RESUMO

Bichon frise (1) and Boxer (2), both with epileptic seizures, underwent lumbar taps for cerebrospinal fluid collection. After the procedure, the first dog became paraplegic, and the second dog did not recover from anesthesia and remained in a coma. Both dogs were euthanatized 12 h after the examination. The dogs were diagnosed with idiopathic epilepsy and fibrillar astrocytoma, respectively, after postmortem examination. They were also diagnosed with progressive myelomalacia, involving C1-C5 until the L4-S3 spinal segments. Since it was not possible to attribute the development of myelomalacia to the primary diseases observed, the lumbar tap likely caused this severe spinal cord injury. These reports highlight myelomalacia as a possible complication of lumbar taps.

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RESUMO

Background Cervical spondylotic myelopathy is a degenerative disease of the intervertebral disc and the vertebral body of the spine that causes cervical spinal cord injury due to central vertebral canal stenosis. Its prevalence is higher in the elderly. Treatment is usually surgical when the spinal cord is affected either clinically with pyramidal release or radiologically with the altered spinal cord. Objective The goal of the present study is to analyze the myelomalacia and the ossification of the posterior longitudinal ligament as prognostic factors in the postoperative evolution of patients with cervical canal compression who underwent laminoplasty with the open- or French-door techniques. Methods We performed a retrospective analysis of 18 surgical cases of spondylotic cervical myelopathy of the same senior neurosurgeon, using the chi-squared test to analyze prognostic factors for patients' postoperative evolution in the Nurick scale, after open-door or French-door laminoplasty. Findings The comparison between the pre and postoperative showed an improvement of 71.43% in cases that did not have ligament ossification compared with 45.45% of cases that presented posterior longitudinal ligament ossification. Also, there was a better prognosis in patients without myelomalacia, as 71.43% of them improved their condition against only 45.45% of improvement in those with myelomalacia. Conclusion There is a need for further studies with larger samples to expressively prove that the presence of longitudinal ligament ossification and the previous presence of myelomalacia are factors that can lead to worse prognosis in the postoperative evolution of patients with cervical spondylotic myelopathy submitted to laminoplasty.

Introdução A mielopatia espondilótica cervical é uma doença degenerativa do disco intervertebral e do corpo da coluna vertebral que causa lesão da medula espinhal cervical devido à estenose do canal vertebral central. Sua prevalência é maior em idosos. O tratamento geralmente é cirúrgico quando a medula espinhal é afetada clinicamente com a liberação piramidal ou radiologicamente com a medula espinhal alterada. Objetivo Este estudo tem como objetivo analisar a mielomalácia e a ossificação do ligamento longitudinal posterior como fatores prognósticos na evolução pós-operatória de pacientes com compressão do canal cervical submetidos à laminoplastia pelas técnicas de porta aberta ou porta francesa. Métodos Foi realizada uma análise retrospectiva de 18 casos cirúrgicos de mielopatia espondilótica cervical do mesmo neurocirurgião sênior, utilizando o teste do quiquadrado para analisar os fatores prognósticos da evolução pós-operatória dos pacientes na escala de Nurick, após laminoplastia aberta ou francesa. Resultados A comparação entre o pré e pós-operatório mostrou uma melhora de 71,43% nos casos que não apresentavam ossificação ligamentar em comparação com 45,45% nos casos que apresentavam ossificação do ligamento longitudinal posterior. Além disso, houve um melhor prognóstico em pacientes sem mielomalácia, pois 71,43% deles melhoraram sua condição contra apenas 45,45% de melhora naqueles com mielomalácia. Conclusão Há necessidade de mais estudos com amostras maiores para comprovar expressivamente que a presença de ossificação ligamentar longitudinal e a presença prévia de mielomalácia são fatores de pior prognóstico na evolução pós-operatória de pacientes com mielopatia espondilótica cervical submetidos à laminoplastia.

