Brachial plexus injuries and dysfunctions

The brachial plexus and its associated structures demonstrate a propensity for certain disease processes not common to other areas of the nervous system. Brachial plexus disease produces a gait disturbance that may mimic musculoskeletal disease. When evaluating a case with possible traumatic brachial plexus disease, one relies heavily on historical, physical, and neurologic information when differentiating musculoskeletal disorders, although both may sometimes be present simultaneously in the same limb. With inflammatory disease, electromyography is extremely helpful, although an empiric dietary change may help confirm a suspicion. Brachial plexus surgery requires careful planning and meticulous technique. Attempts to remove malignant schwannomas have not been as successful as one would hope (Table 2). To a large extent, these dogs are treated late in the course of their disease because they are often treated for extended periods of time for musculoskeletal disease first. Early diagnosis and prompt surgical intervention would help many of these dogs. New histopathologic techniques, electrodiagnostic equipment, and radiographic techniques are helping to define peripheral nerve disease in the companion animal. These techniques will help us categorize and treat these diseases with greater success in the future.     

Serologic survey for Borrelia burgdorferi antibody in horses referred to a mid-Atlantic veterinary teaching hospital

Blood samples obtained from 13 of 100 (13%) and 6 of 91 (7%) horses at the George D. Widener Hospital for Large Animals in the months of June and October, respectively, had antibody to Borrelia burgdorferi as determined by ELISA. Horses from the states of New York, Maryland, Delaware, New Jersey, and Pennsylvania were seropositive for B burgdorferi. The frequency of antibody response in horses from New Jersey was greater (P less than 0.05) than the frequency of antibody response in horses from Pennsylvania or that of horses from the other states combined. Statistically significant difference was not found when a comparison was made between horses with serotiter and open diagnosis of neurologic or musculoskeletal disease and horses with negative serotest results and open diagnosis of neurologic or musculoskeletal disease.     

Association between neurologic and cognitive dysfunction signs in a sample of aging dogs

In human neurology, patients with Alzheimer's disease show seizures and signs of motor deficits, such as movement disorders (i.e., restlessness, slowness, impaired gait, and, rarely, resting tremors). Because canine Cognitive Dysfunction Syndrome (CDS) is considered an Alzheimer-like disease in dogs, it might be possible to document concurrent behavioral and neurologic signs in aging canine patients as well. Twenty-one dogs (14 dogs with CDS-related signs, 7 normal dogs) greater than 7 years of age were studied. Owners completed a behavioral questionnaire and the dogs underwent a neurologic evaluation. Dogs with CDS were twice as likely to show neurologic deficits as dogs without CDS. However, based on this pilot study, a sample of 187 dogs affected with CDS are required to show statistically significant differences between the proportions of dogs with CDS and with neurologic signs and the proportions of control dogs without any of these disorders.     

Orthopedic disorders in neonatal foals.

The first month of life is a vulnerable time for foals. They must adjust to their environment while they are still compromised immunologically, and their musculoskeletal system is rapidly growing and adjusting to stresses from an increasing amount of exercise. Therefore, if a foal is born with or acquires an abnormality or disease related to the musculoskeletal system, rapid adjustments must be made to allow the foal to grow and respond so that future athletic performance will not be compromised. Problems must be identified early, which requires thorough examinations. This article summarizes treatment options for orthopedic disorders that present or become clinically evident within the first month of life.     

Hypovolemic hyponatremia and signs of neurologic disease associated with diarrhea in a foal.

Hypovolemic hyponatremia attributable to severe fluid and electrolyte alterations was diagnosed in a foal with diarrhea. Subsequent consumption of water resulted in rapid reduction of serum sodium concentration and serum osmolar depression. Clinical signs of neurologic disease developed including blindness, loss of menace response, and seizures. Treatment of this condition with IV administered fluids included hypertonic saline solution (7.2%; 2 ml/kg of body weight), and frequent monitoring of serum electrolyte concentrations and osmolality resulted in gradual correction of the fluid and electrolyte imbalance and resolution of the neurologic signs. Hyponatremia has been recognized in foals with renal failure, ruptured urinary bladder, and iatrogenic water overload. The key to diagnosis and management of profound hyponatremia is accurate diagnosis of the status of plasma volume and association of the electrolyte imbalance with clinical signs of neurologic disease. This report describes an unusual complication of a commonly encountered problem in equine practice and documents that the severe metabolic and electrolyte abnormalities associated with diarrhea can result in clinical neurologic disease. The differential diagnosis also should include bacterial sepsis, parasitism, thoracic mass, acute renal failure, congenital neurologic deficit, or seizure syndrome. Serum electrolyte disorders should be considered as a potential cause of signs of neurologic disease in foals with diarrhea.     

