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Santifort KM, Carrera I, Mandigers PJJ. Longitudinal assessment of syringomyelia in Pomeranians. Front Vet Sci 2024; 11:1364464. [PMID: 38751802 PMCID: PMC11094614 DOI: 10.3389/fvets.2024.1364464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/10/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Chiari-like malformation (CM) and syringomyelia (SM) are disorders that, in dogs, affect mainly small and toy breeds, including the Pomeranian. These disorders are linked to a great number of (owner-reported) clinical signs (ORCS) suggestive of pain. Aging was associated with an increased risk of having SM in several studies. However, there are only a few longitudinal studies that assess the presence and severity of CM/SM over time in CKCS dogs and progression of SM was linked to progression of clinical signs. The aim of this study was to investigate ORCS, CM/SM classification, and quantitative syrinx parameters in relation to progression of time (age) within individual Pomeranians. Materials and methods Pomeranians with or without ORCS and with or without diagnoses of CM/SM were included that had undergone two (or more) MRI studies of the craniocervicothoracic region between January 2020 and June 2023. Classification of CM/SM and quantitative syrinx measurements were performed. Absolute values as well as ratios for syrinx height, width, and cross-sectional area were included for analysis. Results A total of 19 Pomeranians were included in the study, of which 11 were male (58%) and 8 were female (42%). The median age at the time of MRI1 was 26 months (range 7-44 months). The median scan interval was 26 months (range 11-49 months). Eleven dogs (58%) were presented with ORCS at the time of MRI1, whereas the other 8 dogs (42%) had no ORCS at that time. At the time of MRI2, there were 17/19 dogs (89%) with ORCS and 2/19 dogs without ORCS (11%). Dogs were significantly more likely to have ORCS at MRI2 than MRI1 (p = 0. 0411). There was no significant difference between CM/SM classification at the time of MRI1 and MRI2. Significant differences were found between MRI1 and MRI2 for syrinx height (based on transverse images) (absolute value and ratio P = 0.0059), syrinx width (absolute value P = 0.1055, ratio P = 0.0039), and syrinx cross sectional area (absolute value P = 0.0195, ratio P = 0.0217). Discussion There are differences in the presence or absence of ORCS as well as quantitative syrinx measurements in Pomeranians at different ages. This finding supports that longitudinal changes occur in the SM status of Pomeranians.
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Affiliation(s)
- Koen M. Santifort
- IVC Evidensia Referral Hospital Arnhem, Neurology, Arnhem, Netherlands
- IVC Evidensia Referral Hospital Hart van Brabant, Neurology, Waalwijk, Netherlands
- Expertise Centre of Genetics, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Ines Carrera
- Vet Oracle Teleradiology, Norfolk, United Kingdom
| | - Paul J. J. Mandigers
- IVC Evidensia Referral Hospital Arnhem, Neurology, Arnhem, Netherlands
- Expertise Centre of Genetics, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
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Bach MBT, Stougaard CL, Thøfner MS, Reimann MJ, Westrup U, Koch J, Fredholm M, Martinussen T, Berendt M, Olsen LH. Relationship between syringomyelia and myxomatous mitral valve disease in Cavalier King Charles spaniels. J Vet Intern Med 2024; 38:904-912. [PMID: 38391152 PMCID: PMC10937514 DOI: 10.1111/jvim.17018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Syringomyelia (SM) and myxomatous mitral valve disease (MMVD) are highly prevalent in Cavalier King Charles spaniels (CKCS). Cardiac status in CKCS with and without SM is currently unknown. OBJECTIVES To investigate the association between SM and MMVD severity in CKCS and CKCS with SM with and without clinical signs of SM. ANIMALS Fifty-five CKCS: 40 with SM (22 symptomatic and 18 asymptomatic) and 15 without SM. METHODS A combined retrospective and prospective study. MRI and echocardiography were used to diagnose SM and MMVD, respectively. The association between SM and MMVD severity (left ventricle internal diameter in diastole normalized to bodyweight [LVIDDN] and left atrium to aortic ratio [LA/Ao]) were tested using multivariable linear regression analysis adjusting for sex and age. RESULTS Overall, no significant difference in LVIDDN and LA/Ao was found between CKCS with or without SM. However, CKCS with symptomatic SM had significantly smaller LVIDDN (1.45 [1.30-1.50]) (median [IQR]) and LA/Ao (1.20 [1.10-1.28]) compared to CKCS with asymptomatic SM (1.60 [1.50-1.90] and 1.40 [1.20-1.75]) as well as CKCS without SM (0.24 [0.03-0.45] and 0.30 [0.05-0.56]) (all P values <.03). CONCLUSIONS AND CLINICAL IMPORTANCE An association between MMVD and SM was not confirmed in this cohort of CKCS, indicating that MMVD and SM do not co-segregate. However, CKCS with symptomatic SM had smaller left ventricle and atrial size compared to CKCS with asymptomatic SM and CKCS without SM.
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Affiliation(s)
- Maiken B. T. Bach
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg CDenmark
| | - Camilla L. Stougaard
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg CDenmark
| | - Maria S. Thøfner
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg CDenmark
| | - Maria J. Reimann
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg CDenmark
| | - Ulrik Westrup
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg CDenmark
| | - Jørgen Koch
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg CDenmark
| | - Merete Fredholm
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg CDenmark
| | - Torben Martinussen
- Department of Public HealthUniversity of CopenhagenFrederiksberg CDenmark
| | - Mette Berendt
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg CDenmark
| | - Lisbeth H. Olsen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg CDenmark
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Pedersen TR, Bach MBT, Stougaard CL, Gredal H, Rusbridge C, Finnerup NB, Berendt M. Clinical predictors of syringomyelia in Cavalier King Charles Spaniels with chiari-like malformation based on owners' observations. Acta Vet Scand 2024; 66:5. [PMID: 38331821 PMCID: PMC10851586 DOI: 10.1186/s13028-024-00725-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/17/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Syringomyelia (SM) is a prevalent inherited developmental condition in Cavalier King Charles Spaniels (CKCSs) with Chiari-like malformation (CM), accompanied by a variety of clinical manifestations, including signs of neuropathic pain. Magnetic resonance imaging (MRI) is the gold standard in SM diagnosis. However, it is desirable to establish clinical predictors that can identify CKCSs with a large clinical syrinx that needs treatment, as some owners cannot afford or lack access to MRI. The aims of the study were to investigate owner-reported clinical signs of SM and clinical predictors of a large clinical syrinx, using predictive values of significant signs, individually and in combinations. Eighty-nine CKCSs participated in this retrospective study. Based on MRI diagnosis, dogs were distributed into three groups: CM without syrinx or with a maximum transverse width < 2 mm (n = 13), CM with small syrinx 2.00-3.99 mm (n = 26) and CM with large syrinx ≥4 mm (n = 50). A structured investigator-owner interview using a standardized questionnaire was used to collect data regarding clinical signs of CM and SM. The statistical tests Pearson's chi-square, Fisher's Exact and Spearman's rank order were used to assess the difference in owner-reported signs between groups. For signs with significant differences, positive and negative predictive values (PPV and NPV) were calculated. RESULTS Following clinical signs were reported significantly more frequent in dogs with a large syrinx: phantom scratching, bilateral scratching of the neck or shoulder, aversion when that area is touched, or exacerbation of clinical signs when the dog is emotionally aroused. Each individual sign had a high PPV, indicative of a large clinical syrinx. The PPV increased further when the signs phantom scratching, aversion to touch to the head, neck or shoulder, and a preferred head posture during sleep were present in combination. CONCLUSIONS Specific clinical signs can be used individually and in combination as clinical predictors of a large clinical syrinx in CKCSs with CM and SM. General practitioners can utilize this information to identify CKCSs with a large syrinx to initiate necessary treatment. This is particularly useful in cases where access to or affordability of an MRI diagnosis is limited.