RESUMO

Progressive hemorrhagic myelomalacia (PHM) is a rare and fatal disorder which is characterized by acute and progressive ischemic necrosis of the parenchyma of the spinal cord, leading to its liquefaction. It may occur after intervertebral disc extrusion, spinal trauma or fibrocartilaginous embolism. The aim of this study was to evaluate cases of progressive hemorrhagic myelomalacia in dogs in the Veterinary Hospital of Universidade Estadual de Londrina between 2000 and 2011, through the analysis of medical records and following of cases. There were certain criteria to include a patient in this study, such a history of paraplegia with upper motor neuron signs, worse of signs progressing to flaccid tetraplegia, progressive clinical changes and/or changes in complementary exams. There were analyzed several aspects, such as epidemiological (breed, age and sex), clinical (progress of clinical and neurological signs), laboratory (cerebrospinal fluid analysis - CSF), radiographic (conventional radiography and contrasted) and elapsed time since the onset of clinical signs until death or euthanasia. The most affected breed was Teckel (43%), the average age was 5.04 years and the neurological syndrome observed initially was the thoracolumbar syndrome grade V. Another commons signs observed were hyperpathia and cranial progression of decreased cutaneous trunci reflex. In seven dogs the cause of the PHM was the thoracolumbar intervertebral disc disease, in a dog the cause was spinal cord trauma, in two dogs PHM was due to lymphoma and in four dogs the likely cause was intervertebral disc disease. CSF analysis, myelography changes and progress of clinical and neurological examinations were extremely important to diagnose PHM. Six animals progressed to tetraplegia and four dogs had already flaccid tetraplegia at the initial care. In four other patients, the identification of signs suggestive of PHM before this progression has led to indication for euthanasia. The prognosis is poor and causes animal suffering, so the clinician should be aware of the history of paraplegia with subsequent change of upper motor neuron syndrome to lower motor neuron, cranial decreased reflex panniculus and presence of abdominal breathing. Some alterations in complementary exams found in this study may also help in early diagnosis, as xanthochromic CSF with increased protein, erythrocytes and pleocytosis. Spinal cord edema and the presence of contrast within the nervous tissue together with clinical signs and CSF alterations are suggestive of PHM.

A mielomalácia hemorrágica progressiva (MHP) é uma afecção rara e fatal, em que ocorre necrose aguda isquêmica e progressiva do parênquima da medula espinhal, levando à liquefação da mesma. Pode ocorrer após extrusão do disco intervertebral, trauma medular ou embolismo fibrocartilaginoso. Este estudo teve como objetivo avaliar casos de mielomalácia hemorrágica progressiva em cães atendidos no Hospital Veterinário da Universidade Estadual de Londrina entre os anos 2000 e 2011, realizando-se a análise dos prontuários de atendimento e acompanhamento dos casos. Os animais do presente estudo atendiam a alguns critérios de inclusão, como histórico de paraplegia com sinais de neurônio motor superior, piora dos sinais progredindo para tetraplegia flácida, alterações clínicas progressivas e/ou alterações nos exames complementares. Foram analisados os aspectos epidemiológicos (raça, idade e sexo), clínicos (evolução dos sinais clínicos e neurológicos), laboratoriais (análise do líquido cefalorraquidiano), radiográficos (radiografias simples e contrastadas) e o tempo decorrido desde o início dos sinais clínicos até óbito ou eutanásia. A raça Teckel foi a mais acometida (43%), a média de idade foi de 5,04 anos e no atendimento inicial a síndrome toracolombar grau V foi a alteração mais encontrada, além de hiperpatia e progressão cranial da diminuição do reflexo cutâneo do tronco. Em sete cães a causa da MHP foi a doença do disco intervertebral toracolombar, em um cão a causa foi o trauma medular, em dois cães a MHP foi decorrente de linfoma e em quatro cães a causa provável foi doença de disco intervertebral. Alterações na análise do líquido cerebroespinhal, na mielografia e na evolução dos sinais clínicos e neurológicos foram extremamente importantes para diagnosticar a MHP. Seis animais progrediram para tetraplegia e quatro cães já apresentavam tetraplegia flácida no atendimento inicial. Em outros quatro pacientes, a identificação de sinais sugestivos de MHP antes desta progressão levou à indicação de eutanásia. Como o prognóstico é ruim e ocasiona sofrimento ao animal, o clínico deve estar atento ao histórico de paraplegia com posterior mudança da síndrome de neurônio motor superior para neurônio motor inferior, diminuição do reflexo cutâneo do tronco cranialmente e presença de respiração abdominal, sendo que algumas alterações em exames complementares encontradas neste trabalho também podem auxiliar no diagnóstico precoce da MHP, como o líquido cerebroespinhal xantocrômico com aumento de proteínas, hemácias e pleocitose. Na mielografia o edema medular e a presença de contraste no interior do tecido nervoso, frente às alterações clínicas e liquóricas, são sugestivas de MHP.

