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Schmidt MJ, Farke D. Surgical management of primary and idiopathic internal hydrocephalus in dogs and cats. Front Vet Sci 2024; 11:1435982. [PMID: 39027907 PMCID: PMC11254760 DOI: 10.3389/fvets.2024.1435982] [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: 05/21/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024] Open
Abstract
Ventriculoperitoneal shunt placement is an effective method to treat internal hydrocephalus in dogs and cats. Although it has a long history in veterinary medicine, the technique continues to evolve. Despite continuing attempts to reduce the incidence of associated complications, shunt failure remains a major problem, and often leads to multiple hospital admissions. This review gives an overview about current knowledge of ventriculoperitoneal shunting techniques in animals, applicable shunt hardware as well as shunt-associated complications and their prevention and treatment.
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Affiliation(s)
| | - Daniela Farke
- Department of Veterinary Clinical Sciences, Neurosurgery, Neuroradiology and Clinical Neurology, Small Animal Clinic, Justus-Liebig-University, Giessen, Germany
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2
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Wess L, Kneissl S. Systematic minireview of the craniocervical junction in dogs with and without brachycephaly. Front Vet Sci 2024; 11:1416670. [PMID: 38881784 PMCID: PMC11177753 DOI: 10.3389/fvets.2024.1416670] [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: 04/12/2024] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Objective To identify, quantify and compare clinical and concurrent imaging findings of occipital hypoplasia (OH), syringomyelia (SM) and atlanto-occipital overlapping (AO) in dogs with or without brachycephaly. Methods A focused systematic search for literature was performed in the Web of Science™, PubMed and Google Scholar databases. Both authors screened and classified the identified articles using EndNote and appraised the articles using the Critical Appraisal Skills Program checklists. The main clinical and concurrent imaging features were extracted and evaluated for coexistence of OH, SM, AO, and other imaging findings. Results Thirty-one articles were included in this minireview. For articles focusing on descriptions of OH, SM and AO, 249 dogs had at least one of these conditions, and 3 of these 249 dogs (1%) had coexistence of all three conditions. For articles focusing on descriptions of the dogs, OH, SM, and AO were identified in 552/19/11/11, 574/2/0/6, and 100/0/0/0 small brachycephalic, small non-brachycephalic, large brachycephalic, and large non-brachycephalic breeds, respectively. For all small brachycephalic dogs, the percentages of affected animals were 40% for OH (p = 0.01), 42% for SM (p < 0.01) and 7% for AO (p = 0.033). The number of dogs having AO and clinical symptoms is low (n = 5). Conclusion OH, SM and AO are more likely to affect small dogs. AO might be limited to small brachycephalic breeds owing to the geometry of the craniocervical junction. Hence, AO alone might not lead to SM. In individual dogs, readers should carefully interpret the clinical relevance of OH or AO in the absence of SM.
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Affiliation(s)
- Lukas Wess
- Diagnostic Imaging, Department of Small Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Sibylle Kneissl
- Diagnostic Imaging, Department of Small Animals and Horses, University of Veterinary Medicine, Vienna, Austria
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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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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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Hobi S, Barrs VR, Bęczkowski PM. Dermatological Problems of Brachycephalic Dogs. Animals (Basel) 2023; 13:2016. [PMID: 37370526 DOI: 10.3390/ani13122016] [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: 05/12/2023] [Revised: 06/01/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Brachycephalic dogs are not only affected by brachycephalic obstructive airway syndrome (BOAS), but are also frequently referred to veterinary dermatologists for skin conditions, with English bulldogs and pugs particularly over-represented. Some skin diseases, such as skin fold dermatitis, are directly associated with the abnormal anatomic conformation of brachycephalic dogs, while for others, such as atopic dermatitis and viral pigmented plaques, there is an underlying genetic basis or a general predisposition. Anatomic alterations associated with brachycephaly, leading to fold formation of the skin and stenosis of the ear canal, together with primary immunodeficiencies described in some breeds, favor the development of pyoderma, Malassezia dermatitis, and otitis externa/media. In addition, the frequently neglected but often lifelong dermatological problems of brachycephalic dogs are an important consideration when discussing genetic and medical conditions affecting the welfare of those dogs. Here we review the current state of knowledge concerning dermatological problems in brachycephalic dogs and combine it with clinical experience in the management of these challenging disorders.
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Affiliation(s)
- Stefan Hobi
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong SAR, China
| | - Vanessa R Barrs
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong SAR, China
- Centre for Animal Health and Welfare, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong SAR, China
| | - Paweł M Bęczkowski
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong SAR, China
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Heiss JD. Cerebrospinal Fluid Hydrodynamics in Chiari I Malformation and Syringomyelia: Modeling Pathophysiology. Neurosurg Clin N Am 2023; 34:81-90. [PMID: 36424067 PMCID: PMC9708110 DOI: 10.1016/j.nec.2022.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anatomic MRI, MRI flow studies, and intraoperative ultrasonography demonstrate that the Chiari I malformation obstructs CSF pathways at the foramen magnum and prevents normal CSF movement through the foramen magnum. Impaired CSF displacement across the foramen magnum during the cardiac cycle increases pulsatile hindbrain motion, pressure transmission to the spinal subarachnoid space, and the amplitude of CSF subarachnoid pressure waves driving CSF into the spinal cord. Central canal septations in adults prevent syrinx formation by CSF directly transmitting its pressure wave from the fourth ventricle to the central canal.
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Affiliation(s)
- John D Heiss
- Clinical Unit, Surgical Neurology Branch, National Institute of Neurological Diseases and Stroke, National Institutes of Health, 10 Center Drive, Room 3D20, MSC-1414, Bethesda, MD 20892, USA.
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Wrzosek MA, Banasik AE, Owsińska-Schmidt K, Zimny A. Diffusion Tensor Imaging in Syringomyelia Secondary to Chiari Malformation in Cavalier King Charles Spaniel-A Preliminary Study. Animals (Basel) 2022; 12:ani12233405. [PMID: 36496926 PMCID: PMC9740166 DOI: 10.3390/ani12233405] [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: 10/30/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Syringomyelia secondary to Chiari-like malformation (so-called CM-SM syndrome) is a common disorder in Cavalier King Charles Spaniels (CKCS) that is diagnosed using standard structural MRI, though imaging findings often do not correlate with the severity of clinical symptoms. Diffusion tensor imaging (DTI) is a technique that defines subtle microstructural changes in the course of many brain and spinal cord diseases, that are not visible on standard MRI. The aim of the study was to identify the correlation between the presence of clinical symptoms and DTI parameters, such as apparent diffusion coefficient (ADC) and fractional anisotropy (FA) within the spinal cord in the course of CM-SM. Study subjects included 18 dogs, CKCS with MRI-confirmed SM (SM group), and 12 CKCS dogs without SM (non-SM group). The SM group was divided into SM-symptomatic group (n = 8) and SM-asymptomatic group, n = 10). All dogs underwent same clinical and neurological assessment followed by MRI examination. All MRI studies were performed on a 1.5T MRI scanner. The MRI spine protocol included: transverse and sagittal T2-weighted images followed by DTI performed in the sagittal plane. The measurements of FA and ADC values were performed manually using the region of interest (ROI) method at the level of three intervertebral discs between C1 and C4. Notable differences in age and body weight were found. No significant differences in FA and ADC values between the SM and non-SM groups were found, but between non-SM, SM-asymptomatic and SM-symptomatic groups significant differences were found in ADC values in all three ROIs and in FA values in ROI-1 and ROI-3. SM-symptomatic dogs compared to non-SM, showed decreased FA value in ROI-1 and ROI-3 also increased ADC value in ROI-1, ROI-2 and ROI-3. SM-symptomatic dogs compared to SM-asymptomatic showed also decreased FA value in ROI-1 and ROI-3, and also increased ADC value in ROI-1, ROI-2 and ROI-3. The results suggest that the values of DTI parameters correlate with the severity of clinical symptoms in the course of CM-SM in animals. The use of DTI evaluation of CM-SM patients carries a potential value as a clinically relevant protocol for an objective assessment of the spinal cord.