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Affiliation(s)
- Tenna Remler Pedersen
- Department of Clinical Veterinary Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlaegevej 16, C DK-1870, Frederiksberg, Denmark.
| | - Maiken Bayer Thode Bach
- Department of Clinical Veterinary Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlaegevej 16, C DK-1870, Frederiksberg, Denmark
| | - Camilla Løkke Stougaard
- Department of Clinical Veterinary Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlaegevej 16, C DK-1870, Frederiksberg, Denmark
| | - Hanne Gredal
- Department of Clinical Veterinary Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlaegevej 16, C DK-1870, Frederiksberg, Denmark
| | - Clare Rusbridge
- Department of Clinical Sciences, School of Veterinary Medicine, University of Surrey, Daphne Jackson Rd, GU2 7AL, Guildford, Great Britain
| | - Nanna Brix Finnerup
- The Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
| | - Mette Berendt
- Department of Clinical Veterinary Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlaegevej 16, C DK-1870, Frederiksberg, Denmark
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Liatis T, De Decker S. Head tilt as a clinical sign of cervical spinal or paraspinal disease in dogs: 15 cases (2000-2021). J Small Anim Pract 2024; 65:56-65. [PMID: 37752722 DOI: 10.1111/jsap.13674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 06/30/2023] [Accepted: 09/06/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVES To characterise head tilt as a rare clinical sign of cervical spinal or paraspinal disease in dogs. MATERIALS AND METHODS Retrospective single-centre case-series study of dogs with head tilt and cervical spinal or paraspinal disease in the absence of intracranial abnormalities. Descriptive statistics were used. RESULTS Fifteen dogs met the inclusion criteria of this study. Median age at onset was 6 years (range 2.5 to 12 years). Onset of neurological signs was mainly chronic (9/15, 60%). Most common presenting complaints included head tilt (9/15, 60%) and cervical hyperaesthesia (8/15, 53%). Most common neurological findings included head tilt (15/15, 100%), generalised proprioceptive ataxia and tetraparesis (6/15, 40%) and cervical hyperaesthesia (8/15, 53%). Diagnoses included post-operative complication of C2 spinal nerve root mass removal (2/15, 13%), C3-C4 intervertebral disc extrusion (2/15, 13%), cervical paraspinal myositis (2/15, 13%) and one of each: C2 vertebral malformation, C2 spinal nerve root mass, C1-C2 meningioma, C2 vertebral fracture, C4-C5 intervertebral disc extrusion, C4 vertebral body mass, C5-C7 osseous-associated cervical spondylomyelopathy, and concurrent C5-C6 and C6-C7 intervertebral disc protrusions. Two dogs were euthanased shortly after diagnosis and two of 15 were dogs lost to follow-up. No post-mortem examination was performed for these cases. For the 11 of 15 remaining dogs, head tilt resolved in eight of 15 (53%) dogs after treatment of the underlying condition and in three of 15 (20%) dogs, it remained static. CLINICAL SIGNIFICANCE Head tilt can be a rare clinical sign of cervical spinal or paraspinal disease in dogs.
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Affiliation(s)
- T Liatis
- Queen Mother Hospital for Animals, Royal Veterinary College, University of London, Hatfield, AL9 7TA, UK
| | - S De Decker
- Queen Mother Hospital for Animals, Royal Veterinary College, University of London, Hatfield, AL9 7TA, UK
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Santifort KM, Carrera I, Bossens K, Mandigers PJJ. Phenotypic characterization of Pomeranians with or without Chiari-like malformation and syringomyelia. Front Vet Sci 2023; 10:1320942. [PMID: 38169622 PMCID: PMC10758411 DOI: 10.3389/fvets.2023.1320942] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Chiari-like malformation (CM) and syringomyelia (SM) are frequently diagnosed conditions in small and toy dog breeds, such as the Cavalier King Charles Spaniel and Griffon Bruxellois. CM/SM is only rarely reported in Pomeranians in literature to date. The aims of this study are to 1/describe the phenotype of Pomeranians with or without CM/SM and 2/evaluate for differences and associations between CM/SM and owner-reported clinical signs (ORCS) or signalment factors. Materials and methods From February 2015 to June 2023, historical data and signalment (including country of origin, pedigree, sex and neuter status, age, and body weight) and ORCS of Pomeranians were recorded at multiple institutions. MRI studies of all dogs were evaluated for classification of CM/SM. Additionally, quantitative measurements were performed for SM. Results A total of 796 dogs from 22 different countries were included. Total prevalence of CM was 54.9% (437/796) and the prevalence of SM was 23.9% (190/796). The top 5 ORCS included 1/scratching with skin contact, rubbing head or ears, or both (57.6% of dogs with ORCS), 2/air licking (30.7% of dogs with ORCS), 3/spontaneous signs of pain (26.0% of dogs with ORCS), 4/persistent licking front and/or hind paws (22.6% of dogs with ORCS), 5/phantom scratching (22.6% of dogs with ORCS). Phantom scratching, vocalization, head shaking, spontaneous signs of pain, and air licking were associated with having SM. There were no statistically significant associations between quantitative syrinx measurements and ORCS. There were statistically significant associations between CM classification and 1/country of origin, 2/having a pedigree, and 3/age. There were statistically significant associations between SM classification and 1/age and 2/body weight. Discussion This is the first large study evaluating CM/SM in the Pomeranian dog breed. Veterinary clinicians can use these findings to increase the likelihood of correctly determining the presence or absence of CM/SM in Pomeranians. Breeders may consider using the information regarding signalment factors as well as ORCS associated with CM/SM classifications to select dogs for screening procedures. But an MRI-based diagnosis is needed to properly ascertain the exact CM/SM status of their breeding stock until a fool-proof characteristic or genetic marker is found.