Assuntos

RESUMO

Progressive hemorrhagic myelomalacia (PHM) is a rare and fatal disorder which is characterized by acute and progressive ischemic necrosis of the parenchyma of the spinal cord, leading to its liquefaction. It may occur after intervertebral disc extrusion, spinal trauma or fibrocartilaginous embolism. The aim of this study was to evaluate cases of progressive hemorrhagic myelomalacia in dogs in the Veterinary Hospital of Universidade Estadual de Londrina between 2000 and 2011, through the analysis of medical records and following of cases. There were certain criteria to include a patient in this study, such a history of paraplegia with upper motor neuron signs, worse of signs progressing to flaccid tetraplegia, progressive clinical changes and/or changes in complementary exams. There were analyzed several aspects, such as epidemiological (breed, age and sex), clinical (progress of clinical and neurological signs), laboratory (cerebrospinal fluid analysis - CSF), radiographic (conventional radiography and contrasted) and elapsed time since the onset of clinical signs until death or euthanasia. The most affected breed was Teckel (43%), the average age was 5.04 years and the neurological syndrome observed initially was the thoracolumbar syndrome grade V. Another commons signs observed were hyperpathia and cranial progression of decreased cutaneous trunci reflex. In seven dogs the cause of the PHM was the thoracolumbar intervertebral disc disease, in a dog the cause was spinal cord trauma, in two dogs PHM was due to lymphoma and in four dogs the likely cause was intervertebral disc disease. CSF analysis, myelography changes and progress of clinical and neurological examinations were extremely important to diagnose PHM. Six animals progressed to tetraplegia and four dogs had already flaccid tetraplegia at the initial care. In four other patients, the identification of signs suggestive of PHM before this progression has led to indication for euthanasia. The prognosis is poor and causes animal suffering, so the clinician should be aware of the history of paraplegia with subsequent change of upper motor neuron syndrome to lower motor neuron, cranial decreased reflex panniculus and presence of abdominal breathing. Some alterations in complementary exams found in this study may also help in early diagnosis, as xanthochromic CSF with increased protein, erythrocytes and pleocytosis. Spinal cord edema and the presence of contrast within the nervous tissue together with clinical signs and CSF alterations are suggestive of PHM.(AU)

A mielomalácia hemorrágica progressiva (MHP) é uma afecção rara e fatal, em que ocorre necrose aguda isquêmica e progressiva do parênquima da medula espinhal, levando à liquefação da mesma. Pode ocorrer após extrusão do disco intervertebral, trauma medular ou embolismo fibrocartilaginoso. Este estudo teve como objetivo avaliar casos de mielomalácia hemorrágica progressiva em cães atendidos no Hospital Veterinário da Universidade Estadual de Londrina entre os anos 2000 e 2011, realizando-se a análise dos prontuários de atendimento e acompanhamento dos casos. Os animais do presente estudo atendiam a alguns critérios de inclusão, como histórico de paraplegia com sinais de neurônio motor superior, piora dos sinais progredindo para tetraplegia flácida, alterações clínicas progressivas e/ou alterações nos exames complementares. Foram analisados os aspectos epidemiológicos (raça, idade e sexo), clínicos (evolução dos sinais clínicos e neurológicos), laboratoriais (análise do líquido cefalorraquidiano), radiográficos (radiografias simples e contrastadas) e o tempo decorrido desde o início dos sinais clínicos até óbito ou eutanásia. A raça Teckel foi a mais acometida (43%), a média de idade foi de 5,04 anos e no atendimento inicial a síndrome toracolombar grau V foi a alteração mais encontrada, além de hiperpatia e progressão cranial da diminuição do reflexo cutâneo do tronco. Em sete cães a causa da MHP foi a doença do disco intervertebral toracolombar, em um cão a causa foi o trauma medular, em dois cães a MHP foi decorrente de linfoma e em quatro cães a causa provável foi doença de disco intervertebral. Alterações na análise do líquido cerebroespinhal, na mielografia e na evolução dos sinais clínicos e neurológicos foram extremamente importantes para diagnosticar a MHP. Seis animais progrediram para tetraplegia e quatro cães já apresentavam tetraplegia flácida no atendimento inicial. Em outros quatro pacientes, a identificação de sinais sugestivos de MHP antes desta progressão levou à indicação de eutanásia. Como o prognóstico é ruim e ocasiona sofrimento ao animal, o clínico deve estar atento ao histórico de paraplegia com posterior mudança da síndrome de neurônio motor superior para neurônio motor inferior, diminuição do reflexo cutâneo do tronco cranialmente e presença de respiração abdominal, sendo que algumas alterações em exames complementares encontradas neste trabalho também podem auxiliar no diagnóstico precoce da MHP, como o líquido cerebroespinhal xantocrômico com aumento de proteínas, hemácias e pleocitose. Na mielografia o edema medular e a presença de contraste no interior do tecido nervoso, frente às alterações clínicas e liquóricas, são sugestivas de MHP.(AU)

