Neurology Case of the Month (Feb 2013): Paraparetic dogWritten on February 10, 2013 by Mark Troxel, DVM, DACVIM (Neurology) Hospital: Massachusetts Veterinary Referral Hospital

Signalment: 2yr FS Corgi Mix

History: Referred to MVRH for evaluation of difficulty walking. Three days prior to admission, she was less willing to walk in the evening and was unable to go down stairs. The following day she was ataxic in the pelvic limbs and was taken to another referral hospital’s emergency department. At that time, she was still ambulatory and was discharged with activity restriction, Piroxicam, and misoprostol. That night she became progressively weaker and was unable to walk the following morning. No known trauma. No prior neurological conditions. No past medical history. Good appetite. No weight loss. No C/S/OND/V/D/PU/PD

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Neurological exam:

Mental status: BAR
Gait/posture: Nonambulatory paraparesis & HL proprioceptive ataxia; FLs appeared normal
Cranial nerves: WNL
Postural reactions:
Absent CP/hop boths HLs
Spinal reflexes: WNL x 4
Spinal pain: None
Muscle tone: Normal x 4
Muscle atrophy: None
Pain sensation: Normal x 4
Cutaneous trunci: WNL bilaterally

 

Neurolocalization = T3-L3 spinal cord

 

 

Differential diagnoses

  • Intervertebral disk herniation/protrusion
  • Inflammatory/infectious disease
  • Neoplasia
  • Trauma
  • Uncommon/rare considerations: Vertebral/spinal cord anomaly, other degenerative spinal cord disease

 

Diagnostics

  • CBC/biochemical profile: Mild signs of dehydration with mildly elevated Hct and TP
  • T3-sacrum spinal radiographs: WNL
  • MRI: T2-weighted hypointensity of the T12-13, L3-4, and L6-7 disks, but no evidence of spinal cord compression or intramedullary disease
  • CSF: WBC 650 cells/uL (normal < 5), Protein 1451.6 (normal < 25); Differential cytology: 77% nondegenerate neutrophils, 13% small well-differentiated lymphocytes, 8% large mononuclear cells, and 2% eosinophils
  • CSF C&S: Negative
  • Infectious disease panel: Negative for rickettsial diseases, Toxoplasma, Neospora, Canine Distemper, and Cryptococcus

 

Diagnosis
Inflammatory spinal cord disease (presumptive GME)

 

Treatment

  • Physical therapy and supportive care
  • Prednisone 2 mg/kg PO BID x 2 days, then 1 mg/kg PO BID x 2 weeks, then slow taper q4weeks
  • Cytarabine injections 50mg/m2 BID x 2 days repeated every 4 weeks

 

Prognosis
The prognosis for inflammatory spinal cord disease is generally fair to good if treated early and aggressively.

 

Outcome
The patient made a full recovery and was weaned off prednisone & cytarabine over 12 months. To date (6 years later), the patient has had no recurrence of inflammatory spinal cord disease. She had an acute on chronic T12-13 intervertebral disk herniation 3 years later that was treated with a right T12-13 hemilaminectomy.

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