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Affiliation(s)
- Marcin Adam Wrzosek
- Department of Internal Diseases with a Clinic for Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, 50-366 Wrocław, Poland
- Correspondence:
| | - Aleksandra Ewa Banasik
- Department of Internal Diseases with a Clinic for Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, 50-366 Wrocław, Poland
| | - Karolina Owsińska-Schmidt
- Department of Internal Diseases with a Clinic for Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, 50-366 Wrocław, Poland
| | - Anna Zimny
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, 50-551 Wrocław, Poland
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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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Neville V, Mounty J, Benato L, Hunter K, Mendl M, Paul ES. Thinking outside the lab: Can studies of pet rats inform pet and laboratory rat welfare? Appl Anim Behav Sci 2022. [DOI: 10.1016/j.applanim.2021.105507] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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10
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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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Fisher AS, Lanigan MT, Upton N, Lione LA. Preclinical Neuropathic Pain Assessment; the Importance of Translatability and Bidirectional Research. Front Pharmacol 2021; 11:614990. [PMID: 33628181 PMCID: PMC7897667 DOI: 10.3389/fphar.2020.614990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/10/2020] [Indexed: 02/04/2023] Open
Abstract
For patients suffering with chronic neuropathic pain the need for suitable novel therapies is imperative. Over recent years a contributing factor for the lack of development of new analgesics for neuropathic pain has been the mismatch of primary neuropathic pain assessment endpoints in preclinical vs. clinical trials. Despite continuous forward translation failures across diverse mechanisms, reflexive quantitative sensory testing remains the primary assessment endpoint for neuropathic pain and analgesia in animals. Restricting preclinical evaluation of pain and analgesia to exclusively reflexive outcomes is over simplified and can be argued not clinically relevant due to the continued lack of forward translation and failures in the clinic. The key to developing new analgesic treatments for neuropathic pain therefore lies in the development of clinically relevant endpoints that can translate preclinical animal results to human clinical trials. In this review we discuss this mismatch of primary neuropathic pain assessment endpoints, together with clinical and preclinical evidence that supports how bidirectional research is helping to validate new clinically relevant neuropathic pain assessment endpoints. Ethological behavioral endpoints such as burrowing and facial grimacing and objective measures such as electroencephalography provide improved translatability potential together with currently used quantitative sensory testing endpoints. By tailoring objective and subjective measures of neuropathic pain the translatability of new medicines for patients suffering with neuropathic pain will hopefully be improved.
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Affiliation(s)
- Amy S. Fisher
- Transpharmation Ltd., The London Bioscience Innovation Centre, London, United Kingdom
| | - Michael T. Lanigan
- Transpharmation Ltd., The London Bioscience Innovation Centre, London, United Kingdom
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Neil Upton
- Transpharmation Ltd., The London Bioscience Innovation Centre, London, United Kingdom
| | - Lisa A. Lione
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
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12
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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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13
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Schmierer PA, Tünsmeyer J, Tipold A, Hartnack-Wilhelm S, Lesczuk P, Kästner SBR. Randomized controlled trial of pregabalin for analgesia after surgical treatment of intervertebral disc disease in dogs. Vet Surg 2020; 49:905-913. [PMID: 32329092 DOI: 10.1111/vsu.13411] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 01/15/2020] [Accepted: 02/25/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the effect of perioperative pregabalin on pain behavior in dogs after intervertebral disc surgery. STUDY DESIGN Prospective, randomized, controlled clinical trial with a blinded observer. ANIMALS Forty-six client-owned dogs undergoing intervertebral disc surgery. METHODS Dogs were randomly assigned to two groups, with the placebo group receiving opioids alone and the pregabalin group receiving opioids plus pregabalin. Opioid analgesia consisted of 0.6 mg/kg l-methadone given intravenously at anesthetic induction, followed by 0.2 mg/kg given at 8, 16, and 24 hours after extubation and fentanyl patches applied at the end of surgery. Pregabalin was given orally (4 mg/kg) 1 hour before anesthesia, followed by postoperative treatment three times per day (4 mg/kg) for 5 days. The outcome measures were the treatment-group differences in peri-incisional mechanical sensitivity and Glasgow Composite Measure Pain Scale (CMPS-SF) assessed during the first 5 postoperative days. Pregabalin serum concentrations were measured after 24, 72, and 120 hours. RESULTS Pregabalin reduced pain levels in the treatment group by a mean of 2.5 CMPS-SF units (95% confidence interval [CI] = -3.19 to -1.83, P < .001) compared with the control group during the study period. Pregabalin increased the mechanical nociceptive threshold by a mean of 6.89 N per day (95% CI = 1.87-11.92, P < .001) and of 7.52 N per day (95% CI = 2.29-12.77, P < .001) during the study period, depending on location. Mean levels of serum pregabalin were 5.1, 4.71, and 3.68 μg/mL at 24, 72, and 120 hours postoperatively, respectively. CONCLUSION Postoperative signs of pain after surgical treatment of intervertebral disc herniation (IVDH) were reduced when dogs received perioperative pregabalin rather than opioids alone. CLINICAL SIGNIFICANCE Perioperative pregabalin reduces postoperative pain after surgical treatment of IVDH.
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Affiliation(s)
- Philipp A Schmierer
- Clinic for Small Animal Surgery, Vetsuisse Faculty University of Zurich, Zurich, Switzerland.,Tierklinik Posthausen, Posthausen, Germany
| | - Julia Tünsmeyer
- Small Animal Clinic, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Andrea Tipold
- Small Animal Clinic, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Sonja Hartnack-Wilhelm
- Department for Biostatistics, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - Piotr Lesczuk
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Department of Neurodegeneration Diagnostics, Medical University of Bialystok, Bialystok, Poland.,Department of Biochemical Diagnostics, University Hospital of Bialystok, Bialystok, Poland
| | - Sabine B R Kästner
- Small Animal Clinic, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
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Hechler AC, Hostnik ET, Cook LB, Cole LK, Moore SA. Mechanical quantitative sensory testing in cavalier King Charles spaniels with and without syringomyelia. BMC Vet Res 2020; 16:94. [PMID: 32197618 PMCID: PMC7085174 DOI: 10.1186/s12917-020-02313-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Syringomyelia (SM) is a debilitating condition in the cavalier King Charles spaniel (CKCS) that results in neuropathic pain and diminished quality of life. Von Frey aesthesiometry (VFA) is a method of mechanical quantitative sensory testing that provides an objective sensory threshold (ST) value and can be used to quantify neuropathic pain (NP) and monitor response to therapy. The utility of VFA has been previously established in client-owned dogs with acute spinal cord injury but the technique has not been evaluated in dogs with SM. The goal of this study was to evaluate ST, as determined by VFA, in dogs with and without SM, to assess the utility of VFA in quantifying NP in SM-affected dogs. We hypothesized the SM-affected CKCS would have lower ST values, consistent with hyperesthesia, when compared to control CKCS. Additionally, we hypothesized that ST values in SM-affected dogs would be inversely correlated with syrinx size on MRI and with owner-derived clinical sign scores. RESULTS ST values for the thoracic and pelvic limbs differed significantly between the SM-affected and control CKCS (p = 0.027; p = 0.0396 respectively). Median ST value (range) for the thoracic limbs was 184.1 g (120.9-552) for control dogs, and 139.9 g (52.6-250.9) for SM-affected dogs. The median ST value (range) for the pelvic limbs was 164.9 g (100.8-260.3) in control dogs and 129.8 g (57.95-168.4) in SM-affected dogs. The ST values in SM-affected dogs did not correlate with syrinx height on MRI (r = 0.314; p = 0.137). Owner-reported clinical sign scores showed an inverse correlation with pelvic limb ST values, where dogs with lower ST values (hyperesthesia) were reported by their owners to display more frequent and severe clinical signs (r = - 0.657; p = 0.022). CONCLUSION ST values were lower in SM-affected CKCS compared to control dogs, suggesting the presence of neuropathic pain. Dogs with lower ST pelvic limb values were perceived by their owners to have more severe clinical signs classically associated with SM. Our results suggest that VFA might offer quantitative assessment of neuropathic pain in SM-affected dogs and could be useful for monitoring response to therapy in future clinical studies.