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Affiliation(s)
- Koen M. Santifort
- Neurology, IVC Evidensia Referral Hospital Arnhem, Arnhem, Netherlands
- Neurology, IVC Evidensia Referral Hospital Hart van Brabant, Waalwijk, Netherlands
- Expertise Centre of Genetics, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Ines Carrera
- Vet Oracle Teleradiology, Norfolk, United Kingdom
| | - Kenny Bossens
- Department of Neurology, Orion Small Animal Hospital, Herentals, Belgium
| | - Paul J. J. Mandigers
- Neurology, IVC Evidensia Referral Hospital Arnhem, Arnhem, Netherlands
- Expertise Centre of Genetics, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
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Lemke L, Carlson R, Flegel T, Volk A, Volk HA, Tipold A, Nessler JN. Interleukin-31 in serum and cerebrospinal fluid of dogs with syringomyelia. BMC Vet Res 2023; 19:244. [PMID: 37993920 PMCID: PMC10666301 DOI: 10.1186/s12917-023-03817-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Syringomyelia is a spinal cord cavity containing cerebrospinal fluid (CSF)-like fluid. If syringomyelia asymmetrically involves the dorsal horn grey matter of the spinal cord, affected dogs show increased signs of dysesthesia and neuropathic pain, like increased itching behaviour. In the dorsal horn, amongst others, receptors for Interleukin-31 (IL-31) can be found. IL-31 is one of the main cytokines involved in the pathogenesis of pruritus in atopic dermatitis in different species. This study investigates suspected elevated levels of IL-31 in serum and CSF of dogs showing signs of pain or increased itching behaviour related to syringomyelia. The IL-31 were measured in archived samples (52 serum and 35 CSF samples) of dogs with syringomyelia (n = 48), atopic dermatitis (n = 3) and of healthy control dogs (n = 11) using a competitive canine IL-31 ELISA. RESULTS Mean serum IL-31 level in dogs with syringomyelia was 150.1 pg/ml (n = 39), in dogs with atopic dermatitis 228.3 pg/ml (n = 3) and in healthy dogs 80.7 pg/ml (n = 10). Mean CSF IL-31 value was 146.3 pg/ml (n = 27) in dogs with syringomyelia and 186.2 pg/ml (n = 8) in healthy dogs. Individual patients with syringomyelia (especially dogs with otitis media or otitis media and interna or intervertebral disc herniation) showed high IL-31 levels in serum and CSF samples, but the difference was not statistically significant. IL-31 serum and CSF levels did not differ significantly in dogs with syringomyelia with or without itching behaviour and with or without signs of pain. CONCLUSION Based on this study, increased IL-31 levels seem not to be correlated with itching behaviour or signs of pain in dogs with syringomyelia, but might be caused by other underlying diseases.
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Affiliation(s)
- Laura Lemke
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Regina Carlson
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Thomas Flegel
- Department of Small Animal Medicine, Leipzig University, Leipzig, Germany
| | - Andrea Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Holger Andreas Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Jasmin Nicole Nessler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany.
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Nitzsche B, Schulze S, Boltze J, Schmidt MJ. Reduced cingulate gyrus volume in Cavalier King Charles Spaniels with syringomyelia and neuropathic pain revealed by voxel-based morphometry: a pilot study. Front Neuroanat 2023; 17:1175953. [PMID: 37529422 PMCID: PMC10389659 DOI: 10.3389/fnana.2023.1175953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/26/2023] [Indexed: 08/03/2023] Open
Abstract
Objective Pathomorphological alterations of the central nervous system in dogs, such as syringomyelia and Chiari-like malformation, can cause cranial and cervical hyperesthesia and neuropathic pain. The long-term activity of the pain network can induce functional alteration and eventually even morphological changes in the pain network. This may happen especially in the prefrontal and cingulate cortex, where atrophy of the gray matter (GM) was observed in humans with chronic pain, irrespective of the nature of the pain syndrome. We tested the hypothesis that Cavalier King Charles Spaniels (CKCS) with Chiari-like malformation and associated syringomyelia (SM) and pain show cerebral morphological differences compared to animals without signs of syringomyelia and pain. Methods Volumetric datasets of 28 different brain structures were analyzed in a retrospective manner, including voxel-based morphometry, using magnetic resonance imaging data obtained from 41 dogs. Results Volumetric analyses revealed a decrease in GM volumes in the cingulate gyrus (CG) in CKCS with SM and chronic pain when normalized to brain volume. This finding was supported by voxel-based morphometry, which showed a cluster of significance within the CG. Conclusion GM atrophy in the CG is associated with chronic pain and thus may serve as an objective readout parameter for the diagnosis or treatment of canine pain syndromes.
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Affiliation(s)
- Björn Nitzsche
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
- Faculty of Veterinary Medicine, Institute of Anatomy, Histology and Embryology, University of Leipzig, Leipzig, Germany
- Department of Veterinary Clinical Sciences, Small Animal Clinic, Neurosurgery, Neuroradiology and Clinical Neurology, Justus-Liebig-University, Giessen, Germany
| | - Sabine Schulze
- Small Animal Clinic, Department of Veterinary Medicine, Free University of Berlin, Berlin, Germany
| | - Johannes Boltze
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
| | - Martin J. Schmidt
- Department of Veterinary Clinical Sciences, Small Animal Clinic, Neurosurgery, Neuroradiology and Clinical Neurology, Justus-Liebig-University, Giessen, Germany
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Sahuquillo J, Moncho D, Ferré A, López-Bermeo D, Sahuquillo-Muxi A, Poca MA. A Critical Update of the Classification of Chiari and Chiari-like Malformations. J Clin Med 2023; 12:4626. [PMID: 37510741 PMCID: PMC10380265 DOI: 10.3390/jcm12144626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Chiari malformations are a group of craniovertebral junction anomalies characterized by the herniation of cerebellar tonsils below the foramen magnum, often accompanied by brainstem descent. The existing classification systems for Chiari malformations have expanded from the original four categories to nine, leading to debates about the need for a more descriptive and etiopathogenic terminology. This review aims to examine the various classification approaches employed and proposes a simplified scheme to differentiate between different types of tonsillar herniations. Furthermore, it explores the most appropriate terminology for acquired herniation of cerebellar tonsils and other secondary Chiari-like malformations. Recent advances in magnetic resonance imaging (MRI) have revealed a higher prevalence and incidence of Chiari malformation Type 1 (CM1) and identified similar cerebellar herniations in individuals unrelated to the classic phenotypes described by Chiari. As we reassess the existing classifications, it becomes crucial to establish a terminology that accurately reflects the diverse presentations and underlying causes of these conditions. This paper contributes to the ongoing discussion by offering insights into the evolving understanding of Chiari malformations and proposing a simplified classification and terminology system to enhance diagnosis and management.