Assuntos

RESUMO

Background: Myelomalacia is a multifocal syndrome that causes hemorrhagic infarction of the spinal cord that can occur as a sequel to acute spinal cord injury. It occurs as a consequence of acute spinal cord trauma, usually by extrusion of intervertebral disc in the thoracolumbar spine, affecting up to 10% of dogs with acute paralysis and deep pain loss in the pelvic limbs due to disc disease. This disease may be focal or diffuse; the diffuse form is typically associated with cranial and caudal migration of neurologic signs and is often fatal. The mechanical lesion to the spinal cord triggers secondary injury mediated by the existence of oxygen free radicals, alterations in the concentrations of neurotransmitters ions and amino acids, and it results in the reduction of the spinal cord blood fl ow, ischemia and progressive cranial and caudal necrosis to the focus of the initial injury.Case: A 5-year-old Dachshund male intact dog weighting 8 kg was referred to the Veterinary Teaching Hospital of the Federal University of Rio Grande do Sul (HCV-UFRGS) with initial complaint of acute paralysis of the hind limbs for two days. On clinical examination there was paraplegia, absence of deep pain in the pelvic limbs, with decreased patellar, sciatic and tibial cranial refl exes. The anal sphincter was relaxed and the bladder was easily expressed. The panniculus refl ex was intact up to t

Background: Myelomalacia is a multifocal syndrome that causes hemorrhagic infarction of the spinal cord that can occur as a sequel to acute spinal cord injury. It occurs as a consequence of acute spinal cord trauma, usually by extrusion of intervertebral disc in the thoracolumbar spine, affecting up to 10% of dogs with acute paralysis and deep pain loss in the pelvic limbs due to disc disease. This disease may be focal or diffuse; the diffuse form is typically associated with cranial and caudal migration of neurologic signs and is often fatal. The mechanical lesion to the spinal cord triggers secondary injury mediated by the existence of oxygen free radicals, alterations in the concentrations of neurotransmitters ions and amino acids, and it results in the reduction of the spinal cord blood fl ow, ischemia and progressive cranial and caudal necrosis to the focus of the initial injury.Case: A 5-year-old Dachshund male intact dog weighting 8 kg was referred to the Veterinary Teaching Hospital of the Federal University of Rio Grande do Sul (HCV-UFRGS) with initial complaint of acute paralysis of the hind limbs for two days. On clinical examination there was paraplegia, absence of deep pain in the pelvic limbs, with decreased patellar, sciatic and tibial cranial refl exes. The anal sphincter was relaxed and the bladder was easily expressed. The panniculus refl ex was intact up to t

