Syringomyelia: current concepts in pathogenesis, diagnosis, and treatment

Syringomyelia is a condition that results in fluid-containing cavities within the parenchyma of the spinal cord as a consequence of altered cerebrospinal fluid dynamics. This review discusses the history and the classification of the disorder, the current theories of pathogenesis, and the advanced imaging modalities used in the diagnosis. The intramedullary pulse pressure theory (a new pathophysiologic concept of syringomyelia) also is presented. In addition, the current understanding of the painful nature of this condition is discussed and the current trends in medical and surgical management are reviewed.     

Effects of dobutamine, norepinephrine, and vasopressin on cardiovascular function in anesthetized neonatal foals with induced hypotension

OBJECTIVE: To determine the effects of dobutamine, norepinephrine, and vasopressin on cardiovascular function and gastric mucosal perfusion in anesthetized foals during isoflurane-induced hypotension. ANIMALS: 6 foals that were 1 to 5 days of age. PROCEDURES: 6 foals received 3 vasoactive drugs with at least 24 hours between treatments. Treatments consisted of dobutamine (4 and 8 Sang/kg/min), norepinephrine (0.3 and 1.0 Sang/kg/min), and vasopressin (0.3 and 1.0 mU/kg/min) administered IV. Foals were maintained at a steady hypotensive state induced by a deep level of isoflurane anesthesia for 30 minutes, and baseline cardiorespiratory variables were recorded. Vasoactive drugs were administered at the low infusion rate for 15 minutes, and cardiorespiratory variables were recorded. Drugs were then administered at the high infusion rate for 15 minutes, and cardiorespiratory variables were recorded a third time. Gastric mucosal perfusion was measured by tonometry at the same time points. RESULTS: Dobutamine and norepinephrine administration improved cardiac index. Vascular resistance was increased by norepinephrine and vasopressin administration but decreased by dobutamine at the high infusion rate. Blood pressure was increased by all treatments but was significantly higher during the high infusion rate of norepinephrine. Oxygen delivery was significantly increased by norepinephrine and dobutamine administration; O2 consumption decreased with dobutamine. The O2 extraction ratio was decreased following norepinephrine and dobutamine treatments. The gastric to arterial CO2 gap was significantly increased during administration of vasopressin at the high infusion rate. CONCLUSION AND CLINICAL RELEVANCE: Norepinephrine and dobutamine are better alternatives than vasopressin for restoring cardiovascular function and maintaining splanchnic circulation during isoflurane-induced hypotension in neonatal foals.     

Distribution of substance P and calcitonin gene-related peptide in the spinal cord of Cavalier King Charles Spaniels affected by symptomatic syringomyelia

The causes of clinical signs associated with syringomyelia in the Cavalier King Charles Spaniel (CKCS) are incompletely understood. In this study we compared expression of two pain-related neuropeptides: substance P (SP) and calcitonin gene related peptide (CGRP), in the spinal cord dorsal horn of normal dogs with that in CKCS with and without clinical signs of syringomyelia. There was a decrease in expression of both peptides in CKCS with 'symptomatic' syringomyelia that was also associated with significant asymmetry in SP-I and similar, though non-significant, asymmetry in CGRP-I compared with other groups. The asymmetric distribution of these pain-related peptides may be a consequence of syrinx-associated damage to grey matter but may also play a role in generation of pain.     

Osteogenic proliferation and differentiation of canine bone marrow and adipose tissue derived mesenchymal stromal cells and the influence of hypoxia

The aim of this study was to compare the osteogenic and proliferative potential of canine mesenchymal stromal cells (cMSCs) derived from bone marrow (BM-cMSCs) and adipose tissue (AT-cMSCs). Proliferation potential was determined under varying oxygen tensions (1%, 5%, and 21% O(2)). Effects of reduced oxygen levels on the osteogenic differentiation of AT-cMSCs were also investigated. AT-cMSCs proliferated at a significantly faster rate than BM-cMSCs, although both cell types showed robust osteogenic differentiation. Culture in 5% and 1% O(2) impaired proliferation in cMSC from both sources and osteogenic differentiation in AT-cMSCs. Our data suggests that AT-cMSCs might be more suitable for use in a clinical situation, where large cell numbers are required for bone repair, due to their rapid proliferation combined with robust osteogenic potential. Our data also suggests that the inhibitory effects of hypoxia on both cell proliferation and differentiation should be considered when using MSCs in a potentially hypoxic environment such as a fracture site.     