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Affiliation(s)
- Juan Sahuquillo
- Department of Neurosurgery, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - Dulce Moncho
- Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Clinical Neurophysiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Alex Ferré
- Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Sleep Unit, Pneumology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Diego López-Bermeo
- Department of Neurosurgery, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Aasma Sahuquillo-Muxi
- Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Maria A Poca
- Department of Neurosurgery, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
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Holdsworth JP, Marino DJ, Loughin CA, Miller AD, Sackman JJ, Lesser ML, O'Donnell M. Biopsy and histologic findings of the dura mater at the level of the foramen magnum in 121 CKCS with Chiari-like malformation. Front Vet Sci 2022; 9:954092. [PMID: 36157194 PMCID: PMC9489847 DOI: 10.3389/fvets.2022.954092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
To describe histopathologic features found in dural biopsies of Cavalier King Charles Spaniels (CKCS) with Chiari-like malformation (CM) and identify any associations between age, duration of clinical signs, syrinx location or syringomyelia (SM, and quality of life (QOL). The medical records of 121 consecutive client owned CKCS with CM and SM, confirmed by whole body magnetic resonance imaging (MRI), that underwent foramen magnum decompression (FMD) with cranioplasty and durectomy with biopsy from 2006 to 2016 were retrospectively reviewed. Dural biopsies were submitted to a board-certified veterinary pathologist for histopathologic interpretation. The chi-square test was used to analyze associations between histologic findings and categorical variables. For continuous measures, the Kruskal–Wallis non-parametric test was used to compare distributions across pathology categories. A result was considered statistically significant at the p < 0.05 level of significance. The mean age, duration of pre-surgical clinical signs, and pre-operative QOL (1–5 scale) were 44.27 months, 44.78 weeks, and 2.72, respectively. Syringomyelia was found in the cervical region only in 39 of 121 (32.23%) of dogs, in the cervical and thoracic region only in 17 of 121 (14.05%) of dogs, and in the cervical, thoracic, and lumbar region combined in 65 of 121 (53.72%) of dogs. Sixty-six of one hundred twenty-one (54.55%) dural biopsy specimens had histopathology changes; fifty-five (45.45%) did not. Forty-three of one hundred twenty-one (35.54%) dural biopsy specimens had osseous metaplasia, 16 of 121 (13.22%) had evidence of fibrosis, 4 of 121 (3.31%) had arachnoid hyperplasia, and 3 of 121 (2.48%) had evidence of mineralization. Most dogs with CM were found to have histopathologic changes in the dura at the time of FMD cranioplasty was performed. These dural changes can be observed in dogs experiencing clinical signs for a time period as short as 4 weeks prior to presentation. The histopathologic changes were not associated with age, breed, duration of clinical signs, the location of syringomyelia or QOL. The influence of histopathologic changes on long-term prognosis in dogs without dural decompression is unknown since all dogs in this study had dural resection.
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Affiliation(s)
- Jaclyn P. Holdsworth
- Department of Surgery and the Canine Chiari Institute, Long Island Veterinary Specialists, Plainview, NY, United States
- *Correspondence: Jaclyn P. Holdsworth
| | - Dominic J. Marino
- Department of Surgery and the Canine Chiari Institute, Long Island Veterinary Specialists, Plainview, NY, United States
| | - Catherine A. Loughin
- Department of Surgery and the Canine Chiari Institute, Long Island Veterinary Specialists, Plainview, NY, United States
| | - Andrew D. Miller
- Biomedical Sciences, Section of Anatomic Pathology, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Joseph J. Sackman
- Department of Surgery and the Canine Chiari Institute, Long Island Veterinary Specialists, Plainview, NY, United States
| | - Martin L. Lesser
- Biostatistics Unit, Feinstein Institute for Medical Research, Northwell Health, New York, NY, United States
| | - Marissa O'Donnell
- Department of Surgery and the Canine Chiari Institute, Long Island Veterinary Specialists, Plainview, NY, United States
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10
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Tirrito F, Cozzi F, Bonaldi M, Corazzo S, Contiero B, Lombardo R. Ventriculomegaly in Cavalier King Charles Spaniels with Chiari-like malformation: relationship with clinical and imaging findings. J Vet Med Sci 2022; 84:1185-1193. [PMID: 35831130 PMCID: PMC9523300 DOI: 10.1292/jvms.22-0134] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The objective of this study was to calculate lateral ventricles dimension in Cavalier King Charles Spaniel dogs with Chiari-like malformation and investigate the association between
ventriculomegaly and signalment, clinical signs, ventricular asymmetry, grade of Chiari-like malformation, syringomyelia and index of medullary kinking. Retrospectively, 43 client-owned
Cavalier King Charles Spaniels, older than 1 year of age, with magnetic resonance imaging diagnosis of Chiari-like malformation were enrolled. Initial and follow-up (up to 36 months)
clinical status was graded. Images were reviewed to quantify the enlargement of lateral ventricles, evaluate ventricular symmetry, grade of Chiari-like malformation, grade of syringomyelia
and medullary kinking index. Cases presenting epileptic seizures during the evaluation period were also recorded. The most common initial clinical signs were scratching and neck pain.
Ventriculomegaly was identified in 70% of dogs, Chiari-like malformation grade 2 was observed in 77% of cases, ventricular asymmetry and syringomyelia were identified in 54% and 80% of dogs,
respectively; the median medullary kinking index was 37.77%. Moreover, 28% of dogs presented epileptic seizures. No significant association was identified between dimension of lateral
ventricles and signalment, clinical signs, and imaging findings; no significant association was identified between ventriculomegaly and epilepsy (P≥0.05). In conclusion, the
prevalence of ventriculomegaly in Cavalier King Charles Spaniels is high but this finding does not seem related to the severity of clinical signs, presence of Chiari-like malformation,
syringomyelia and craniocervical junction abnormalities such as medullary kinking.