RESUMO

Background: Myelomalacia is a multifocal syndrome that causes hemorrhagic infarction of the spinal cord that can occur as a sequel to acute spinal cord injury. It occurs as a consequence of acute spinal cord trauma, usually by extrusion of intervertebral disc in the thoracolumbar spine, affecting up to 10% of dogs with acute paralysis and deep pain loss in the pelvic limbs due to disc disease. This disease may be focal or diffuse; the diffuse form is typically associated with cranial and caudal migration of neurologic signs and is often fatal. The mechanical lesion to the spinal cord triggers secondary injury mediated by the existence of oxygen free radicals, alterations in the concentrations of neurotransmitters ions and amino acids, and it results in the reduction of the spinal cord blood flow, ischemia and progressive cranial and caudal necrosis to the focus of the initial injury. Case: A 5-year-old Dachshund male intact dog weighting 8 kg was referred to the Veterinary Teaching Hospital of the Federal University of Rio Grande do Sul (HCV-UFRGS) with initial complaint of acute paralysis of the hind limbs for two days. On clinical examination there was paraplegia, absence of deep pain in the pelvic limbs, with decreased patellar, sciatic and tibial cranial reflexes. The anal sphincter was relaxed and the bladder was easily expressed. The panniculus reflex was intact up to the 10th thoracic vertebra (T10). The patient had exacerbated pain on palpation of the thoracic spine. The other physiological parameters were within normal limits. Based on clinical findings, ascending myelomalacia was the presumed diagnosis. Biochemical and haematological profiles were unremarkable. The myelographic examination did not reveal a site of spinal cord compression, as the column of contrast suffered no deviation or blockage in its path. Pain was medically managed. The following day, the animal had hypothermia, forelimbs paresis, dyspnea and abdominal breathing. The panniculus reflex had migrated cranially, to the height of the 6th thoracic vertebra (T6). The owner opted for euthanasia and the patient was referred to necropsy. At necropsy the L1-L2 intervertebral disc suffered disc protrusion and not extrusion. Along the spinal cord there was multifocal hemorrhage in the white and gray matter, with gliosis, malacia, fibrin deposition and axonal spheroids. In the lumbar spinal segments L1 and L2, there was neutrophilic infiltrate and calcification area in the meninges. Discussion: It is often cited in the literature that young dogs, especially the Dachshund breed, are prone to intervertebral disc disease, with acute paralysis and, in severe cases, myelomalacia ascending, as in this case. What is rare, though, is the occurrence of myelomalacia associated with disc protrusion only instead of disc extrusion. The multifocal character of the disease evidenced by changes and worsening of neurological signs in the course of the disease was reported in this case. The physical examination findings and its evolution are the same cited in the literature, such as atonic bladder, absence of patellar reflex, anal sphincter relaxation. Dyspnea is related to paralysis of the intercostal muscles and diaphragm and is irreversible and fatal. Early diagnosis of myelomalacia ascending hemorrhagic myelomalacia is crucial to prevent death from respiratory failure due to the progression of the disease. Effective treatment for preventing the progression of necrosis and hemorrhage resulting from spinal thoraco-lumbar disc disease, acute paraplegia and which leads to loss of deep pain has not been found yet.

Assuntos

RESUMO

Background: Myelomalacia is a multifocal syndrome that causes hemorrhagic infarction of the spinal cord that can occur as a sequel to acute spinal cord injury. It occurs as a consequence of acute spinal cord trauma, usually by extrusion of intervertebral disc in the thoracolumbar spine, affecting up to 10% of dogs with acute paralysis and deep pain loss in the pelvic limbs due to disc disease. This disease may be focal or diffuse; the diffuse form is typically associated with cranial and caudal migration of neurologic signs and is often fatal. The mechanical lesion to the spinal cord triggers secondary injury mediated by the existence of oxygen free radicals, alterations in the concentrations of neurotransmitters ions and amino acids, and it results in the reduction of the spinal cord blood fl ow, ischemia and progressive cranial and caudal necrosis to the focus of the initial injury.Case: A 5-year-old Dachshund male intact dog weighting 8 kg was referred to the Veterinary Teaching Hospital of the Federal University of Rio Grande do Sul (HCV-UFRGS) with initial complaint of acute paralysis of the hind limbs for two days. On clinical examination there was paraplegia, absence of deep pain in the pelvic limbs, with decreased patellar, sciatic and tibial cranial refl exes. The anal sphincter was relaxed and the bladder was easily expressed. The panniculus refl ex was intact up to t

