Volume 3 | Issue 1 (January 2001)


Veterinary Neurology and Neurosurgery Journal (VNNJ) Case Study 5

Vet Neurol Neurosurg J. January 2001;3(1):1.
Veterinary Neurology and Neurosurgery Journal (VNNJ)

Full Text Article (What's Your Diagnosis?)

June, 2001

Signalment, History, Physical Examination   Neurological Examination   Tests Performed   Case Summary and Diagnosis

Signalment, History, Physical Examination

 Signalment: This patient is a ten-month-old, spayed female Rottweiler

 History: Progressive ataxia, thoracic limb weakness and apparent cervical pain for past three months. The owners noted that the gait "has always been different".

 Past Medical History: No history of trauma or illness was reported by the owners.

 Medications: No medications have been given

Physical Examination

 General: Body weight 22 kg, rectal temperature 38.3; heart rate 120/m; rhythm regular, femoral pulses equal and synchronous. Respiratory rate: panting; Mucous membranes pink, capillary refill time < 2 sec.
Alert and responsive, body condition score 5 / 9

 Integument: No abnormalities noted.

 Eyes, ears, nose and throat: No abnormalities noted.

 Cardiopulmonary, abdominal cavity, musculoskeletal, lymph nodes: No abnormalities noted.

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Neurological Examination

 Consciousness: Alert, responsive.

 Posture: N; Falling, rolling: Absent; Righting reactions: N; Tremor: None

 Circling: Not observed

 Gait:

Postural and Placing Reactions:

 Proprioceptive placing: Slow in all four limbs

 Visual and tactile placing: Not examined

 Hopping, hemistand/walk: Slow in all four limbs.

 Wheelbarrowing: Unable to evaluate properly, fore limbs or hind limbs

Spinal (segmental) reflexes: (N=normal; D= depressed; A= Absent; I= increased;)

 Forelimbs:

 Tendon Reflexes: Extensor Carpi: N: Biceps brachii: N; Triceps brachii: N

 Flexion Reflexes: N

 Crossed Extensor Reflexes: Absent clinically

 Pelvic limbs:

 Tendon Reflexes: Quadriceps: N; Gastroc/Dig. flexors: N.

 Crossed Extensor Reflexes: Absent clinically

 Perineal Reflexes: N

 Cutaneous Trunci Reflexes: Present in all normal segmental levels.

 Painful Stimulation: Normal withdrawal responses.

Cranial Nerves

 I: Not tested

 II: Vision apparently normal.

 III, IV, VI: Pupils equal, normal direct and indirect pupillary light reflexes. Normal ocular positions and movements.

 V: Normal

 VII: Normal

 VIII: No head tilt; Physiological Nystagmus present. No spontaneous nystagmus; no strabismus, Audition apparently normal.

 IX, X, XI: Normal swallowing action in response to stimulation.

 XII: Tongue: Normal position, symmetry, movements.

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Tests Performed

Hematology, Chemistry and Urinalysis

Clinical Chemistry Laboratory Results

Constituent

Patient's Results

Units

Reference Range (Dog)

Alk. Phosphatase

60

U/L

15-127 U/L

ALT (SGPT)

42

U/L

19-70

Ammonia

 

mg/dl

0-92

AST (SGOT)

38

U/L

15-43

Bile acids:

fasting

 

micromol/L

0-12

post-prandial

 

micromol/L

0-16

Bilirubin: direct

 

mg/dl

0-0.1

Bilirubin: total

0.2

mg/dl

0-0.4

Blood urea nitrogen (BUN)

18

mg/dl

8-31

BUN/creatinine ratio

20

 

6-25

Calcium

10.2

mg/dl

9.9-11.4

Cholesterol

249

mg/dl

135-345

Creatine kinase

 

U/L

46-320

Clotting:

PT

 

SEC

7.5-19.5

PTT

 

SEC

9-12

PIVKA

 

SEC

15-18

FDP

   

<10

Creatinine

0.9

mg/dl

0.8-1.6

Glucose

105

mg/dl

70-118

Electrolytes:

Anion gap

10

mmol/l

12-25

Chloride

115

mmol/l

105-116

CO2, total

21

mmol/l

16-26

Potassium

4.0

mmol/l

4.1-5.3

Sodium

144

mmol/l

145-154

Lipase

 

U/L

0-500

Magnesium

 

mg/dl

1.2-2.4

Phosphorus, inorganic

4.0

mg/dl

3.0-6.2

Proteins:

Albumin

3.5

g/dl

2.9-4.2

A/G ratio

1.6

 

0.6-1.2

Globulin

2.2

g/dl

2.3-4.4

Total protein

6.5

g/dl

5.4-7.4

Thyroid:

Thyroxine T4

 

micrograms/dl

1.0-3.6

Free T4-EQ.D.