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Affiliation(s)
- Federica Tirrito
- Clinica Neurologica Veterinaria NVA.,AniCura Istituto Veterinario di Novara.,Studio Veterinario Associato Vet2Vet di Ferri e Porporato
| | | | | | | | - Barbara Contiero
- Department of Veterinary Medicine, Production and Health, University of Padova
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11
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Huenerfauth EI, Bien CG, Bien C, Volk HA, Meyerhoff N. Case Report: Anti-GABAA Receptor Encephalitis in a Dog. Front Vet Sci 2022; 9:886711. [PMID: 35812851 PMCID: PMC9262380 DOI: 10.3389/fvets.2022.886711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/25/2022] [Indexed: 01/21/2023] Open
Abstract
Autoantibodies against neurotransmitter receptors detected in cerebrospinal fluid (CSF) and serum are increasingly recognized in people with human autoimmune encephalitis causing severe neurological deficits, such as seizures and behavioral abnormalities. This case report describes the first encephalitis associated with antibodies against the γ-aminobutyric acid-A receptor (GABAAR) in a dog. A young male intact Cavalier King Charles Spaniel was presented with recent onset of initial multiple generalized tonic-clonic seizures progressing into a status epilepticus. Interictally, he showed alternating stupor and hyperexcitability, ataxia, pleurothotonus and circling behavior to the left side. Magnetic resonance imaging (MRI) of the brain showed breed-specific anatomical abnormalities. Standard CSF analysis was unremarkable. Despite treatment with multiple antiseizure medications (ASMs) seizures and behavior abnormalities sustained. Immunotherapy with dexamethasone was started on the fifth day after disease manifestation. This led to rapid improvement of clinical signs. An extensive antibody search in CSF and serum demonstrated a neuropil staining pattern on a tissue-based assay compatible with GABAAR antibodies. The diagnosis was confirmed by binding of serum and CSF antibodies to GABAAR transfected Human Embryonic Kidney cells. The serum titer was 1:320, the CSF titer 1:2. At the control visit 4.5 weeks after start of immunotherapy, the dog was clinically normal. The GABAAR antibody titer in serum had strongly decreased. The antibodies were no longer detectable in CSF. Based on clinical presentation and testing for GABAAR binding antibodies, this describes the first veterinary patient with an anti-GABAAR encephalitis with a good outcome following ASM and corticosteroid treatment.
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Affiliation(s)
- Enrice I. Huenerfauth
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Foundation, Hannover, Germany
- *Correspondence: Enrice I. Huenerfauth
| | | | | | - Holger A. Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Foundation, Hannover, Germany
| | - Nina Meyerhoff
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Foundation, Hannover, Germany
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12
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Mortensen D, Thoefner MS, Agerholm JS, Slumstrup L, Jensen TS, Bjerrum OJ, Berendt M, Nyengaard JR. Dorsal horn volume loss and pain pathway changes in Cavalier King Charles Spaniels with syringomyelia, signs of pain, and phantom scratching. Pain 2022; 163:2365-2379. [PMID: 35353770 DOI: 10.1097/j.pain.0000000000002630] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/28/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Central neuropathic pain is a core clinical sign of syringomyelia in humans and Cavalier King Charles Spaniel (CKCS) dogs. This histopathological study used spinal cords from CKCS with syringomyelia to investigate: 1) whether specific structural cervical spinal cord entities involved in nociception are affected by loss of neuroparenchyma or other pathological changes in CKCS with pain-related behaviour and phantom scratching, 2) if pain related behaviour or phantom scratching correlated with loss of a specific anatomical entity or upregulation of glia cells, and 3) if syringomyelia-related lesions affected specific functional spinal cord units of nociception.Spinal cord segments C1-C8 from CKCS with MRI-confirmed syringomyelia and clinical signs of pain and phantom scratch (n=8) were compared to CKCS without syringomyelia (n=4). Dogs with unilateral scratching (n=7) had a volume loss (P=0.043) of the dorsal horn laminae I-III in the ipsilateral side compared to the contralateral dorsal horn. A clear pattern of ipsilateral changes in the dorsal root entry zone characterised by deafferentation and reorganization of first-order axons into deeper laminae was found in cases with lateralised scratching. Significant changes in cell number density were not found for astrocytes or microglia, suggesting that the dogs represented cases of end-stage syringomyelia and thus could not reveal astrogliosis and microgliosis, which may be involved in the early phases of syrinx development and phantom scratch.The present relationship between clinical findings and dorsal horn and pain pathway pathology in CKCS suggests that these dogs may be of interest as a supplement to experimental model pain research.
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Affiliation(s)
- Danny Mortensen
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Center for Stochastic Geometry and Advanced Bioimaging
| | - Maria Soendergaard Thoefner
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Joergen Steen Agerholm
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Lasse Slumstrup
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Center for Stochastic Geometry and Advanced Bioimaging
| | | | - Ole Jannik Bjerrum
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Mette Berendt
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Jens Randel Nyengaard
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Center for Stochastic Geometry and Advanced Bioimaging.,Department of Pathology, Aarhus University Hospital, Denmark
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13
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Colverde AS, Nicetto T, Falzone C. Occipital cranioplasty using customized titanium prosthesis yields successful outcome in association with foramen magnum decompression in dogs suffering by Chiari-like malformation. Am J Vet Res 2021; 83:275-282. [PMID: 34968186 DOI: 10.2460/ajvr.21.11.0178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the use of a customized 3-D-printed titanium prosthesis as adjunctive treatment for foramen magnum decompression (FMD) in dogs with Chiari-like malformation (CM) and syringomyelia (SM). ANIMALS 8 dogs with clinical signs and MRI findings of CM-SM. PROCEDURES 3-D reconstruction of CT images of the head was used to simulate an occipital craniectomy and design the prosthesis. FMD was performed, and the prosthesis was implanted. Follow-up was performed 1, 6, and 12 months later, and clinical status was scored. Repeated MRI images were compared to identify changes involving the neural structures, particularly the syrinx. RESULTS All prostheses were easily positioned based on the preoperative 3-D models, with no complications. At 12 months after surgery, 3 dogs were free of previous medications, 4 were still receiving steroid medications but at lower doses, and 1 was occasionally receiving acupuncture. MRI of 5 dogs 6 to 20 months after surgery revealed resolution of SM (n = 1), reduced size of SM (3), or worse SM (1). All dogs showed an increase in size of the caudal cranial fossa. Dogs with a longer presurgical duration of the clinical signs and wider syrinx generally had worse outcomes than other dogs. CLINICAL RELEVANCE Findings suggested that use of customized 3-D-printed titanium prosthesis and associated FMD can represent an adjunctive option to medically treated dogs with CM-SM. Although the small number of cases precludes definitive conclusions, early surgical treatment, particularly in dogs with a small syrinx, could ensure better long-term outcomes, as previously suggested.
