Commonly Encountered Conditions:
Disc extrusions: These patients typically present with neck or back pain along with varying degrees of limb weakness or paralysis. An MRI scan is performed to allow accurate localisation of the disc extrusion and to exclude other neurological diseases. In acute cases, prompt surgical decompression (hemilaminectomy or ventral slot) is required to provide the best chance of a recovery.
Ischaemic myelopathy: This condition is thought to be caused by blockage of a spinal artery by a fragment of intervertebral disc (fibrocartilaginous embolism or FCE) and these patients present with acute-onset weakness or paralysis. A prompt neurological examination and MRI scan are required to confirm the diagnosis and to exclude a compressive disc extrusion that would require urgent surgery. Treatment of these cases comprises physiotherapy and bladder management, and the prognosis can be good to excellent.
Spinal fracture-luxations: Fracture-luxations of the vertebral column are typically seen in polytrauma cases. Prompt referral of these cases for advanced imaging (CT and MRI) and internal fixation of the fracture leads to an excellent outcome in the majority of patients.
Lumbosacral disease and Wobblers syndrome: Chronic compression of the spinal cord and associated nerve roots, often in the lumbosacral joint or neck, can lead to varying degrees of pain and limb dysfunction. These complex cases benefit from advanced imaging (MRI and CT) to identify the cause of the myelopathy or radiculopathy. Surgical decompression by dorsal laminectomy with or without vertebral stabilisation often leads to improved outcomes in these cases.
Congenital vertebral malformations and myelopathies: Commonly seen conditions include hemivertebrae and constrictive myelopathy in brachycephalic breeds; atlantoaxial instability in toy breeds; subarachnoid diverticum; and Chiari-like malformation and syringomyelia. Advanced imaging (MRI and CT) is required to diagnose these conditions and to allow adequate planning for the complex surgical procedures required to rectify them.
Inflammatory CNS disease: Meningitis (inflammation of the linings of the spinal cord) is very common and can affect dogs of any age and breed. Presenting signs classically are fever and neck pain, but many patients can have vague, waxing and waning clinical signs. Inflammation may extend to the spinal cord (meningomyelitis) or the brain (meningoencephalitis), in which case other neurological signs may be present. Diagnosis usually requires MRI scanning and analysis of cerebrospinal fluid (obtained by a cisternal puncture, a lumbar puncture or both). Meningitis is usually immune-mediated and treatment requires protracted courses of corticosteroids, often in conjunction with other immunosuppressive drugs.
Seizures: Canine idiopathic epilepsy is the most common cause of seizures. However, seizures can also be caused by intracranial abnormalities such as brain tumours and encephalitis, and by extracranial disease such as portosystemic shunts and insulinoma. Bloods, liver function tests, MRI scanning and CSF analysis should be performed in all patients to exclude these disease processes and allow a diagnosis of idiopathic epilepsy to be reached. Treatment of epilepsy, when required, requires long-term anticonvulsants such as phenobarbitone.
Vestibular disease: The vestibular system is responsible for balance and comprises sensors within the inner ear (peripheral vestibular system) and brain (central vestibular system). Patients with vestibular disease typically present with a head tilt, leaning or falling to the side, circling and nystagmus (flickering of the eyes from side to side). Patients with acute vestibular disease are often nauseous. Causes of vestibular disease include inner ear disease, ischaemic or haemorrhagic stroke, inflammatory disease and neoplasia. In older patients, vestibular syndrome is often idiopathic. MRI and CSF analysis are required to differentiate these causes and to ensure optimal treatment of these patients.
Paroxysmal Dyskinesia: Episodic movement disorders such as cramping, spasm and tremors are increasingly recognised in dogs. Assessment of video footage and a thorough neurological examination are required to exclude epilepsy (which often mimics this condition). MRI and CSF analysis should be performed to exclude structural or inflammatory brain disease. With the exception of gluten-sensitive paroxysmal dyskinesia in Border Terriers and episodic falling syndrome in CKCS, these conditions are frustrating to treat. However, most patients can lead perfectly normal lives in spite of this disease.