The molecular basis for recognition of bacterial ligands at equine TLR2, TLR1 and TLR6

TLR2 recognises bacterial lipopeptides and lipoteichoic acid, and forms heterodimers with TLR1 or TLR6. TLR2 is relatively well characterised in mice and humans, with published crystal structures of human TLR2/1/Pam3CSK4 and murine TLR2/6/Pam2CSK4. Equine TLR4 is activated by a different panel of ligands to human and murine TLR4, but less is known about species differences at TLR2. We therefore cloned equine TLR2, TLR1 and TLR6, which showed over 80% sequence identity with these receptors from other mammals, and performed a structure-function analysis. TLR2/1 and TLR2/6 from both horses and humans dose-dependently responded to lipoteichoic acid from Staphylococcus aureus, with no significant species difference in EC50 at either receptor pair. The EC50 of Pam2CSK4 was the same for equine and human TLR2/6, indicating amino acid differences between the two species’ TLRs do not significantly affect ligand recognition. Species differences were seen between the responses to Pam2CSK4 and Pam3CSK4 at TLR2/1. Human TLR2/1, as expected, responded to Pam3CSK4 with greater potency and efficacy than Pam2CSK4. At equine TLR2/1, however, Pam3CSK4 was less potent than Pam2CSK4, with both ligands having similar efficacies. Molecular modelling indicates that the majority of non-conserved ligand-interacting residues are at the periphery of the TLR2 binding pocket and in the ligand peptide-interacting regions, which may cause subtle effects on ligand positioning. These results suggest that there are potentially important species differences in recognition of lipopeptides by TLR2/1, which may affect how the horse deals with bacterial infections.     

Media coverage of lethal control: A case study of kangaroo culling in the Australian Capital Territory

Culling kangaroos, Australia’s most abundant marsupial, is a controversial practice in the Australian Capital Territory (ACT). The ACT government introduced a kangaroo management plan in response to the growing kangaroo population causing damage in grassland ecosystems. Although some groups (e.g., local government, some researchers) support implementation of this plan, critics claim it is inhumane and lacks concrete evidence. To examine media portrayal of this debate, this study conducted a content analysis of newspaper coverage between 2006 and 2016. Although ACT newspapers were impartial in their presentation of the debate, sources that previous studies found were typically considered trustworthy to speak on the scientific validity of the program were found to have conflicting messages and be less represented in the media. Thus, future research should explore if the messenger is more important than the message in determining influences on public perceptions about the use of lethal control.     

Chiari-like malformation with syringomyelia in the Cavalier King Charles spaniel: long-term outcome after surgical management

Objective– To evaluate long-term success of cranial cervical decompression for management of canine Chiari-like malformation with syringomyelia (CM/SM).
Study Design– Retrospective clinical study.
Animals– Cavalier King Charles spaniels (n=15).
Methods– After diagnosis by magnetic resonance imaging (MRI) dogs had cranial cervical decompression with durotomy. Seven dogs had the durotomy patched with biocompatible collagen matrix. Clinical outcome was monitored for >12 months.
Results– All dogs either improved (80%) or were unchanged (20%) postoperatively. Postoperative MRI in 6 dogs revealed persistence of syringomyelia. Seven dogs (47%) subsequently deteriorated, 0.2–2.3 years after surgery (mean, 1.3 years) and 2 dogs were eventually euthanatized as a consequence. Twelve dogs were still alive, 1–6.5 years after surgery (mean, 2.5 years).
Conclusion– Cranial cervical decompression surgery is associated with low mortality and morbidity, and results in clinical improvement in most dogs. The procedure seemingly does not result in syrinx collapse and resolution. Clinical improvement may not be sustained and some dogs can be expected to deteriorate.
Clinical Relevance– Cranial cervical decompression surgery may have a role in management of CM/SM. In dogs with severe pain, it can improve quality of life for several years; however, it does not appear to adequately address the primary cause of syringomyelia. Further prospective study is needed to better understand the pathogenesis and treatment of this disorder. Because this condition causes neuropathic pain but does not necessarily result in euthanasia more information is needed on appropriate pain management for these patients.