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14
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Quinlan LM. The Puppy in the Pit: Osteobiography of an Eighteenth-Century Dog at the Three Cranes Tavern, Massachusetts. INTERNATIONAL JOURNAL OF HISTORICAL ARCHAEOLOGY 2021; 27:363-392. [PMID: 34785878 PMCID: PMC8581961 DOI: 10.1007/s10761-021-00636-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 05/29/2023]
Abstract
Boston's "Big Dig" construction project resulted in the excavation of multiple archaeological sites dating from the seventeenth to nineteenth centuries, including the Great House/Three Cranes Tavern in Charlestown, Massachusetts (USA). An otherwise unremarkable pit below the tavern foundation contained bones originally identified as a cat skeleton, which has subsequently been reidentified as a dog. This paper discusses site context, osteological evidence for the dog's reclassification, and the shifts in cultural meaning this may indicate. Employing an osteobiographical approach, it draws together points of connection between the modern skeletal assessment, a series of 1980s excavations, and the motivations of eighteenth-century tavern inhabitants.
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Affiliation(s)
- Liz M. Quinlan
- Archaeology, University of York, Environment Building, Wentworth Way, York, YO10 5NG UK
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15
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The link between neurology and behavior in veterinary medicine: A review. J Vet Behav 2021. [DOI: 10.1016/j.jveb.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Mortality Resulting from Undesirable Behaviours in Dogs Aged Three Years and under Attending Primary-Care Veterinary Practices in Australia. Animals (Basel) 2021; 11:ani11020493. [PMID: 33668532 PMCID: PMC7918417 DOI: 10.3390/ani11020493] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/20/2022] Open
Abstract
Simple Summary There is increasing evidence that undesirable behaviours (UBs) in dogs can compromise the welfare of both canine companions and their associated humans. Indeed, in a recent UK study of patient records from primary-care veterinary practices, UBs emerged as the predominant cause for mortality in young dogs. The current companion study of dogs attending veterinary practices in Australia from 2013 to 2018 reports a comparable proportion of mortality (29.7%) due to UBs among dogs aged three years and under. The most commonly reported UB was aggression. Neutered dogs and purebred dogs (and specifically Australian Cattle Dogs and American Staffordshire terriers) had an elevated risk of death ascribed to at least one UB. The risk factors associated with these UBs are also reported, including interventions applied by the attending clinician (if any). The results highlight the influence of UBs on dog welfare in Australia, and infer the benefits of educating dog owners and veterinary professionals in modifying and managing UBs. Abstract There is increasing evidence that undesirable behaviours (UBs) in dogs can compromise the welfare of both canine companions and their carers. Veterinarians are regularly consulted about affected animals and may be asked to euthanase the more severely affected individuals. A recent study of veterinary records showed that UBs were the predominant cause of mortality in young dogs in the UK. This companion study from Australia reports the proportion of mortality due to UBs among dogs aged three years and under that attended veterinary practices from 2013 to 2018. Deidentified patient records were extracted from the VetCompass Australia database and manually assessed to reveal the prevalence and type of UBs reported. The results reveal that 29.7% of the 4341 dogs that died at three years of age or under had deaths ascribed to at least one UB, and that the most commonly reported UB was aggression. Neutered dogs had 2.5× the odds of death due to an UB compared to intact dogs, and crossbred dogs were found to have 1.43× the odds of a UB related death compared to purebred dogs. The breeds at highest risk were Australian cattle dogs (odds ratio (OR) 4.77) and American Staffordshire terriers (OR 4.69). The attending veterinarian referred behaviour cases to a behaviourist or dog trainer in 11.0% of all UB cases, and attempted pharmacological therapy in 5.9% of cases. The results reveal how often UBs affect dogs and their owners in Australia, and infer the beneficial impact that educating dog owners and veterinary professionals in modifying and managing UBs may have.
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17
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The Need for Head Space: Brachycephaly and Cerebrospinal Fluid Disorders. Life (Basel) 2021; 11:life11020139. [PMID: 33673129 PMCID: PMC7918167 DOI: 10.3390/life11020139] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 12/12/2022] Open
Abstract
Brachycephalic dogs remain popular, despite the knowledge that this head conformation is associated with health problems, including airway compromise, ocular disorders, neurological disease, and other co-morbidities. There is increasing evidence that brachycephaly disrupts cerebrospinal fluid movement and absorption, predisposing ventriculomegaly, hydrocephalus, quadrigeminal cistern expansion, Chiari-like malformation, and syringomyelia. In this review, we focus on cerebrospinal fluid physiology and how this is impacted by brachycephaly, airorhynchy, and associated craniosynostosis.
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18
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Sparks CR, Woelfel C, Robertson I, Olby NJ. Association between filum terminale internum length and pain in Cavalier King Charles spaniels with and without syringomyelia. J Vet Intern Med 2021; 35:363-371. [PMID: 33426675 PMCID: PMC7848331 DOI: 10.1111/jvim.16023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022] Open
Abstract
Background Lumbar syringomyelia (SM), lumbosacral pain, and more caudal spinal cord termination are reported in Cavalier King Charles spaniels (CKCS). Data are lacking on the clinical relevance of alterations in their spinal cord terminal structures. Objectives To compare spinal cord termination level and filum terminale internum length (FTIL) with presence of lumbar SM and clinical signs in CKCS. Animals Forty‐eight CKCS. Methods In this prospective study, pain was quantified using owner and clinician assessments. Vertebral level of spinal cord and dural sac termination, presence of SM, and FTIL were determined from sagittal magnetic resonance imaging (MRI) sequences. Kappa and intraclass correlation (ICC) analyses determined interobserver reliability. The MRI findings were compared to owner and clinician‐reported pain quantification. Results Interobserver reliability was good for spinal cord and dural sac termination (kappa = 0.61 and 0.64, respectively) and excellent for FTIL (ICC: 92% agreement). The spinal cord terminated at 6th lumbar vertebra in 1, 7th lumbar vertebra in 31, and the sacrum in 15 dogs, and termination level was associated with lumbar SM (P = .002) but not clinical signs. Mean FTIL was 2.9 ± 1.08 mm; it was associated with owner‐reported pain (P = .033) and spinal palpation scores (P = .023). Painful CKCS without SM had shorter FTIL compared to normal CKCS and painful CKCS with SM (P = .02). Conclusions Painful CKCS without SM have decreased distance between the termination of the spinal cord and dural sac, suggesting a shorter FTIL. More caudal spinal cord termination is associated with development of lumbar SM.