Rupture of the gastrocnemius muscle in six foals

Rupture of the gastrocnemius muscle and subsequent disruption of the reciprocal mechanism of the hind limb was diagnosed in 6 foals examined at 7 hours to 3 weeks of age. In 2 foals, the musculoskeletal injury was detected as an ancillary finding to clinical signs of neurologic dysfunction ascribed to hypoxic ischemic insult during delivery, whereas in the other 4 foals, musculoskeletal injury, manifested as inability to rise or stand unsupported, was the chief complaint at admission. Five foals had a history of dystocia and assisted delivery. Common clinical signs were inability to rise, disruption of the reciprocal mechanism, swelling in the caudal aspect of the thigh, instability of the stifle joint, and stifle joint effusion. For mild gastrocnemius injury, exercise restriction via forced recumbency, with minimal or no bandaging, may be sufficient treatment. For more severe disruption of the muscle, limb stabilization via splinting and intensive nursing and monitoring are necessary. Four foals had important concurrent problems, including musculoskeletal deformations (joint contractures), hypoxic ischemic disease, and failure of passive transfer and associated problems (ie, sepsis, polyarthritis, and pneumonia). Moderate to severe gastrocnemius muscle injury is difficult to treat successfully, and the long-term prognosis for athletic function should be regarded as guarded.     

Retrospective Study on Seroprevalence of Borrelia burgdorferi Antibodies in Horses in Minnesota

To determine the seroprevalence of Borrelia burgdorferi antibodies in horses in Minnesota, the database of the Veterinary Diagnostic Laboratory, University of Minnesota, was searched over a 10-year period (May 2001 to May 2010). A total of 1,260 equine serum samples submitted by 112 veterinary clinics were tested using an indirect fluorescent antibody test. Samples with titers of ≥1:320 were considered positive. The average rate of seroprevalence was 58.7%, indicating high exposure of horses to B burgdorferi in Minnesota. Our results indicate that borreliosis should be considered as a differential in cases of horses with undiagnosed musculoskeletal or neurologic disease.     

Initial clinical impressions of the U.C. Davis large animal lift and its use in recumbent equine patients

The U.C. Davis Large Animal Lift (LAL) is a lightweight sling developed to help lift horses in clinical and rescue situations. Here we report on its first use in 16 recumbent horses with neurologic, muscular and musculoskeletal disorders. For each horse, history, sedation, ease and time of LAL application and hoisting, standing ability, LAL tolerance and outcome were recorded. The LAL was easily and safely applied in all horses in less than five minutes and the procedure was well tolerated with minimal to no sedation.While 10 horses were able to stand in the LAL after being hoisted, 6 horses were unable to stand and were eventually euthanized due to the inability to regain weight bearing function.The LAL has shown to be a useful devise to evaluate the standing ability of recumbent horses and can be used alone or in combination with the Anderson Sling Support Devise to allow standing support of horses with a variety of debilitating problems.     

Veterinary Neurologic Rehabilitation: The Rationale for a Comprehensive Approach

The increase in client willingness to pursue surgical procedures, the heightened perceived value of veterinary patients, and the desire to provide comprehensive medical care have driven the recent demand of using an integrative treatment approach in veterinary rehabilitation. Physical therapy following neurologic injury has been the standard of care in human medicine for decades, whereas similar rehabilitation techniques have only recently been adapted and utilized in veterinary medicine. Spinal cord injury is the most common neurologic disease currently addressed by veterinary rehabilitation specialists and will be the primary focus of this review; however, research in other neurologic conditions will also be discussed. Of particular interest, to clients and veterinarians are techniques and modalities used to promote functional recovery after neurologic injury, which can mean the difference between life and death for many veterinary patients.The trend in human neurologic rehabilitation, often regardless of etiology, is a multimodal approach to therapy. Evidence supports faster and improved recoveries in people after neurologic injury using a combination of rehabilitation techniques. Although the primary neurological disorders researched tend to be spinal cord injury, peripheral neuropathies, allodynia, multiple sclerosis, and strokes—many correlations can be made to common veterinary neurological disorders. Such comprehensive protocols entail gait training activities in combination with neuromuscular electrical stimulation and directed exercises. Additionally, pain-relieving and functional benefits are bolstered when acupuncture is used in addition to rehabilitation. Studies, both laboratory and clinical, support the use of acupuncture in the management of neurologic conditions in small animals, specifically in cases of intervertebral disc disease, other myelopathies, and neuropathic pain conditions. Acupuncture’s ability to promote analgesia, stimulate trophic factors, and decrease inflammation, including neuroinflammation, make it an alluring adjunct therapy after neurologic injury.Although there is limited research in veterinary medicine on physical techniques that expedite recovery after neurologic injury, there are sparse publications on clinical veterinary research suggesting the benefits of acupuncture, rehabilitation, and LASER in dogs with intervertebral disk disease. Accordingly, due to the relative lack of evidence-based studies in veterinary neurologic rehabilitation, much of the data available is human or laboratory-animal based, however, evidence supports the utilization of an early, comprehensive treatment protocol for optimal neurologic recovery. The rationale for why an integrative approach is critical will be detailed in this review; in addition, literature on specific physical rehabilitation techniques that have evidence of improved recoveries after neurologic injury, will be addressed.     

