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Gualtiero Gandini

Afecções da medula espinhal de felinos

Describe the most common diseases affectingthe spinal cord of the cat

INDEX:

Goal :

1. General principles

2. Vitamin D and feline spinal cord disorders

3. Diseases mimicking spinal cord signs

1.General principles

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Relevant reviews2002

2004

2008

2009

PROCEEDINGS OF THE ESFM FELINE CONGRESS, STOCKHOLM, SEPTEMBER 2002

Spinal cord disordersRichard A LeCouteurJournal of Feline Medicine and Surgery (2003) 5, 121–131

Relevant reviews2009

2010

2011

20142016

Brain camp – Bologna

Retrospective study on 205 cats

with histologically confirmed spinal cord lesion

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CLINICAL PRESENTATION

…… ONSET:

• ACUTE: mainly associated to trauma

• 60% inflammatory and vascular casescharacterized by subacute signs (<30gg.)

• all the other VITAMIN D categories have insidious onset and chronic-progressive course

✓ LOCALIZATION: Lumbosacral (124 cats), thoracic (118) and cervical (116);

✓ FOCAL localization (102)

✓MULTIFOCAL localization (95)

✓ Inflammatory diseases associated to multifocallocalization (FIP and cryptococcosis).

✓ TRAUMA: associated to Thoracic or LS localization

✓ NEOPLASIA: LS localization most frequent

CLINICAL PRESENTATION

…… LOCALIZATION:

• YOUNG CATS (<2 years): infectious, congenital,traumatic diseases. FIP most common

• CATS >2<8 years: lymphosarcoma, vertebral neoplasia,FIP most common diseases;

• CATS >8 years: vertebral neoplasia , lymphosarcoma, ischemic diseases

CLINICAL PRESENTATION

…… AGE AT DEATH:

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prevalence:

1. Inflammatory – 32%2. Neoplastic – 27%3. Trauma – 14%4. Congenital – 11%5. Vascular – 9%6. Degenerative – 6%

…. prevalence:

205 Cats 92 Cats

1. Neoplastic – 27%2. Inflammatory* – 14%3. Trauma – 9%4. Vascular – 6.5%5. Degenerative – 5.4%6. Congenital – 3%

…. the ranking :

1. FIP2. Lymphoma

3. Vertebral Neoplasms

4. Trauma

4. Ischemic Disorders

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2.Vitamin D &

spinal cord disorders

…. the winner:

1°: Infiammatory/infectious

Feline InfectiousPeritonitis (FIP) NEXT LECTURE!!!

2°: Neoplastic

• Lymphoma : most represented (20 cases)• Vertebral column neoplasia (17 cases)

. Osteosarcoma (8 cases)

. Fibrosarcoma (3 cases)• meningeal tumours (7 cases)

FIBROBLASTIC OSTEOSARCOMA

Most frequent localization: Lumbar and sacral

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V VascularI Inflammatory/infectiousT TraumaA Anomalous (Congenital)M MetabolicI IdiopathicN Neoplastic

D Degenerative

Meningomyelitis(FIP!!)

LymphomaOsteosarcoma

Meningioma, other…

Intervertebral Disk Disease

(Protrusion)

Chronic ataxia and paresis : differential diagnoses

Globoid cellluekodystrophy,

Neuraxonal dystrophy

Spine anomalies; subarachnoiddiverticulum

JAVMA, Vol 232, No. 2, January 15, 2008

• Lymphoma: frequent in young adult cats (4-6y)(any age: 6m-17y)

• Literature: 87% extradural!• Systemic involvement (kidney, Bone marrow, liver, lymphnodes)

• Multifocal CNS involvement• Prognosis: poor

LYMPHOMA

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• NEUROLOGIC SIGNS: according to the localization and staging

• EXTRA NEUROLOGIC SIGNS:abdominal palpation; thorax x-ray according to the localization

• CSF EXAMINATION: - mononuclear pleocytosis (mitoses?)- increased proteins

• ADVANCED DIAGNOSTIC IMAGING:Magnetic Resonance Imaging

• NEUROPATHOLOGY

Photo: prof. Carlo CANTILE - Pisa

LYMPHOMADIAGNOSIS

“Capo” Cat ,DSHMc, 11y – NRN 3667

“Capo” Cat ,DSHMc, 11y – NRN 3667

T2-W T1-W T1-W + c.e.

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…."giriamo pagina"….

“Mici”, DSH , Fs, 8y; [NRN 1078]

since ten days crouched stance and gait, reluctance to jump

hyperalgesia on palpation of the TL region

“Mici”, DSH , Fs, 8y; [NRN 1078]

DIFFERENTIAL DIAGNOSES?