Background: Myelomalacia is a multifocal syndrome that causes hemorrhagic infarction of the spinal cord that can occur as a sequel to acute spinal cord injury. It occurs as a consequence of acute spinal cord trauma, usually by extrusion of intervertebral disc in the thoracolumbar spine, affecting up to 10% of dogs with acute paralysis and deep pain loss in the pelvic limbs due to disc disease. This disease may be focal or diffuse; the diffuse form is typically associated with cranial and caudal migration of neurologic signs and is often fatal. The mechanical lesion to the spinal cord triggers secondary injury mediated by the existence of oxygen free radicals, alterations in the concentrations of neurotransmitters ions and amino acids, and it results in the reduction of the spinal cord blood fl ow, ischemia and progressive cranial and caudal necrosis to the focus of the initial injury.Case: A 5-year-old Dachshund male intact dog weighting 8 kg was referred to the Veterinary Teaching Hospital of the Federal University of Rio Grande do Sul (HCV-UFRGS) with initial complaint of acute paralysis of the hind limbs for two days. On clinical examination there was paraplegia, absence of deep pain in the pelvic limbs, with decreased patellar, sciatic and tibial cranial refl exes. The anal sphincter was relaxed and the bladder was easily expressed. The panniculus refl ex was intact up to t

RESUMO

Six cases of cat paraplegia diagnosed in years 2001 and 2002 in Antioquia province (Colombia) are reported in this paper. Diagnosis was supported on clinical exams, radiography, myelogram, necropsy, and histopathology. Clinical signs where ataxia, decreased superficial sensitivity, loss of deep sensitivity, progressive paralysis, hind limb atrophy, and urinary and fecal retention. Necropsy and histopathology analysis revealed the presence of a nematode in the spinal cord meningeal blood vessels at the T10-L4 segment level, causing medullar compression and myelomalacia. Differential diagnose was conducted through the analysis of the parasite's histopathological cuts. Its morphological characteristics differed from those of other possible nematodes such as filarial erratic larve, Ancylostome sp, and Ascaris sp. It was concluded that the nematode is compatible with the one described as Gurltia paralysans.

En este trabajo se reportan seis casos de paraplejia en gatos, presentados durante los años 2001 y 2002 en el departamento de Antioquia (Colombia). El diagnóstico se realizó mediante examen clínico, radiografía, mielografía, necropsia e histopatología. Los signos clínicos fueron ataxia, disminución de la sensibilidad superficial, pérdida de la sensibilidad profunda, parálisis progresiva, atrofia de músculos del tren posterior, así como retención urinaria y fecal. La necropsia y el análisis histopatológico mostraron la presencia de un nematodo ubicado en los vasos sanguíneos de las meninges de la médula espinal, a nivel del segmento T10-L4, y el cual produjo compresión medular y mielomalacia. Al hacer diagnóstico diferencial mediante análisis de los cortes histopatológicos del parásito, se encontró que sus características morfológicas diferían de las de otros nematodos posibles, como es el caso de las larvas erráticas de filaria, Ancylostoma sp. y Ascaris sp, por lo cual se concluyó que el nematodo presente es compatible con el descrito como Gurltia paralysans.

Neste trabalho reportam-se seis casos de paraplegia em gatos, apresentados durante os anos 2001 e 2002 no departamento de Antioquia (Colômbia). O diagnóstico foi feito pelo exame clínico, radiografia, mielografia, necropsia e histopatologia. As sinais clínicas foram: ataxia, diminuição da sensibilidade ao toque leve, perda sensorial profunda, paralisia progressiva, atrofia dos músculos na parte traseira, bem como retenção urinária e fecal. A necropsia e a análise histopatológica mostrou a presença de um nematóide localizados nos vasos sanguíneos das meninges da medula espinhal no segmento T10-L4, e que provocou a compressão da medula espinhal e mielomalácia. Ao fazer um diagnóstico diferencial pela análise das amostras do parasita, verificou-se que as suas características morfológicas diferentes às de outros nematóides possíveis, como é o caso das larvas erráticas de filaria, Ancylostoma sp e Ascaris sp, por isso, concluiu-se que este nematóide é compatível com o descrito como Gurltia paralysans.