Complementary and alternative medicine for neurologic disorders

The use of complementary and alternative veterinary medicine in treating neurologic disorders has increased in popularity in response to advances in human alternative and integrative therapies. Neurolocalization of lesions to the brain, spinal cord, and neuromuscular systems is discussed, as well as the diagnostics and therapeutics used to treat such disorders. Emphasis is placed on integrative and alternative treatments for such neurologic diseases as seizures, cerebrovascular accidents, canine cognitive disorder, meningitis, intervertebral disc disease, fibrocartilagenous embolism, degenerative myelopathy, and myopathies. Thorough physical and neurologic examinations, establishment of a correct diagnosis, and integrative therapeutics are aimed at improving the overall quality of life of the veterinary patient.     

Production and growth related disorders and other metabolic diseases of poultry--a review

In humans, metabolic complaints may be associated with a failure in one of the body hormone or enzyme systems, a storage disease related to lack of metabolism of secretory products because of the lack of production of a specific enzyme, or the breakdown or reduced activity of some metabolic function. Some of these disorders also occur in poultry, as do other important conditions such as those associated with increased metabolism, rapid growth or high egg production that result in the failure of a body system because of the increased work-load on an organ or system. These make up the largest group of poultry diseases classified as metabolic disorders and cause more economic loss than infectious agents. Poultry metabolic diseases occur primarily in two body systems: (1) cardiovascular ailments, which in broiler chickens and turkeys are responsible for a major portion of the flock mortality; (2) musculoskeletal disorders, which account for less mortality, but in broilers and turkeys slow down growth (thereby reducing profit), and cause lameness, which remains a major welfare concern. In addition, conditions such as osteoporosis and hypocalcaemia in table-egg chickens reduce egg production and can kill.     

Reassessment of cytologic values in canine cerebrospinal fluid by use of cytocentrifugation

Using cytocentrifugation, nearly one fourth of canine cerebrospinal fluid (CSF) samples with cell counts in the normal range had abnormalities in cell type or morphologic features. Cerebrospinal fluid samples from 145 dogs with neurologic disorders were evaluated by use of this method. These results indicate that low hemacytometer counts in canine CSF should not be interpreted as normal. By increasing the detection of abnormalities in CSF, cytocentrifugation might improve diagnosis and treatment of canine neurologic disease.     

Diseases of pet rodents

The main pet rodent species are introduced with some brief notes on their suitability as pets and normal behaviour. The general clinical features of disease are discussed with some emphasis on species variation. The important diseases that occur in the United Kingdom are described under the headings of respiratory disease, diseases of the alimentary tract, diseases of the central nervous system, skin lesions, musculoskeletal disorders, palpable swellings, urinogenital disorders, diseases of pregnancy and injuries.     

Antinuclear antibodies: presence and specificity in autoimmune connective tissue disease in the dog.

Autoimmune connective tissue disease in both animals and humans present as multi-systemic disorders. Clinical signs referable to joints, musculoskeletal system and Dermatopathies are present. Autoantibody production is a regular feature of systemic autoimmune disease and these antibodies have diagnostic value in both human and veterinary medicine. In this study, we demonstrate that many of the commonly used diagnostic techniques developed for use with human patients may also be adapted for use in dogs. However, in some instances, 'canine specific' autoantibodies, distinct from analogous human antibodies may be detected in sera from dogs with a diagnosis of autoimmune disease. This finding indicates that dogs may develop 'dog-specific' autoimmune connective tissue disease.     