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Affiliation(s)
- Ashley C Hechler
- The Ohio State University Veterinary Medical Center, 601 Vernon L. Tharp Street, Columbus, OH, 43221, USA
| | - Eric T Hostnik
- The Ohio State University Veterinary Medical Center, 601 Vernon L. Tharp Street, Columbus, OH, 43221, USA
| | - Laurie B Cook
- The Ohio State University Veterinary Medical Center, 601 Vernon L. Tharp Street, Columbus, OH, 43221, USA
| | - Lynette K Cole
- The Ohio State University Veterinary Medical Center, 601 Vernon L. Tharp Street, Columbus, OH, 43221, USA
| | - Sarah A Moore
- The Ohio State University Veterinary Medical Center, 601 Vernon L. Tharp Street, Columbus, OH, 43221, USA.
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15
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Thoefner MS, Skovgaard LT, McEvoy FJ, Berendt M, Bjerrum OJ. Pregabalin alleviates clinical signs of syringomyelia-related central neuropathic pain in Cavalier King Charles Spaniel dogs: a randomized controlled trial. Vet Anaesth Analg 2019; 47:238-248. [PMID: 32005620 DOI: 10.1016/j.vaa.2019.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 09/12/2019] [Accepted: 09/21/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE We aimed to assess the efficacy and benefit-risk profile of pregabalin (PGN) to reduce the clinical signs of central neuropathic pain (CNeP) as reflected by scratching episodes in dogs with symptomatic syringomyelia (SM). STUDY DESIGN Randomized, double-blind, placebo-controlled crossover study. ANIMALS A total of 12 client-owned Cavalier King Charles Spaniels (age, 1.1-7.4 years, bodyweight, 8.2-10.8 kg) with magnetic resonance imaging-confirmed SM and clinical signs of CNeP. METHODS Dogs were randomized to either PGN 150 mg or placebo for 25 days, followed by 48 hour washout period before crossover to the alternate phase of 25 days. The primary outcome was defined as number of scratching events during 10 minutes of video-recorded physical activity. Treatment effect was estimated using a generalized estimation equation model. Benefit-risk and quality of life assessments were obtained through owner interviews focusing on potential adverse events. RESULTS The treatment effect estimate was an 84% (95% confidence interval = 75-89%) reduction in mean number of scratching events relative to baseline compared with placebo (p < 0.0001). Owner-assessed satisfactory quality of life was status quo and rated as 'good' or 'could not be better' in six/11 dogs and improved in four/11 dogs. The most prevalent adverse events were increased appetite in nine/12 dogs and transient ataxia in nine/12 dogs. There was one dog withdrawn by the owner 7 days after crossover to PGN owing to persistent ataxia. No dogs needed rescue analgesia during the trial. CONCLUSIONS AND CLINICAL RELEVANCE PGN is superior to placebo in the reduction of clinical signs of SM-related CNeP in dogs. At a dose range of 13-19 mg kg-1 orally twice daily, the encountered adverse events were acceptable to all but one owner.
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Affiliation(s)
- Maria S Thoefner
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Lene T Skovgaard
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Fintan J McEvoy
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Berendt
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole J Bjerrum
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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16
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Girod M, Allerton F, Vangrinsven E, Tutunaru AC, de Marchin J, Gómez-Fernández-Blanco C, Ruiz-Nuño A, Wojnicz A, Farnir F, Gommeren K, Peeters D. CSF omeprazole concentration and albumin quotient following high dose intravenous omeprazole in dogs. Res Vet Sci 2019; 125:266-271. [PMID: 31326702 DOI: 10.1016/j.rvsc.2019.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 06/09/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
Clinical signs of syringomyelia and hydrocephalus occur secondary to cerebrospinal fluid (CSF) accumulation within the central nervous system. Omeprazole is recommended to treat these conditions despite little evidence of its capacity to decrease CSF production in the dog. Studies into new treatments are hampered by difficulties in measuring CSF production. The albumin quotient (QAlb), the ratio between CSF and serum albumin concentrations, may reflect CSF production and any decrease in CSF production should be associated with an increase in QAlb. The primary objective of this study was to determine CSF omeprazole concentration after administration of a high intravenous dose of omeprazole and to evaluate its impact on QAlb in the dog. The second aim was to validate QAlb as a surrogate marker of CSF production. Eighteen dogs were included in this prospective crossover placebo-controlled study. Each dog received omeprazole (10 mg/kg), acetazolamide (50 mg/kg) combined with furosemide (1 mg/kg) and saline. Blood and CSF samples were obtained on day 0 and then every 7 days, one hour after drug administration. Omeprazole concentrations (2.0 ± 0.4 μmol/L) reached in CSF after high dose omeprazole were lower than the concentrations previously described as decreasing CSF production in dogs. There was no significant increase in QAlb following administration of acetazolamide/furosemide, prohibiting validation of QAlb as a surrogate marker for CSF production. Several dogs presented transient mild side effects after injection of acetazolamide/furosemide. High dose omeprazole was well tolerated in all dogs.
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Affiliation(s)
- M Girod
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Quartier Vallée 2, avenue de Cureghem 3, B44, 4000 Liège, Belgium.
| | - F Allerton
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Quartier Vallée 2, avenue de Cureghem 3, B44, 4000 Liège, Belgium
| | - E Vangrinsven
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Quartier Vallée 2, avenue de Cureghem 3, B44, 4000 Liège, Belgium
| | - A C Tutunaru
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Quartier Vallée 2, avenue de Cureghem 3, B44, 4000 Liège, Belgium
| | - J de Marchin
- Labocit, Citadelle Hospital, Boulevard du 12ème de ligne, 1, 4000 Liège, Belgium
| | - C Gómez-Fernández-Blanco
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Quartier Vallée 2, avenue de Cureghem 3, B44, 4000 Liège, Belgium
| | - A Ruiz-Nuño
- Servicio Farmacología Clínica, Hospital Universitario de la Princesa, planta 7ª, Diego de León, 62, 28006 Madrid, Spain
| | - A Wojnicz
- Servicio Farmacología Clínica, Hospital Universitario de la Princesa, planta 7ª, Diego de León, 62, 28006 Madrid, Spain
| | - F Farnir
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Quartier Vallée 2, avenue de Cureghem 3, B44, 4000 Liège, Belgium
| | - K Gommeren
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Quartier Vallée 2, avenue de Cureghem 3, B44, 4000 Liège, Belgium
| | - D Peeters
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Quartier Vallée 2, avenue de Cureghem 3, B44, 4000 Liège, Belgium
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17
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Pregabalin for the treatment of syringomyelia-associated neuropathic pain in dogs: A randomised, placebo-controlled, double-masked clinical trial. Vet J 2019; 250:55-62. [PMID: 31383420 DOI: 10.1016/j.tvjl.2019.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 06/27/2019] [Accepted: 06/30/2019] [Indexed: 11/22/2022]
Abstract
Pregabalin is the first-line treatment for neuropathic pain (NeP) in humans. Dogs with Chiari-like malformation and syringomyelia (CM/SM) associated with NeP could benefit from pregabalin. The aim of this study was to evaluate the efficacy of pregabalin for NeP in dogs with CM/SM. Eight dogs with symptomatic CM/SM were included in a double-masked, randomised, crossover placebo-controlled clinical trial. All dogs received anti-inflammatory drugs as base-line treatment during placebo or pregabalin phase of 14±4 days each. Analgesic efficacy was assessed with a daily numerical rating scale (NRS) recorded by dog owners (0-10, 10=worst pain) and quantitative sensory testing at baseline, placebo and pregabalin phases. Blood samples were collected to report pregabalin exposure and to assess renal function. Daily NRS scores recorded by dog owners in the pregabalin group were lower than in the placebo group (P=0.006). Mechanical thresholds were higher with pregabalin compared to baseline or placebo (P=0.037, P<0.001). Cold latency at 15°C was prolonged on the neck and humeri with pregabalin compared to baseline (P<0.001 for both) or placebo (P=0.02, P=0.0001). Cold latency at 0°C was longer on pregabalin compared to baseline and placebo (P=0.001, P=0.004). There was no pregabalin accumulation between first and last dose. This study demonstrates the efficacy of pregabalin for the treatment of NeP due to CM/SM on daily pain scores recorded by dog owners. Pregabalin significantly reduced mechanical hyperalgesia, cold hyperalgesia (0°C) and allodynia (15°C) compared to placebo. Pregabalin was non-cumulative and well tolerated with occasional mild sedation.