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Affiliation(s)
- Courtney R Sparks
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Christian Woelfel
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Ian Robertson
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
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19
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Grapes NJ, Packer RMA, De Decker S. Clinical reasoning in canine cervical hyperaesthesia: which presenting features are important? Vet Rec 2020; 187:448. [PMID: 32917838 DOI: 10.1136/vr.105818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 07/19/2020] [Accepted: 07/23/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND To evaluate whether clinical features from the history, presentation, physical and neurological examination of dogs with cervical hyperaesthesia are statistically predictive of the underlying diagnosis. METHODS Two 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. RESULTS Ninety-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. CONCLUSIONS Easy-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.
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Affiliation(s)
- Nicholas John Grapes
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | | | - Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
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20
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Korff CP, Williamson BG. Clinical Presentation of Chiari-like Malformation in 2 Persian Cats. Top Companion Anim Med 2020; 41:100460. [PMID: 32823159 DOI: 10.1016/j.tcam.2020.100460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 10/24/2022]
Abstract
Two Persian breed cats, 10 and 5 years of age, were presented separately for difficulty prehending food as well as behavioral abnormalities including interanimal aggression and restlessness, pacing, or compulsive overgrooming. Both cats would regularly rest their head and neck in an extended position. Neurologic examination demonstrated calvarial and craniocervical junction pain in both and an L4-S3 myelopathy in one. Brain MRI of both cases, and CT and necropsy in 1 case, demonstrated ventriculomegaly and caudal fossa crowding, cerebellar indentation, and foramen magnum herniation consistent with Chiari-like malformation. No syringomyelia was present in either cat. The 2 cats were treated with anti-inflammatory doses of prednisolone with little to no clinical response, but experienced improvement with pregabalin and omeprazole. The 2 cats' clinical signs were consequently attributed to neuropathic and posture-related pain secondary to Chiari-like malformation. Persian breed cats may have a predisposition to Chiari-like malformation, which may not be solely a morphometric variant, and symptomatic cats may present with manifestations of neuropathic pain different from the classic signs reported in dogs.
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Affiliation(s)
- Courtney P Korff
- Department of Clinical Sciences, Cornell University, College of Veterinary Medicine, Ithaca, NY, USA.
| | - Baye G Williamson
- Department of Clinical Sciences, Cornell University, College of Veterinary Medicine, Ithaca, NY, USA
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21
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Tauro A, Rusbridge C. Syringopleural shunt placement in a pug with a cervical spinal diverticulum and associated syringomyelia. Clin Case Rep 2020; 8:1142-1148. [PMID: 32695345 PMCID: PMC7364096 DOI: 10.1002/ccr3.2845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 01/12/2023] Open
Abstract
We report persistence of associated syringomyelia and formation of newly caudal spinal arachnoid diverticulum, following marsupialization surgery. We describe syringopleural shunt placement as a novel approach to treat both conditions in a Pug dog.
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Affiliation(s)
- Anna Tauro
- ChesterGates Veterinary SpecialistsChesterUK
| | - Clare Rusbridge
- School of Veterinary MedicineGuildfordUK
- Fitzpatrick ReferralsEashingUK
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22
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Rusbridge C. New considerations about Chiari‐like malformation, syringomyelia and their management. IN PRACTICE 2020. [DOI: 10.1136/inp.m1869] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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23
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Mills DS, Demontigny-Bédard I, Gruen M, Klinck MP, McPeake KJ, Barcelos AM, Hewison L, Van Haevermaet H, Denenberg S, Hauser H, Koch C, Ballantyne K, Wilson C, Mathkari CV, Pounder J, Garcia E, Darder P, Fatjó J, Levine E. Pain and Problem Behavior in Cats and Dogs. Animals (Basel) 2020; 10:E318. [PMID: 32085528 PMCID: PMC7071134 DOI: 10.3390/ani10020318] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 12/13/2022] Open
Abstract
We argue that there is currently an under-reporting of the ways in which pain can be associated with problem behavior, which is seriously limiting the recognition of this welfare problem. A review of the caseloads of 100 recent dog cases of several authors indicates that a conservative estimate of around a third of referred cases involve some form of painful condition, and in some instances, the figure may be nearly 80%. The relationship is often complex but always logical. Musculoskeletal but also painful gastro-intestinal and dermatological conditions are commonly recognized as significant to the animal's problem behavior. The potential importance of clinical abnormalities such as an unusual gait or unexplained behavioral signs should not be dismissed by clinicians in general practice, even when they are common within a given breed. In general, it is argued that clinicians should err on the side of caution when there is a suspicion that a patient could be in pain by carefully evaluating the patient's response to trial analgesia, even if a specific physical lesion has not been identified.
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Affiliation(s)
- Daniel S. Mills
- Animal Behavior, Cognition & Welfare Group, University of Lincoln, Lincoln LN6 7DL, UK; (K.J.M.); (A.M.B.); (L.H.); (H.V.H.); (J.P.)
| | | | - Margaret Gruen
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC 27606, USA;
| | - Mary P. Klinck
- Veterinary Behavior Consultant, Sainte-Anne-de-Bellevue, QC H9X0A6, Canada;
| | - Kevin J. McPeake
- Animal Behavior, Cognition & Welfare Group, University of Lincoln, Lincoln LN6 7DL, UK; (K.J.M.); (A.M.B.); (L.H.); (H.V.H.); (J.P.)
| | - Ana Maria Barcelos
- Animal Behavior, Cognition & Welfare Group, University of Lincoln, Lincoln LN6 7DL, UK; (K.J.M.); (A.M.B.); (L.H.); (H.V.H.); (J.P.)
| | - Lynn Hewison
- Animal Behavior, Cognition & Welfare Group, University of Lincoln, Lincoln LN6 7DL, UK; (K.J.M.); (A.M.B.); (L.H.); (H.V.H.); (J.P.)
| | - Himara Van Haevermaet
- Animal Behavior, Cognition & Welfare Group, University of Lincoln, Lincoln LN6 7DL, UK; (K.J.M.); (A.M.B.); (L.H.); (H.V.H.); (J.P.)
| | - Sagi Denenberg
- Langford Veterinary Services, University of Bristol, Langford BS40 5DU, UK;
- North Toronto Veterinary Behavior Specialty Clinic, Thornhill, ON L3T 2K9, Canada
| | - Hagar Hauser
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104, USA;
| | - Colleen Koch
- Animal Behavior Services, Lincoln Land Animal Clinic, Jacksonville, IL 62650, USA;
| | - Kelly Ballantyne
- Insight Animal Behavior Services, P.C., 815 W. Randolph St., Chicago, IL 60607, USA;
| | | | - Chirantana V Mathkari
- Department of Animal and Avian Sciences, University of Maryland, College Park, Maryland, MD 20742, USA;
| | - Julia Pounder
- Animal Behavior, Cognition & Welfare Group, University of Lincoln, Lincoln LN6 7DL, UK; (K.J.M.); (A.M.B.); (L.H.); (H.V.H.); (J.P.)