Kinematic analysis of the pelvic limbs of healthy dogs during stair and decline slope walking

Objectives : To evaluate range of motion (ROM) of the pelvic limb in healthy dogs descending stairs compared with decline slope walking. Methods : Reflective spheres were placed on the skin over the joints of the right pelvic limb of seven adult, hound-type dogs with no clinical signs of orthopaedic or neurologic disease. Five trials of stair and ramp descent of each dog were recorded using four 60 Hz digital infrared cameras. Two-dimensional kinematic data were collected as dogs walked down stairs and on a continuous decline of equivalent slope. Maximum and minimum joint angles and ROM were calculated for the coxofemoral, femorotibial and tibiotarsal joints. Results : Stair descent resulted in significantly greater femorotibial flexion and tibiotarsal flexion and extension compared with continuous slope descent. Significantly greater ROM was achieved in the coxofemoral, femorotibial and tibiotarsal joints during stair descent. Clinical Significance : Compared with a continuous slope, stair descent achieves greater ROM in the pelvic limbs of dogs. Stair descent may be a useful therapeutic exercise to improve ROM in dogs with musculoskeletal disease of the pelvic limb, and ramp descent may be easier for dogs with limited motion of pelvic limb joints.     

Feline lameness.

Feline lameness is an increasingly recognized clinical problem. Today's veterinary practitioner must be comfortable with his/her ability to diagnose the various conditions responsible for lameness in the cat and be able to discuss the significance of their findings with the client. Disease of the feline musculoskeletal system can be grouped into broad categories, including: trauma, arthritis, infectious causes, developmental disorders, neoplasia, and muscular problems. Specific diseases from each of these categories will be discussed, particularly those that differ in their presentation or clinical behavior from that same disease in the canine patient.     

COMPUTED TOMOGRAPHY OF PRIMARY INFLAMMATORY BRAIN DISORDERS IN DOGS AND CATS

A retrospective study of 22 animals with histologically confirmed, primary inflammatory brain disease was undertaken to determine the value of computed tomography in such patients. The histologic diagnosis was confirmed at necropsy in 18 patients and by surgical biopsy in four. All affected animals had neurologic deficits; the most common presenting complaint was seizures. Abnormalities were identified on computed tomography images in 21 of the 22 patients. The abnormalities included ventricular changes, falcial deviation, edema, focal changes in parenchymal opacity, focal contrast enhancement, periventricular contrast enhancement, and a ring-like pattern of contrast enhancement. Many lesion types identified in this study, such as falcial deviation, changes in parenchymal opacity, and ring-pattern enhancement, have previously been associated with neoplasia. The abnormalities correlated well with the lesion localization predicted by neurologic examination and confirmed by surgery or necropsy. Although computed tomography findings were often judged to be compatible with inflammatory disease, they did not predict the type of pathologic process. The findings suggest that computed tomography is valuable in the evaluation of animals with primary inflammatory brain disorders, but differentiation of neoplasia from non-neoplastic diseases is not always possible.     

Cerebrospinal fluid cytology in canine neurologic disease

Samples of cerebrospinal fluid (CSF) of 93 dogs with neurologic diseases were examined by cytomorphologic technique, and the changes in the CSF were correlated with histopathologic examinations of the central nervous system (CNS). It was concluded that CSF examination is a significant aid in obtaining a neurologic diagnosis and that good correlation exists between the CSF changes and the pathologic changes in the CNS. The CSF examination allows making a diagnosis of encephalitis and differentiation between viral and other causes (although in mycotic infection the cell membrane preparation can be used to identify the cause directly), could allow making differentiation between congenital malformations and congenital degenerative disease, and helps in identifying physical spinal cord damage, differentiating it from muscular, neurogenic, or functional disorders clinically presented as spinal ataxia. The CSF cytologic examination can indicate the presence of hemorrhage in the CNS. There is not enough experience available in the diagnosis of brain tumors by means of CSF examination; however, in dogs with lymphosarcoma in the CNS, CSF cytologic changes can be diagnostic.     

Common malignant musculoskeletal neoplasms of dogs and cats.

Malignancies of the musculoskeletal system in dogs and cats can be categorized as either primary or metastatic within the bony or soft structures that comprise the musculoskeletal system. By far, the most common tumor that affects the musculoskeletal system in dogs is osteosarcoma. The most common tumors that affect the musculoskeletal system in cats are injection site sarcomas. These tumors are locally infiltrative; whereas up to 25% metastasize, most animals die from our inability to control local disease. The aim of this article is to provide a brief review of the biologic behavior of and treatment recommendations for common tumors of the musculoskeletal system, excluding the oral and nasal cavities.