Clinical reasoning in canine cervical hyperaesthesia: which presenting features are important?

Abstract

BackgroundTo evaluate whether clinical features from the history, presentation, physical and neurological examination of dogs with cervical hyperaesthesia are statistically predictive of the underlying diagnosis.MethodsTwo hundred and ninety-eight dogs presenting with cervical hyperaesthesia between January 2010 and October 2018 were investigated. Only neurologically normal dogs with cervical hyperaesthesia on examination were included, while those with concurrent neurological deficits including gait abnormalities and proprioceptive deficits were excluded. Univariate analysis of clinical variables was performed, and those associated with each diagnosis were retained for multivariable binary logistic regression models.ResultsNinety-five per cent of cervical hyperaesthesia presentations were represented by eight conditions that included steroid-responsive meningitis arteritis (SRMA; n=100), intervertebral disc extrusion (n=78), syringomyelia (SM; n=51), intervertebral disc protrusion (n=30), neoplasia (n=8), cervical spondylomyelopathy (n=7), immune-mediated polyarthritis (n=5) and meningoencephalomyelitis of unknown aetiology (n=5). Younger age (P=0.003), pyrexia (P=0.003) and haematology abnormalities (P=0.03) comprising leucocytosis, neutrophilia or monocytosis were associated with a diagnosis of SRMA.ConclusionsEasy-to-recognise clinical features can be used to identify the most likely differential diagnosis in neurologically normal dogs with cervical hyperaesthesia, which may aid the decision making of veterinary surgeons evaluating dogs with this presentation.

Detection of Extracellular Traps in Canine Steroid-Responsive Meningitis-Arteritis

“…A German study showed a sex predisposition for male individuals ( 46 ), but other studies do not show significant difference in sex distribution of this disease ( 47 , 48 ). The assembly of signalment, clinical signs, and laboratory findings of CSF and blood analysis associated with a quick clinical improvement after application of immunosuppressive therapy with glucocorticosteroids and an exclusion of an infectious etiology lead to the antemortem diagnosis of SRMA ( 40 , 48 – 50 ).…”

Cervical vertebral veins and caudal cerebral sinuses thrombosis secondary to corticosteroid therapy for an immune‐mediated polyarthritis in a dog

“…Some diseases are traditionally associated with a poor outcome like neoplasia, protein-losing nephropathy or liver dysfunction. [1][2][3] In our case, corticosteroid administration as treatment of immune-mediated polyarthritis was assumed to be responsible for the thrombotic phenomenon. Even though cervical pain was marked and dilatation of venous structures was judged severe based on CT images, outcome remained excellent.…”

“…In canine patients affected by venous thrombosis, prognosis is strongly dependent on the primary condition promoting hypercoagulability. Some diseases are traditionally associated with a poor outcome like neoplasia, protein‐losing nephropathy or liver dysfunction 1–3 . In our case, corticosteroid administration as treatment of immune‐mediated polyarthritis was assumed to be responsible for the thrombotic phenomenon.…”

“…or a distant organ (brain, forelimbs) 1 . In a retrospective study investigating cervical hyperesthesia in dogs, almost all of the patients suffered from a limited list of diseases: steroid‐responsive meningitis arteritis, intervertebral disc diseases (herniation and protrusion), syringomyelia, neoplasia, cervical spondylomyelopathy, immune‐mediated polyarthritis and meningoencephalomyelitis of unknown origin 2 . This report describes a case of neck pain without neurological deficits related to cervical vertebral venous thrombosis in a dog receiving corticosteroid treatment.…”

Key feature-cases as virtual patients in education of veterinary neurology

“…The first three basic cases deal with the neurological examination, a scheme for reflecting upon differential diagnoses (VITAMIN D scheme) (21) and the 5-finger rule for Clinical Reasoning (24). In several studies evaluating the 5-finger rule (onset, clinical course, symmetry of clinical signs, pain and neurological localization) and signalment for Clinical Reasoning specific patterns were identified to help in diagnosing and differentiating neurological diseases in dogs or cats (see Figure 1) (22,23,(25)(26)(27)(28). Furthermore 35 patient cases on the most frequently occurring diseases of the central and peripheral nervous system as well as myopathies could be created.…”