| | - Elena Garcia
- Ars Veterinaria Hospital. Carrer dels Cavallers, 37, 08034 Barcelona, Spain; (E.G.); (P.D.); (J.F.)
| | - Patrícia Darder
- Ars Veterinaria Hospital. Carrer dels Cavallers, 37, 08034 Barcelona, Spain; (E.G.); (P.D.); (J.F.)
| | - Jaume Fatjó
- Ars Veterinaria Hospital. Carrer dels Cavallers, 37, 08034 Barcelona, Spain; (E.G.); (P.D.); (J.F.)
| | - Emily Levine
- Animal Behavior Clinic of New Jersey, 240 Humphrey St, Englewood, NJ 07631, USA;
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Knowler SP, Dumas E, Spiteri M, McFadyen AK, Stringer F, Wells K, Rusbridge C. Facial changes related to brachycephaly in Cavalier King Charles Spaniels with Chiari-like malformation associated pain and secondary syringomyelia. J Vet Intern Med 2019; 34:237-246. [PMID: 31691386 PMCID: PMC6979263 DOI: 10.1111/jvim.15632] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/23/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Recent studies including an innovative machine learning technique indicated Chiari-like malformation (CM) is influenced by brachycephalic features. OBJECTIVES Morphometric analysis of facial anatomy and dysmorphia in CM-associated pain (CM-P) and syringomyelia (SM) in the Cavalier King Charles Spaniel (CKCS). ANIMALS Sixty-six client-owned CKCS. METHODS Retrospective study of anonymized T2W sagittal magnetic resonance imaging of 3 clinical groups: (1) 11 without central canal dilation (ccd) or SM (CM-N), (2) 15 with CM-P with no SM or <2 mm ccd (CM-P), and (3) 40 with syrinx width ≥4 mm (SM-S). Morphometric analysis assessed rostral skull flattening and position of the hard and soft palate relative to the cranial base in each clinical group and compared CKCS with and without SM-S. RESULTS Sixteen of 28 measured variables were associated to SM-S compared to CM-N and CM-P. Of these 6 were common to both groups. Predictive variables determined by discriminant analysis were (1) the ratio of cranial height with cranial length (P < .001 between SM-S and CM-N) and (2) the distance between the cerebrum and the frontal bone (P < .001 between SM-S and CM-P). CM-P had the lowest mean height of the maxillary area. CONCLUSIONS AND CLINICAL IMPORTANCE CKCS with CM-P and SM-S have cranial brachycephaly with osseous insufficiency in the skull with rostral flattening and increased proximity of the hard and soft palate to the cranial base. Changes are greatest with CM-P. These findings have relevance for understanding disease pathogenesis and for selection of head conformation for breeding purposes.
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Affiliation(s)
- Susan P Knowler
- School of Veterinary Medicine, Faculty of Health & Medical Sciences, Daphne Jackson Road, Guildford, Surrey, GU7 Q22, United Kingdom
| | - Eleonore Dumas
- School of Veterinary Medicine, Faculty of Health & Medical Sciences, Daphne Jackson Road, Guildford, Surrey, GU7 Q22, United Kingdom
| | - Michaela Spiteri
- Centre for Vision, Speech, and Signal Processing, University of Surrey, Guildford, GU2 7XH, United Kingdom
| | | | - Felicity Stringer
- Fitzpatrick Referrals Orthopaedics and Neurology, Halfway Lane, Eashing, Godalming, Surrey, GU7 Q22, United Kingdom
| | - Kevin Wells
- Centre for Vision, Speech, and Signal Processing, University of Surrey, Guildford, GU2 7XH, United Kingdom
| | - Clare Rusbridge
- School of Veterinary Medicine, Faculty of Health & Medical Sciences, Daphne Jackson Road, Guildford, Surrey, GU7 Q22, United Kingdom.,Fitzpatrick Referrals Orthopaedics and Neurology, Halfway Lane, Eashing, Godalming, Surrey, GU7 Q22, United Kingdom
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Rusbridge C, McFadyen AK, Knower SP. Behavioral and clinical signs of Chiari-like malformation-associated pain and syringomyelia in Cavalier King Charles spaniels. J Vet Intern Med 2019; 33:2138-2150. [PMID: 31290195 PMCID: PMC6766577 DOI: 10.1111/jvim.15552] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 06/19/2019] [Indexed: 02/02/2023] Open
Abstract
Background Diagnosis of Chiari‐like malformation‐associated pain (CM‐P) or clinically relevant syringomyelia (SM) is challenging. We sought to determine common signs. Animals One hundred thirty client‐owned Cavalier King Charles spaniels with neuroaxis magnetic resonance imaging (MRI) and diagnosis of CM‐P/SM. Dogs with comorbidities causing similar signs were excluded with exception of otitis media with effusion (OME). Methods Retrospective study of medical records relating signalment, signs, and MRI findings. Dogs were grouped by SM maximum transverse diameter (1 = no SM; 2 = 0.5‐1.99 mm; 3 = 2‐3.9 mm: 4 = ≥4 mm). Differences between all groups—groups 1 versus 2‐4 and groups 1‐3 versus 4—were investigated. Continuous variables were analyzed using 2‐sample t‐tests and analysis of variance. Associations between categorical variables were analyzed using Fisher's exact or chi‐square tests. Results Common signs were vocalization (65.4%), spinal pain (54.6%), reduced activity (37.7%), reduced stairs/jumping ability (35.4%), touch aversion (30.0%), altered emotional state (28.5%), and sleep disturbance (22%). Head scratching/rubbing (28.5%) was inversely associated with syrinx size (P = .005), less common in group 4 (P = .003), and not associated with OME (P = .977). Phantom scratching, scoliosis, weakness, and postural deficits were only seen in group 4 (SM ≥4 mm; P = .004). Conclusions and Clinical Importance Signs of pain are common in CM/SM but are not SM‐dependent, suggesting (not proving) CM‐P causality. Wide (≥4 mm) SM is associated with signs of myelopathy and, if the dorsal horn is involved, phantom scratching (ipsilateral) and torticollis (shoulder deviated ipsilateral; head tilt contralateral).
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Affiliation(s)
- Clare Rusbridge
- Fitzpatrick Referrals, Surrey, United Kingdom.,School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Surrey, United Kingdom
| | | | - Susan P Knower
- School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Surrey, United Kingdom
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