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18
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Sparks CR, Robertson I, Olby NJ. Morphometric analysis of spinal cord termination in Cavalier King Charles Spaniels. J Vet Intern Med 2019; 33:717-725. [PMID: 30758868 PMCID: PMC6430917 DOI: 10.1111/jvim.15437] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 01/18/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There is an association between Chiari malformations, syringomyelia (CMSM) and tethered cord syndrome (TCS) in people, suggesting Cavalier King Charles Spaniels (CKCS) with CMSM could also have TCS. Currently there are no data on the position of the caudal spinal cord structures in CKCS. OBJECTIVE To describe and compare location of spinal cord termination in CKCS with weight-matched controls and to examine the relationship between SM and spinal cord termination. ANIMALS Thirty-nine CKCS and 33 controls with thoracolumbar MRIs; 34 of 39 CKCS also had cervical MRIs. METHODS Blinded retrospective study. Spinal cord and dural sac termination were determined from T2-weighted sagittal and transverse images and half-Fourier acquisition single-shot turbo spin echo sequences. Intra-observer reliability was determined using kappa analysis. Presence of SM was compared with location of spinal cord and dural sac termination. RESULTS Intra-observer reliability was moderate for identifying spinal cord termination (Kappa = 0.6) and good for dural sac termination (Kappa = 0.8). The spinal cord terminated at lumbar vertebra 6 (L6) in 1, 7 (L7) in 22, and sacrum in 16 CKCS versus 9 at L6, 23 at L7, 1 at sacrum in controls. Spinal cord (P < .001) and dural sac (P = .002) termination were significantly more caudal in CKCS compared to controls. The presence of thoracolumbar SM was associated with more caudal dural sac termination in CKCS (P = .03). CONCLUSIONS AND CLINICAL IMPORTANCE The relationship between TL SM and possible spinal cord tethering because of a more caudal dural sac termination should be investigated.
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Affiliation(s)
- Courtney R Sparks
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Ian Robertson
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, North Carolina
| | - Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
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19
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Thoefner MS, Westrup U, Toft N, Bjerrum OJ, Berendt M. Mechanical sensory threshold in Cavalier King Charles spaniels with syringomyelia-associated scratching and control dogs. Vet J 2019; 246:92-97. [PMID: 30902196 DOI: 10.1016/j.tvjl.2019.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/13/2019] [Accepted: 01/28/2019] [Indexed: 02/06/2023]
Abstract
It is assumed that Cavalier King Charles spaniels with Chiari-like malformation and syringomyelia experience central neuropathic pain. An association between spinal cord parenchymal lesions and specific clinical signs (e.g. spontaneous and evoked scratching, withdrawal, and paroxysmal pain manifestations with vocalisation) has been suggested. This led to the hypothesis that mechanical sensory threshold is altered in clinical cases. The aim of this study was to quantify the cervical mechanical sensory threshold using Semmes-Weinstein monofilaments in nine Cavalier King Charles spaniels with Chiari-like malformation and assumed syringomyelia-associated central neuropathic pain compared to eight control dogs. Clinical and neurological examination including magnetic resonance imaging was undertaken. Mean mechanical sensory threshold was not significantly different between case and control dogs (t-test on log10 transformed data; P=0.25). Substantial variation within and between dogs was seen, with individual thresholds ranging from 0.04 to 26g in case dogs and from 0.02 to 10g in control dogs. Based on these results, it is unlikely that Cavalier King Charles spaniels with Chiari-like malformation and syringomyelia have increased mechanical sensation characterised by lower mechanical sensory threshold when quantified with Semmes-Weinstein monofilaments. Whether clinical cases experience central neuropathic pain remains unknown. The assessment of sensory function in dogs with assumed central neuropathic pain should be multimodal and include not only mechanical but also tactile and thermal threshold quantification. The use of threshold quantification in a clinical setting is challenging due to an insufficient signal relative to the biological background noise within and between dogs.
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Affiliation(s)
- M S Thoefner
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlaegevej 16, 1870 Frederiksberg C, Denmark.
| | - U Westrup
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlaegevej 16, 1870 Frederiksberg C, Denmark
| | - N Toft
- Toft Analytics, Noerrevangsvej 8, 3500 Vaerloese, Denmark
| | - O J Bjerrum
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen E, Denmark
| | - M Berendt
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlaegevej 16, 1870 Frederiksberg C, Denmark
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20
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Taguchi T, Koh R, Takawira C, Rademacher N, Gilad GM, Aronson RD, Lopez MJ. Agmatine for Pain Management in Dogs With Coxofemoral Joint Osteoarthritis: A Pilot Study. Front Vet Sci 2018; 5:311. [PMID: 30631768 PMCID: PMC6315183 DOI: 10.3389/fvets.2018.00311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/26/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Pain from coxofemoral joint (CFJ) osteoarthritis (OA) characteristic of canine hip dysplasia (CHD) afflicts many dogs. Intervertebral disc (IVD) degeneration is a common CFJ OA comorbidity. Non-steroidal anti-inflammatory drug (NSAID) administration is standard for treatment of pain from degenerative joint disease. Potential side effects and tolerance from prolonged administration drive efforts to identify compounds that may be alternatives to or combined with NSAIDs. Agmatine, decarboxylated arginine, reportedly alleviates neuropathic pain, a likely component of OA pain. The objective of this study was to compare treatment response to agmatine and carprofen in dogs with varying degrees of CFJ OA with or without IVD degeneration and to test the hypothesis that agmatine improves hindlimb use comparably to carprofen and more than placebo. Methods: Nine hound-type dogs received oral carprofen (4.4 mg/kg, sid) for 7 days. Six months later, oral agmatine sulfate (25 mg/kg, bid) or placebo (hydroxypropyl methylcellulose, bid) was administered to the same dogs for 28 days with a 2 week washout period between treatments. Validated pain assessment scores were measured before treatment and every seven days throughout the treatment periods. Serum chemistry levels and ground reaction forces (GRF) were quantified before and after each treatment period. A board-certified radiologist quantified radiographic CFJ OA based on Orthopedic Foundation for Animals criteria and IVD degeneration on magnetic resonance images. GRFs were compared among treatments at each time point and among time points for each treatment. Results: There were no detectable adverse effects with any treatment. Significant results included improved GRFs in dogs with mild CFJ OA (N = 3) following agmatine administration compared to carprofen or placebo and a trend for improved GRFs in dogs with moderate CFJ OA (N = 2) following carprofen vs. agmatine or placebo. Neither agmatine nor carprofen improved GRFs in dogs with severe CFJ OA (N = 4). The GRFs improved in dogs with IVD degeneration (N = 3) following carprofen treatment compared to agmatine or placebo regardless of CFJ OA score, but no effect was observed in dogs with normal lumbar spines (N = 6). Conclusions: Results support agmatine over carprofen treatment to improve limb use in dogs with early or mild CFJ OA, while carprofen may be the better choice for dogs with moderate CFJ OA or IVD degeneration regardless of CFJ OA severity.
