chiens appartenant à des clients pour lesquels un diagnostic présomptif de MEFC avait été posé à l'aide du critère spécifique de l'IRM ont été inclus. L'analyse statistique a été réalisée en utilisant le test exact de Fisher. Vingt-trois pour cent (14/61) des IRM affichaient une hyperintensité anormale du muscle et 43 % (26/61) présentaient de l'hypersthésie de la colonne vertébrale. Aucun lien n'a été trouvé entre l'hyperintensité musculaire et la douleur persistant au-delà de 12 heures. La signification de l'hyperintensité musculaire est toujours inconnue. Le taux de 43 % de cas présomptifs de MEFC affichant des signes de douleur prolongée représente une prévalence supérieure aux données déjà signalées et pourrait affecter les diagnostics cliniques différentiels. Ce fait revêt une importance particulière lorsque l'IRM n'est pas possible et qu'un diagnostic présomptif doit se baser sur les signes cliniques.(Traduit par Isabelle Vallières).

An Unusual Case of Metastatic Seminoma in a Dog.

An 8 yr old, reportedly castrated male Boston terrier presented with a history of generalized hyperesthesia and intermittent shifting leg lameness. Physical examination revealed a caudal abdominal mass and bilateral shoulder pain. A complete blood count, serum biochemistry panel, and urinalysis were unremarkable. Thoracic radiographs demonstrated bony proliferation and lysis of the third sternebra, an expansile lesion of the left tenth rib, and lucency in both proximal humeral metaphyses. Abdominal radiographs and ultrasound revealed a soft tissue mass within the caudoventral right abdomen. Ultrasonography also revealed an enlarged lymph node within the right retroperitoneal space. Exploratory laparotomy identified the mass as a retained testicle. A cryptorchidectomy, lymph node biopsy, and bilateral percutaneous core biopsies of the proximal humeri were performed. Histopathologic examination revealed malignant seminoma of the testicle with metastasis to lymph node and bone. Adjuvant chemotherapy was recommended, but it was declined by the owner. All follow-up was lost. This case highlights a unique case for causative hyperesthesia secondary to a novel site of metastasis from malignant seminoma. Metastasis to bone has not been reported in humans or dogs and represents a very unusual and aberrant variant of the normally relatively benign biological behavior of seminoma in the dog.

Acute onset of generalized tremors, mild ataxia, and hyperesthesia in a young dog after presumptive ingestion of a giant sea hare belonging to the genus Aplysia.

OBJECTIVE: To describe an unusual case of canine toxicosis from presumptive sea hare ingestion, its management, and outcome. CASE SUMMARY: A young dog was treated for acute toxicosis after partially ingesting a giant sea hare washed up on a beach. The primary symptoms of generalized tremors, mild ataxia, and hyperesthesia occurred rapidly within 20 minutes of ingestion. Decontamination procedures were performed early and the dog made a full recovery within an approximate period of 6 hours. NEW OR UNIQUE INFORMATION PROVIDED: Sea hare toxicosis should be considered as a potential cause of acute onset of tremors, ataxia, and hyperesthesia in previously healthy dogs living in coastal areas.

[Doramectin intoxication in 3 kittens]. / Doramectin-Intoxikation bei drei Katzenwelpen.

This case report describes 3 kittens with suspected doramectin toxicity. In a litter of 7 kittens treated with doramectin, 3 developed neurological symptoms. One kitten showed mild apathy and tremors, while a second one additionally presented behavioral changes and seizures that had to be treated with diazepam. Both kittens recovered completely. A third kitten was presented to us in coma 3 days following treatment with doramectin. Subsequently, this kitten developed behavioral changes such as aggression, hyperesthesia, tremors, and seizures and died 36 hours after presentation. Histopathologic examination of the brain showed cytotoxic edema and polioencephalomalacia. The doramectin dosage of the deceased kitten was 380 µg/kg.

Compressive myelopathy associated with ectasia of the vertebral and spinal arteries in a dog.

A 4-year-old dog was presented for acute, progressive tetraparesis and cervical hyperesthesia. Symmetrical tubular structures coursing along the lateroventral aspects of the spinal cord at the fourth and fifth cervical vertebrae were identified in magnetic resonance images. At necropsy, vertebral arteries and their spinal branches were severely ectatic bilaterally, and the cervical spinal cord was compressed. Histologically, the ectatic branches of the vertebral and ventral spinal arteries were surrounded by fibrosis with scant mononuclear cell infiltrates and hemorrhage. Spinal branches of the vertebral arteries had focally severe reduction in the tunica media. A thrombus was in an arterial branch. Smaller vessels in adjacent tissue had fibrinoid degeneration. Axonal degeneration was detected in the affected spinal cord and nerve roots. The segmental degenerative radiculomyelopathy in this dog was attributed to anomalous ectasia of the vertebral and ventral spinal arteries.