 

ng/ml

1.0-3.5

TSH-Canine

 

mU/L

2-30

Tri-iodothyro. T3

 

ng/dl

75-150

Triglycerides

 

mg/dl

19-133

Hemogram Results

Parameter

Patient's results

Reference Values (Dog)

Erythrocytes

6.93

5.5-8.5 million

Hemoglobin (Hb)

17.2

12.0-18.0 g/dl

Hematocrit

45

37-55%

Mean corpuscular volume

69.3

62-77 fl

Mean corpusc. Hb

24.8

33-37 g/d

Mean corpusc. Hb conc.

35.8

21.5-26.5 pg

Reticulocytes

-

0.5-1 %

Leucocytes

10800

6000-17000/microliter

Band

 

0-300/microliter

Neutrophils

6804

3000-11500/microliter

Lymphocytes

2700

1000-4800/microliter

Monocytes

756

150-1350/microliter

Eosinophils

540

100-1250/microliter

Basophils

0

Rare

Platelets

356,000

200-500x1000

Icteric Index

 

2.0-5.0

Plasma proteins

7.4

6.0-8.0

Fibrinogen

300

200-400 mg/dl

Protein:fibrinogen

 

>15:1

Cerebrospinal Fluid Studies

Cerebrospinal Fluid: Total and Differential Cell Counts; Total Protein

Fluid from: Lumbar region
Gross appearance: Colorless
Specific Gravity: 1.005
Protein: 43 mg/dl

Total erythrocytes: 1953/uL
Total nucleated cells: < 5/uL

Differential Nucleated Cell Counts:

Neutrophils: 6%
Monocytes: 47%
Mature lymphocytes: 6%

Imaging

Plain Radiograph (1 film) and Myelography (6 films)

Click on an image to see a larger view.
Figure 1.
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Figure 2.
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Figure 3.
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Figure 4.
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Figure 5.
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Figure 6.
Figure 6.
 

Figure 7.
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Figure 8.
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Survey Radiographs: Please note: Only one suspicious area was found on the pre-myelographic survey films. That film is not shown here but is included with the myelographic films above.

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Case Summary and Diagnosis

The clinical signs in this case indicated a cervical myelopathy. Diagnostic imaging revealed compression of the dorsal and lateral aspects of the spinal cord at vertebral level C 2-3. At laminectomy, a fibrous mass was removed. Histopathology revealed the mass to consist of nothing more than fibrotic tissue. Postoperative course was good.

See pre and post op video  Watch the Video

There are several disorders in young Rottweiler dogs that cause signs similar to those of this dog. Neuroaxonal dystrophy, leukoencephalomyelopathy, subarachnoid cyst and fibrotic stenosis all have been described in this breed. All three disorders will cause a progressive ataxia and hypermetria, especially in the thoracic limbs. Myelography and/or other imaging is helpful in revealing spinal cord compression. CSF examination may be helpful also. In both neuroaxonal dystrophy1 and leukoencephalomyelopathy2 the ancillary tests yield normal results. In these diseases, diagnoses must be made by necropsy and histological examination of the brain and spinal cord.

In an earlier report, Baum, de Lahunta, and Trotter3 described a young Rottweiler with a progressive cervical myelopathy. Their diagnostic testing, surgical findings and surgical biopsy report were similar to this case. The cause of the stenosis at this site in Rottweilers is still unknown. It is thought that ligamentous proliferation may be secondary to joint instability and chronic stress, but instability was not identified in the previous case report nor in this case.

References

1.  Chrisman CL, Cork L, Gamble AD. Neuroaxonal dystrophy of Rottweiler dogs. J Am Vet Med Assoc 1984; Vol 184: 464-467.

2.  Gamble AD, Chrisman C. A leukoencephalomyelopathy of Rottweiler Dogs. Vet Pathol 1984; 21:274-280.

3.  Baum F, de Lahunta A, Trotter E J. Cervical fibrotic stenosis in a young Rottweiler. J Am Vet Med Assoc 1992; Vol 201: 1222-1224.

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