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Affiliation(s)
- Takashi Taguchi
- Laboratory for Equine and Comparative Orthopedic Research, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
| | - Ronald Koh
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
| | - Catherine Takawira
- Laboratory for Equine and Comparative Orthopedic Research, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
| | - Nathalie Rademacher
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
| | - Gad M Gilad
- Gilad & Gilad LLC, Henderson, NV, United States
| | - Randy D Aronson
- P.A.W.S. (Partners in Animal Wellness Services) Veterinary Center, Tucson, AZ, United States
| | - Mandi J Lopez
- Laboratory for Equine and Comparative Orthopedic Research, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
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21
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Sparks CR, Gorney A, Williams K, Griffith EH, Cerda-Gonzalez S, Lascelles BDX, Olby NJ. Investigation of sensory thresholds in Cavalier King Charles Spaniels with and without Chiari-like malformations and syringomyelia. J Vet Intern Med 2018; 32:2021-2028. [PMID: 30307645 PMCID: PMC6272044 DOI: 10.1111/jvim.15297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/01/2018] [Accepted: 07/17/2018] [Indexed: 11/29/2022] Open
Abstract
Background Cavalier King Charles Spaniels (CKCS) suffer pain associated with Chiari‐like malformation and syringomyelia (CMSM). People suffer from a similar condition and describe numerous sensory abnormalities. Sensory changes have not been quantified in affected CKCS. Objectives To use quantitative sensory testing (QST) to quantify thermal and mechanical thresholds in CKCS and to compare QST in dogs with and without syringomyelia (SM). Animals Forty‐four CKCS. Methods Prospective study. Dogs underwent neurological examinations and craniocervical magnetic resonance imaging (MRI). Thermal testing was performed over the humerus and thorax (n = 32); mechanical testing was performed on the paw and neck (n = 44). Latencies, thresholds, and response rates were compared with presence and severity of SM on MRI, presence of pain reported by the owner and pain identified on examination. Results Thirty dogs had SM, 30 were painful on examination, 29 were owner‐reported symptomatic. Thermal and mechanical variables were not significantly different based on presence or severity of SM. Dogs with pain on examination had decreased mechanical thresholds on the paw (0.38 kg, SD = 0.18) and neck (2.05 kg, SD = 0.74) compared to thresholds of dogs without pain on examination on the paw (0.60 kg, SD = 0.30) and neck (2.72 kg, SD = 0.57; P = .021). Conclusions and Clinical Importance Mechanical and thermal sensitivity does not appear to be related to the presence of SM, but mechanical sensitivity appears to be related to the presence of pain and clinical signs. Mechanical testing may be useful for assessing sensory abnormalities during clinical trials.
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Affiliation(s)
- Courtney R Sparks
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Angela Gorney
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Kim Williams
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Emily H Griffith
- Department of Statistics, North Carolina State University, Raleigh, North Carolina
| | - Sofia Cerda-Gonzalez
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - B Duncan X Lascelles
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina.,Comparative Pain Research and Education Center, North Carolina State University, Raleigh, North Carolina
| | - Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina.,Comparative Pain Research and Education Center, North Carolina State University, Raleigh, North Carolina
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22
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Bradbrook C, Clark L. State of the art analgesia-Recent developments pharmacological approaches to acute pain management in dogs and cats: Part 2. Vet J 2018; 236:62-67. [PMID: 29871752 DOI: 10.1016/j.tvjl.2018.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
Abstract
There has been considerable interest in the area of acute pain management over recent years, focusing on pain assessment, pharmacological and non-pharmacological interventions. The evidence base for our clinical decision making and treatment of patients is ever increasing and becoming more robust. There is still a tendency to base some aspects of pain management on poor quality evidence and this requires further input in years to come. With new literature come new ideas and this review will detail the current knowledge base behind pharmacological management of acute pain in dogs and cats. The known mechanisms of action of each analgesic and its evidence will be considered. The second part of this review will consider the non-traditional analgesics, describing their component drugs individually, thereby focusing on their mechanisms of action and the current evidence for their use in acute pain management.
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Affiliation(s)
| | - L Clark
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Herts, SG5 3HR, UK
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23
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Cockburn A, Smith M, Rusbridge C, Fowler C, Paul ES, Murrell JC, Blackwell EJ, Casey RA, Whay HR, Mendl M. Evidence of negative affective state in Cavalier King Charles Spaniels with syringomyelia. Appl Anim Behav Sci 2018. [DOI: 10.1016/j.applanim.2017.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Hechler AC, Moore SA. Understanding and Treating Chiari-like Malformation and Syringomyelia in Dogs. Top Companion Anim Med 2018; 33:1-11. [DOI: 10.1053/j.tcam.2018.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 11/11/2022]
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25
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Alisauskaite N, Spitzbarth I, Baumgärtner W, Dziallas P, Kramer S, Dening R, Stein VM, Tipold A. Chronic post-traumatic intramedullary lesions in dogs, a translational model. PLoS One 2017; 12:e0187746. [PMID: 29166400 PMCID: PMC5699804 DOI: 10.1371/journal.pone.0187746] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 10/25/2017] [Indexed: 12/21/2022] Open
Abstract
Objectives Post-traumatic intramedullary myelopathies and cavitations are well described lesions following spinal cord injury (SCI) in humans and have been described in histopathological evaluations in dogs. Human intramedullary myelopathies/cavitations are associated with severe initial SCI and deterioration of clinical signs. Canine intervertebral disc extrusions share similarities with SCI in humans. In this descriptive study, magnetic resonance imaging (MRI) findings in spinal cords of dogs suffering from chronic post-traumatic myelopathies, including cavitations, are elucidated. An additional aim of the study was to compare diagnostic imaging and histopathological findings and identify similarities between human and canine chronic post-traumatic spinal cord lesions. Methods Thirty-seven dogs with thoracolumbar SCI and one or more 3Tesla MRI investigations more than 3 weeks after SCI were included. Extent of intramedullary lesions and particularly cavitations were evaluated and measured in sagittal and transverse MRI planes. These data were compared with clinical data. Results A total of 91.9% of study patients developed chronic intramedullary lesions, and 86.5% developed intramedullary cavitations. Paraplegia without deep pain perception at initial examination was significantly associated with longer chronic myelopathies/cavitations (P = 0.002/P = 0.008), and with larger maximal cross-sectional area (mCSA) of the lesions (P = 0.041/0.005). In addition, a non-ambulatory status after decompressive surgery was also associated with the development of longer intramedullary lesions/cavitations (P<0.001) and larger lesion mCSA (P<0.001/P = 0.012). All dogs with negative outcome developed myelopathies/cavitations. In the group of 21 dogs with positive outcome, 3 did not develop any myelopathies, and 5 did not develop cavitations. Conclusions Development of chronic intramedullary lesions/cavitations are common findings in canine SCI. Extensive chronic intramedullary lesions/cavitations reflect a severe initial SCI and negative clinical outcome. This supports the hypothesis that chronic spinal cord changes following SCI in humans share similarities with canine chronic spinal cord changes after spontaneous intervertebral disc extrusion.