Subluxação atlantoaxial em 14 cães (2003-2008) / Atlantoaxial subluxation in 14 dogs (2003-2008)

O objetivo deste trabalho foi realizar um estudo retrospectivo dos casos de subluxação atlantoaxial em cães, por meio de consulta dos registros neurológicos do Hospital Veterinário Universitário (HVU), entre os anos de 2003 e 2008. Foram identificados a raça, o sexo, a idade, a etiologia, os sinais neurológicos, a duração dos sinais clínicos, o tratamento empregado, a resposta ao tratamento, o tempo de recuperação, a recidiva e a relação entre a duração dos sinais clínicos e a recuperação pós-operatória. Foram feitos o diagnóstico de subluxação atlantoaxial em 14 cães, sendo as raças Poodle (35,7 por cento), Pinscher (21,4 por cento) e Yorkshire Terrier (21,4 por cento) as mais acometidas e a maioria (92,8 por cento) com idade inferior a 24 meses. A principal causa da instabilidade foi a agenesia do processo odontoide do áxis (71,4 por cento) e os sinais clínicos variaram desde hiperestesia cervical até tetraparesia não ambulatória. O tratamento predominante foi o cirúrgico, que demonstrou ser eficaz com recuperação satisfatória em 90 por cento dos casos e menor possibilidade de recidiva, quando comparado ao trata,mento clínico. O tempo de recuperação predominante foi de 30-60 dias após a cirurgia, não existindo relação deste com a duração dos sinais clínicos.

A retrospective study on atlantoaxial subluxation in dogs was done by reviewing the cases filed from 2003 to 2008 in the neurological records of the Veterinary Hospital of the Universidade Federal de Santa Maria, at Santa Maria, Rio Grande do Sul, Brazil. The following data were identified: Breed, sex, age, etiology, clinical signs, duration of clinical course, assessment of the therapy employed and its efficacy, response to treatment and relapse. Fourteen dogs were diagnosed as affected by atlantoaxial subluxation and the condition was more frequent in dogs under twenty-four month old years and of toy breeds, such as Poodle (35.7 percent), Pinscher (21.4 percent) and Yorkshire terrier (21.4 percent). The main cause found for the instability was agenesis of the odontoid process. Clinical signs ranged from cranial cervical pain to non-ambulatory tetraparesis. The predominant treatment employed was surgical which demonstrated to be efficacious in 90 percent of the cases with minor risks of relapse when compared with clinical treatment. The predominant time of recovery was 30-60 days after surgery. No correlation was found between the duration of clinical signs before surgery and the time of recovery.

Understanding behavior: feline hyperesthesia syndrome.

The etiology of feline hyperesthesia syndrome can be difficult to determine. Behavior modification and medications may help in treatment.

The Shetland Islands scrapie monitoring and control programme: analysis of the clinical data collected from 772 scrapie suspects 1985-1997.

There were 574 scrapie positive suspects (histopathological scrapie lesions present) and 198 scrapie negative suspects (histopathological scrapie lesions absent). The greatest number of scrapie cases were recorded in sheep of 2, 3 and 4 years of age which represented 17%, 36% and 23% of the scrapie positive suspects, respectively. The sign sensitivities and specificities for the ten recorded signs were, respectively: pruritus (62%, 42%), ataxia (23%, 74%), hyperaesthesia (32%, 74%), wool loss (25%, 73%), fleece discolouration (29%, 85%), bruxism (23%, 69%), nibbling reflex (17%, 58%), head rubbing (47%, 78%), poll rubbing (25%, 83%). These single signs had poor discriminatory values with likelihood ratios close to one (range 0.89-1.21); combinations of the four signs, pruritus, wool loss, ataxia, hyperaesthesia and emaciation were more discriminatory (range 0.30-4.3). This study covered a time period when bovine spongiform encephalopathy (BSE) might have been introduced into the sheep population on the Shetland Islands via contaminated feed. No temporal changes could be detected in the age structure of the affected animals.

Cervical hyperaesthesia in a Maltese Terrier with necrotising meningoencephalitis.

A 15-month-old female neutered Maltese Terrier was presented with a 12 hour history of low head carriage, reluctance to move and yelping when picked up. Physical examination was unremarkable apart from cervical hyperaesthesia. Twenty four hours after initial assessment there was significant clinical deterioration, with the dog exhibiting lateral cervical flexion and neurological abnormalities consistent with diffuse multifocal cerebral dysfunction. Cerebrospinal fluid analysis revealed a marked pleocytosis. Euthanasia was elected and gross necropsy findings included swelling of the right frontal cortex and a focal area of necrosis in the ventrolateral grey matter of the frontal cortex. Histological examination of the brain tissue revealed focal areas of necrosis and generalised non-suppurative inflammation consistent with a morphological diagnosis of necrotising encephalomyelitis.