BENIGN:• Bone cyst• Bone Sequestrum• Physitis

NEOPLASIA:• Osteo/Chondro/fibrosarcoma• Lymphosarcoma• Metastases

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“Mici”, DSH , Fs, 8y; [NRN 1078]

“Mici”, DSH , Fs, 8y; [NRN 1078]

Diagnosis

Treatment

Neoplasia vertebral body L2

Decompressive surgery

Osteoblastic osteosarcoma

Aetiologic DiagnosisOutcome

One year later: recurrence, second CT and decompressive surgery

two years later: further recurrence, CT and euthanasia

OSTEOSARCOMA

• Bone primitive tumors are quite rare in the cat• Osteosarcoma is the most common bone neoplasia in the cat • Osteosarcoma affects more frequently the appendicular skeleton• less reported in axial skeleton • Prognosis more favourable in the cat than in the dog• Treatment: surgical palliative treatment• Axial: shorter survival time than appendicular osteosarcoma

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…."giriamo pagina"….

«Chronic presentation»

4°: anomalous/hereditary• Storage diseases:

- gangliosidosis- glycogenosis- sphyngomyelinosis- mucopolysaccharidosis type VI

• Neuraxonal Dystrophy

• Globoid Cell leukodystrophy (Krabbe disease)

•FeLV-associated degenerative myelopathy

• Subarachnoid diverticulum• Hydrosyringomyelia

DIAGNOSIS

• CLINICAL PRESENTATIONyoung age, chronic progressive course

• EXCLUSION OF OTHER DISEASEblood work, MRI, CSF

• POST MORTEM CONFIRMATION

Globoid cell Leukodystrophy

«Tommy» DSH, M, 4m NRN 4886

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Globoid cell Leukodystrophy

«Flash» DSH, MC, 9 m NRN 5145

Globoid cell Leukodystrophy

CORTESIA DR. CARLO CANTILE

«Goldrake» Maine Coon, MC, 18 m NRN 5519

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«Goldrake» Maine Coon, MC, 18 m NRN 5519

…… upside down???

Acute ataxia and paresis: differential diagnoses

V VascularI Inflammatory/infectiousT TraumaA Anomalous (Congenital)M MetabolicI IdiopathicN Neoplastic

D Degenerative

Trauma

FibrocartilaginousEmbolic

Myelopathy

Intervertebral Disk Disease (extrusion;

ANNPE)

Aorticthromboembolism

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Trauma

Vertebral trauma:- car accidents- falls - penetrating wounds- gunshots

EXOGENOUS ENDOGENOUS

higherincidence?

Intervertebral disk disease:- acute non-compressive nucleous

pulpous extrusion (ANPPE)- disk extrusion

concomitantinjuries (30-83%)!

Nrad 9024

L2L1 L3

Cat DSH, Fs, 3 years(the cat of my boss!) Trauma PRESENTATION:

Acute paraplegia

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Intervertebral disk disease

sporadic disease dogsincidence 0.02-0,12 2% dogs median age: 8yearsBoth acute and chronic herniationT13-L1; L4-5; L7-S1 most common sites

VASCULAR ANATOMY

spinal branchesof the vertebral artery,intercostal arteriesand lumbar arteries

dorsal and ventralradicular arteries

dorsal spinal artery

ventral spinal artery

centralartery

Fibrocartilagineous Embolic Myelopathy (CEM)

C. Botteron – Bern

Occlusion of the spinal vasculature by fibrocartilaginous material histologically and histochemically identical to thenucleus pulposus of the intervertebral disc, causing ischemic necrosis of dependent regions of spinal cord parenchyma.

Cortesia di C. Botteron –

Berna«Samuele» DSH, MC, 3 years

Overall quite similar to the canine FCEM

Older cats (median age 10 y[6m-17y])

Typically non-progressive after 6 hours

Lateralization less common – 58%

Good outcome – 79% cases

Fibrocartilagineous Embolic Myelopathy (CEM)

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Tired?

3.Diseases mimicking

spinal cord signs

Cortesia dr.ssa Gianni - Milano

acute onset of pain and severe paraparesis

????

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Ischemic Neuromyopathy consequence of arterial thromboembolism (ATE):

- endotelial lesion (i.e. neoplasia, heart valve)- blood stasis- hypercoagulable state

Thromboembolism Occlusion of the aortic trifurcation : ischemia of the tributary area

CLINICAL SIGNS proportional to:• extension of the ischemic damage• presence of collateral network circulation

PAIN (sometimes dramatic!)Flaccid Paresis/paralysisAbsent spinal reflexesdistal limbs cold and cyanotic nail bedsAbsence of the femoral pulse

Courtesy dr. Gianni - Milan

Ischemic neuromyopathy and … neoplasia

where do you localize?

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1. Cats are….. cats!2. Spinal cord diseases differ greatly from those of dogs3. Cats spinal diseases carry a poorer prognosis compared to dogs4. Most frequent disease: FIP5. Most frequent tumor: Lymphoma6. Acute onset disease: trauma; FCEM, IVDD

7. Subacute/Chronic onset disease: FIP, neoplasia8. Consider age for your differential:

• younger cats: FIP; Lymphoma• older cats: Neoplasia; FCEM; IVDD

….. Questions?