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Affiliation(s)
- Neringa Alisauskaite
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
- * E-mail:
| | - Ingo Spitzbarth
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
- Centre for Systems Neuroscience, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Wolfgang Baumgärtner
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
- Centre for Systems Neuroscience, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Peter Dziallas
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Sabine Kramer
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Ricarda Dening
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Veronika Maria Stein
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
- Centre for Systems Neuroscience, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
- Centre for Systems Neuroscience, University of Veterinary Medicine Hannover, Hannover, Germany
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Sparks CR, Cerda-Gonzalez S, Griffith EH, Lascelles BDX, Olby NJ. Questionnaire-based Analysis of Owner-reported Scratching and Pain Signs in Cavalier King Charles Spaniels Screened for Chiari-like Malformation and Syringomyelia. J Vet Intern Med 2017; 32:331-339. [PMID: 29105875 PMCID: PMC5787193 DOI: 10.1111/jvim.14856] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/25/2017] [Accepted: 09/19/2017] [Indexed: 12/14/2022] Open
Abstract
Background Chiari‐like malformation (CM) and syringomyelia (SM) cause a pain syndrome in Cavalier King Charles spaniels (CKCS). Clinical signs are not consistently apparent on neurologic examination, and owner reporting of signs provides vital clinical history. However, owner questionnaires for this disease are not well developed. Objectives To develop a tool to capture owner‐reported clinical signs for use in clinical trials and to compare owner‐reported signs with the presence of pain on neurologic examination and SM on magnetic resonance imaging (MRI). Animals Fifty client‐owned CKCS. Methods Owners completed a questionnaire and pain/scratch map. Each dog underwent a neurologic examination and craniocervical magnetic resonance imaging (MRI). Questionnaire responses were developed into scores, area of shading for pain/scratch maps was measured, and consistency of responses between these tools was assessed. Owner‐reported findings were compared with neurologic examination findings and presence and severity of SM on MRI. Results Thirty‐three dogs were symptomatic and 17 asymptomatic; 30 had SM. The most common sign of pain was crying out when lifted (n = 11). Extent of shaded areas on maps positively correlated with questionnaire scores for pain (r2 = 0.213, P = 0.006) and scratch (r2 = 0.104, P = 0.089). Owner‐reported findings were not significantly associated with presence or severity of SM or neurologic examination findings. Owner‐reported lateralization of signs was significantly associated with SM lateralization (P < 0.0001). Conclusions The questionnaire and maps may be useful for clinical trials. Lack of association of owner‐reported signs with SM highlights our lack of understanding of the pathophysiology of pain in this disease.
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Affiliation(s)
- C R Sparks
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - S Cerda-Gonzalez
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - E H Griffith
- Department of Statistics, North Carolina State University, Raleigh, NC
| | - B D X Lascelles
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC.,Comparative Pain Research and Education Center, North Carolina State University, Raleigh, NC
| | - N J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC
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Minato S, Baroni M. Chiari-like malformation in two cats. J Small Anim Pract 2017; 59:578-582. [PMID: 29027670 DOI: 10.1111/jsap.12768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/15/2017] [Accepted: 03/13/2017] [Indexed: 11/29/2022]
Abstract
Two male, neutered, domestic, shorthaired cats were evaluated for progressive paresis and ataxia. Neurological examinations suggested a spinal cord lesion in each case. Complete blood examination and cerebrospinal fluid analysis were unremarkable in both cats. MRI revealed malformation of the occipital bone with herniation of the cerebellar vermis through the foramen magnum but without syringomyelia. Chiari-like malformation was suspected in both patients. MRI repeated one year later in both cats because of progression of clinical signs yielded the same findings as the initial scans. Foramen magnum decompression in one cat was associated with resolution of clinical signs.
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Affiliation(s)
- S Minato
- Valdinievole Veterinary Clinic, Monsummano Terme, 51015, Italy
| | - M Baroni
- Valdinievole Veterinary Clinic, Monsummano Terme, 51015, Italy
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28
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Olsen E, Suiter EJ, Pfau T, McGonnell IM, Matiasek K, Giejda A, Volk HA. Cavalier King Charles Spaniels with Chiari-like malformation and Syringomyelia have increased variability of spatio-temporal gait characteristics. BMC Vet Res 2017; 13:159. [PMID: 28587601 PMCID: PMC5461676 DOI: 10.1186/s12917-017-1077-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 05/26/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Chiari-like malformation in the Cavalier King Charles Spaniel is a herniation of the cerebellum and brainstem into or through the foramen magnum. This condition predisposes to Syringomyelia; fluid filled syrinxes within the spinal cord. The resulting pathology in spinal cord and cerebellum create neuropathic pain and changes in gait. This study aims to quantify the changes in gait for Cavalier King Charles Spaniel with Chiari-like malformation and Syringomyelia. METHODS We compared Cavalier King Charles Spaniel with Chiari-like malformation with (n = 9) and without (n = 8) Syringomyelia to Border Terriers (n = 8). Two video cameras and manual tracking was used to quantify gait parameters. RESULTS AND CONCLUSIONS We found a significant increase in coefficient of variation for the spatio-temporal characteristics and ipsilateral distance between paws and a wider base of support in the thoracic limbs but not in the pelvic limbs for Cavalier King Charles Spaniels compared with the border terrier.
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Affiliation(s)
- Emil Olsen
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA UK
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Cornell University, 930 Campus Road, Ithaca, N.Y. 14850 USA
| | - Emma Jane Suiter
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA UK
| | - Thilo Pfau
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA UK
| | - Imelda M McGonnell
- Department of Comparative Biomedical Sciences, The Royal Veterinary College, London, England UK
| | - Kaspar Matiasek
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig Maximilians University, Veterinarstr, 13, D-80539 Munich, Germany
| | - Anna Giejda
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA UK
| | - Holger Andreas Volk
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA UK
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29
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Use of Morphometric Mapping to Characterise Symptomatic Chiari-Like Malformation, Secondary Syringomyelia and Associated Brachycephaly in the Cavalier King Charles Spaniel. PLoS One 2017; 12:e0170315. [PMID: 28122014 PMCID: PMC5266281 DOI: 10.1371/journal.pone.0170315] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 01/02/2017] [Indexed: 11/19/2022] Open
Abstract
Objectives To characterise the symptomatic phenotype of Chiari-like malformation (CM), secondary syringomyelia (SM) and brachycephaly in the Cavalier King Charles Spaniel using morphometric measurements on mid-sagittal Magnetic Resonance images (MRI) of the brain and craniocervical junction. Methods This retrospective study, based on a previous quantitative analysis in the Griffon Bruxellois (GB), used 24 measurements taken on 130 T1-weighted MRI of hindbrain and cervical region. Associated brachycephaly was estimated using 26 measurements, including rostral forebrain flattening and olfactory lobe rotation, on 72 T2-weighted MRI of the whole brain. Both study cohorts were divided into three groups; Control, CM pain and SM and their morphometries compared with each other. Results Fourteen significant traits were identified in the hindbrain study and nine traits in the whole brain study, six of which were similar to the GB and suggest a common aetiology. The Control cohort had the most elliptical brain (p = 0.010), least olfactory bulb rotation (p = 0.003) and a protective angle (p = 0.004) compared to the other groups. The CM pain cohort had the greatest rostral forebrain flattening (p = 0.007), shortest basioccipital (p = 0.019), but a greater distance between the atlas and basioccipital (p = 0.002) which was protective for SM. The SM cohort had two conformation anomalies depending on the severity of craniocervical junction incongruities; i) the proximity of the dens (p <0.001) ii) increased airorhynchy with a smaller, more ventrally rotated olfactory bulb (p <0.001). Both generated ‘concertina’ flexures of the brain and craniocervical junction. Conclusion Morphometric mapping provides a diagnostic tool for quantifying symptomatic CM, secondary SM and their relationship with brachycephaly. It is hypothesized that CM pain is associated with increased brachycephaly and SM can result from different combinations of abnormalities of the forebrain, caudal fossa and craniocervical junction which compromise the neural parenchyma and impede cerebrospinal fluid flow.
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30
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Knowler SP, Kiviranta AM, McFadyen AK, Jokinen TS, La Ragione RM, Rusbridge C. Craniometric Analysis of the Hindbrain and Craniocervical Junction of Chihuahua, Affenpinscher and Cavalier King Charles Spaniel Dogs With and Without Syringomyelia Secondary to Chiari-Like Malformation. PLoS One 2017; 12:e0169898. [PMID: 28121988 PMCID: PMC5266279 DOI: 10.1371/journal.pone.0169898] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/23/2016] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To characterize and compare the phenotypic variables of the hindbrain and craniocervical junction associated with syringomyelia (SM) in the Chihuahua, Affenpinscher and Cavalier King Charles Spaniel (CKCS). METHOD Analysis of 273 T1-weighted mid-sagittal DICOM sequences of the hindbrain and craniocervical junction from 99 Chihuahuas, 42 Affenpinschers and 132 CKCSs. The study compared 22 morphometric features (11 lines, eight angles and three ratios) of dogs with and without SM using refined techniques based on previous studies of the Griffon Bruxellois (GB) using Discriminant Function Analysis and ANOVA with post-hoc corrections. RESULTS The analysis identified 14/22 significant traits for SM in the three dog breeds, five of which were identical to those reported for the GB and suggest inclusion of a common aetiology. One ratio, caudal fossa height to the length of the skull base extended to an imaginary point of alignment between the atlas and supraoccipital bones, was common to all three breeds (p values 0.029 to <0.001). Associated with SM were a reduced occipital crest and two acute changes in angulation i) 'sphenoid flexure' at the spheno-occipital synchondrosis ii) 'cervical flexure' at the foramen magnum allied with medulla oblongata elevation. Comparing dogs with and without SM, each breed had a unique trait: Chihuahua had a smaller angle between the dens, atlas and basioccipital bone (p value < 0.001); Affenpinschers had a smaller distance from atlas to dens (p value 0.009); CKCS had a shorter distance between the spheno-occipital synchondrosis and atlas (p value 0.007). CONCLUSION The selected morphometries successfully characterised conformational changes in the brain and craniocervical junction that might form the basis of a diagnostic tool for all breeds. The severity of SM involved a spectrum of abnormalities, incurred by changes in both angulation and size that could alter neural parenchyma compliance and/or impede cerebrospinal fluid channels.
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Affiliation(s)
- Susan P. Knowler
- School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Anna-Mariam Kiviranta
- Department of Equine and Small Animal Medicine, 00014 University of Helsinki, Finland
| | | | - Tarja S. Jokinen
- Department of Equine and Small Animal Medicine, 00014 University of Helsinki, Finland
| | - Roberto M. La Ragione
- School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Clare Rusbridge
- School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
- Fitzpatrick Referrals, Godalming, Surrey, United Kingdom
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31
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O'Leary DJ. Acupuncture as an aid to treatment of Chiari‐like malformation (CM)/syringomyelia (SM) in a Cavalier King Charles spaniel (CKCS). VETERINARY RECORD CASE REPORTS 2016. [DOI: 10.1136/vetreccr-2016-000329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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32
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Sanchis-Mora S, Pelligand L, Thomas CL, Volk HA, Abeyesinghe SM, Brodbelt DC, Church DB, Thomson PC, McGreevy PD, O'Neill DG. Dogs attending primary-care practice in England with clinical signs suggestive of Chiari-like malformation/syringomyelia. Vet Rec 2016; 179:436. [PMID: 27534983 DOI: 10.1136/vr.103651] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 12/17/2022]
Abstract
Chiari-like malformation/syringomyelia (CM/SM) in dogs describes a developmental disorder that can cause pain and reduced quality of life. This retrospective study aimed to report the period prevalence, clinical signs and risk factors for diagnosis of symptomatic CM/SM in the veterinary primary-care setting using a cross-sectional design. The study population included all dogs within the VetCompass Programme (September 1, 2009-June 13, 2014). Overall, the period prevalence of symptomatic CM/SM was 0.05 per cent (95 per cent CI 0.04 per cent to 0.06 per cent) for all breeds. The period prevalence in the Cavalier King Charles Spaniel (CKCS) was 1.6 per cent (95 per cent CI 1.2 to 2.06). Other breeds at increased odds included the King Charles Spaniel (KCS), Affenpinscher, Chihuahua and Pomeranian. Insured dogs had 4.6 times the odds (95 per cent CI 2.95 to 7.17) of having a diagnosis of CM/SM compared with uninsured dogs. Pain was the most commonly associated clinical sign (67 dogs, 72 per cent). Analgesics were prescribed to 72 (77.4 per cent) of the symptomatic dogs. Despite its low overall period prevalence, the high proportion of affected dogs identified with chronic pain suggests a significant welfare issue. Financial implications could impede the diagnostic process and lead to underestimation of the true prevalence. This study may help to inform clinicians about the clinical relevance and the need for improved awareness of clinical signs, particularly in high-risk breeds, to optimise the management of CM/SM in primary-care practice.
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Affiliation(s)
- S Sanchis-Mora
- Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA, UK
| | - L Pelligand
- Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA, UK
| | - C L Thomas
- Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA, UK
| | - H A Volk
- Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA, UK
| | - S M Abeyesinghe
- Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA, UK
| | - D C Brodbelt
- Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA, UK
| | - D B Church
- Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA, UK
| | - P C Thomson
- Faculty of Veterinary Science, University of Sydney, New South Wales 2006, Australia
| | - P D McGreevy
- Faculty of Veterinary Science, University of Sydney, New South Wales 2006, Australia
| | - D G O'Neill
- Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA, UK
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33
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Cerda-Gonzalez S, Olby NJ, Griffith EH. Longitudinal Study of the Relationship among Craniocervical Morphology, Clinical Progression, and Syringomyelia in a Cohort of Cavalier King Charles Spaniels. J Vet Intern Med 2016; 30:1090-8. [PMID: 27311874 PMCID: PMC5094541 DOI: 10.1111/jvim.14362] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 04/20/2016] [Accepted: 05/17/2016] [Indexed: 12/01/2022] Open
Abstract
Background Craniocervical junction (CCJ) anomalies and secondary syringomyelia are commonly diagnosed in Cavalier King Charles spaniel (CKCS). Familiarity with the natural history of these abnormalities is vital to understanding the disease syndrome. Objective To evaluate magnetic resonance imaging (MRI) predictors of worsening clinical signs, syringomyelia, and morphology in CKCS longitudinally. Animals Fifty‐four client‐owned CKCS, 5–13 years old; 50% currently symptomatic. Methods Longitudinal observational study. We enrolled CKCS with an MRI of the CCJ performed ≥3 years earlier. We used questionnaires and neurologic examinations to grade initial and current clinical status. Dogs that could be anesthetized were reimaged. Morphologic assessments included the presence and severity of: Chiari‐like malformations, medullary position, atlantooccipital overlapping (AOO), dorsal atlantoaxial bands, and syringomyelia. Cranial cavity volumes and foramen magnum height were measured. Results Clinical status was evaluated in 54 dogs; 36/54 were reimaged. Mean follow‐up was 71 months. Of initially asymptomatic dogs, 32% were symptomatic at re‐evaluation. Of initially symptomatic dogs, 56% had worsened; 13% had improved with medical management. The morphology of the CCJ at initial imaging did not predict development of either new or worsened signs or syringomyelia by the time of re‐evaluation. Conclusion Craniocervical junction anomalies assessed in this study did not appear predictive of future clinical status or syringomyelia in our cohort. The impacts of syringomyelia, AOO, and atlantoaxial bands on future clinical status merit further study in larger groups of CKCS. Clinical progression in our cohort of medically managed CKCS did not differ substantially from published reports of those treated surgically.
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Affiliation(s)
| | - N J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC.,Center for Comparative Medicine and Translational Research, North Carolina State University, Raleigh, NC
| | - E H Griffith
- Department of Statistics, North Carolina State University, Raleigh, NC
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Girod M, Allerton F, Gommeren K, Tutunaru A, de Marchin J, Van Soens I, Ramery E, Peeters D. Evaluation of the effect of oral omeprazole on canine cerebrospinal fluid production: A pilot study. Vet J 2016; 209:119-24. [DOI: 10.1016/j.tvjl.2015.10.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 10/18/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
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Abstract
Disorders of the somatosensory system such as neuropathic pain are common in people with chronic neurologic and musculoskeletal diseases, yet these conditions remain an underappreciated morbidity in veterinary patients. This is likely because assessment of neuropathic pain in people relies heavily on self-reporting, something our veterinary patients are not able to do. The development of neuropathic pain is a complex phenomenon, and concepts related to it are frequently not addressed in the standard veterinary medical curriculum such that veterinarians may not recognize this as a potential problem in patients. The goals of this review are to discuss basic concepts in the pathophysiology of neuropathic pain, provide definitions for common clinical terms used in association with the condition, and discuss pharmacological treatment options for dogs with neuropathic pain. The development of neuropathic pain involves key mechanisms such as ectopic afferent nerve activity, peripheral sensitization, central sensitization, impaired inhibitory modulation, and pathologic activation of microglia. Treatments aimed at reducing neuropathic pain are targeted at one or more of these mechanisms. Several drugs are commonly used in the veterinary clinical setting to treat neuropathic pain. These include gabapentin, pregabalin, amantadine, and amitriptyline. Proposed mechanisms of action for each drug, and known pharmacokinetic profiles in dogs are discussed. Strong evidence exists in the human literature for the utility of most of these treatments, but clinical veterinary-specific literature is currently limited. Future studies should focus on objective methods to document neuropathic pain and monitor response to therapy in veterinary patients.
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Affiliation(s)
- Sarah A Moore
- Department of Veterinary Clinical Sciences, The Ohio State University , Columbus, OH , USA
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36
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Abstract
Chiari-like malformation is a condition of the craniocervical junction in which there is a mismatch of the structures of the caudal cranial fossa causing the cerebellum to herniate into the foramen magnum. This herniation can lead to fluid buildup in the spinal cord, also known as syringomyelia. Pain is the most common clinical sign followed by scratching. Other neurologic signs noted are facial nerve deficits, seizures, vestibular syndrome, ataxia, menace deficit, proprioceptive deficits, head tremor, temporal muscle atrophy, and multifocal central nervous system signs. MRI is the diagnostic of choice, but computed tomography can also be used.
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Sanchis-Mora S, Pelligand L, Volk HA, Abeyesinghe SM. Diagnosis and treatment of canine neuropathic pain. Vet Rec 2015; 177:470. [DOI: 10.1136/vr.h5927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | - Holger A. Volk
- Royal Veterinary College; Hawkshead Lane North Mymms AL9 7TA
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Plessas IN, Volk HA, Rusbridge C, Vanhaesebrouck AE, Jeffery ND. Comparison of gabapentin versus topiramate on clinically affected dogs with Chiari-like malformation and syringomyelia. Vet Rec 2015; 177:288. [DOI: 10.1136/vr.103234] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2015] [Indexed: 01/21/2023]
Affiliation(s)
- I. N. Plessas
- Department of Clinical Science and Services; Royal Veterinary College; Hawkshead Lane North Mymms AL9 7TA UK
| | - H. A. Volk
- School of Veterinary Medicine, University of Surrey; Guildford Surrey GU2 7XH UK
| | - C. Rusbridge
- Department of Neurology; Fitzpatrick Referrals; Halfway Lane, Eashing, Godalming Surrey GU7 2QQ UK
| | - A. E. Vanhaesebrouck
- Department of Veterinary Medicine; Veterinary Medicine School, University of Cambridge; Madingley Road Cambridge CB3 0ES UK
| | - N. D. Jeffery
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine, Iowa State University; 2503 Vet Med, 1600 South 16th Street Ames Iowa 50011 USA
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Williams H, Murrell J, Granger N. Developing a ‘bedside’ test for cervical neck pain in Cavalier King Charles spaniels with syringomyelia. Vet Rec 2015; 177:184. [DOI: 10.1136/vr.h4379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Heather Williams
- School of Veterinary Sciences; University of Bristol; Langford House Langford Somerset BS40 5DU
| | - Jo Murrell
- School of Veterinary Sciences; University of Bristol; Langford House Langford Somerset BS40 5DU
| | - Nicolas Granger
- School of Veterinary Sciences; University of Bristol; Langford House Langford Somerset BS40 5DU
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40
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Cerda-Gonzalez S, Olby NJ, Griffith EH. Medullary position at the craniocervical junction in mature cavalier King Charles spaniels: relationship with neurologic signs and syringomyelia. J Vet Intern Med 2015; 29:882-6. [PMID: 25929341 PMCID: PMC4895408 DOI: 10.1111/jvim.12605] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 03/16/2015] [Accepted: 03/26/2015] [Indexed: 12/28/2022] Open
Abstract
Background Medullary elevation (ie, medullary kinking) at the craniocervical junction (CCJ) is reported in dogs with Chiari‐like malformations (CM), but its diagnostic criteria and clinical relevance are unclear. Objective To describe the position of the medulla at the CCJ in mature cavalier King Charles spaniels (CKCS), and evaluate its relationship with clinical status and the presence of syringomyelia. Animals Thirty‐six CKCS, 5–12 years of age, including 16 asymptomatic dogs. Methods Dogs were assigned a neurologic grade; magnetic resonance imaging (MRI) of the CCJ then was performed. The presence of a CM and syringomyelia was recorded and syringomyelia severity was quantified. Medullary position was quantified using the medullary kinking index, the elevation angle and obex position relative to the foramen magnum. The relationship between medullary position measures and presence and severity of neurologic signs and syringomyelia was investigated. Results Chiari‐like malformation was found in 33 dogs; 26 of them had syringomyelia. Mean medullary kinking index was 46.4% (SD, 10.3), elevation angle was 132° (SD, 12) and obex position was 3.5 mm (SD, 0.8). A higher medullary kinking index was associated with the presence of neurologic signs (P = .0368). Obex position was associated with the presence (P = .0018) and severity of syringomyelia (P = .0164). Conclusions and clinical importance There is a significant association between medullary elevation and clinical signs, whereas more caudal brainstem positions appear related to the presence of syringomyelia.
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Affiliation(s)
| | - N J Olby
- North Carolina State University, Raleigh, NC
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41
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Epstein M, Rodan I, Griffenhagen G, Kadrlik J, Petty M, Robertson S, Simpson W. 2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats*. J Am Anim Hosp Assoc 2015; 51:67-84. [DOI: 10.5326/jaaha-ms-7331] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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42
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Epstein ME, Rodanm I, Griffenhagen G, Kadrlik J, Petty MC, Robertson SA, Simpson W. 2015 AAHA/AAFP pain management guidelines for dogs and cats. J Feline Med Surg 2015; 17:251-72. [PMID: 25701863 PMCID: PMC11148887 DOI: 10.1177/1098612x15572062] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
RATIONALE The robust advances in pain management for companion animals underlie the decision of the American Animal Hospital Association (AAHA) and American Association of Feline Practitioners (AAFP) to expand on the information provided in the 2007 AAHA/AAFP Pain Management Guidelines. The 2015 Guidelines summarize and offer a discriminating review of much of this new knowledge. RELEVANCE Pain management is central to veterinary practice, alleviating pain, improving patient outcomes, and enhancing both quality of life and the veterinarian-client-patient relationship. These Guidelines support veterinarians in incorporating pain management into practice, improving patient care. APPROACHES The management of pain requires a continuum of care that includes anticipation, early intervention, and evaluation of response on an individual patient basis. A team-oriented approach, including the owner, is essential for maximizing the recognition, prevention and treatment of pain in animals. EVIDENCE BASE The Guidelines include both pharmacologic and non-pharmacologic modalities to manage pain; they are evidence-based insofar as possible and otherwise represent a consensus of expert opinion. Behavioral changes are currently the principal indicator of pain and its course of improvement or progression, and the basis for recently validated pain scores. Post-surgical pain is eminently predictable but a strong body of evidence exists supporting strategies to mitigate adaptive as well as maladaptive forms. Chronic pain is dominated by degenerative joint disease (DJD), which is one of the most significant and under-diagnosed diseases of cats and dogs. DJD is ubiquitous, found in pets of all ages, and inevitably progresses over time; evidence-based strategies for management are established in dogs, and emerging in cats.
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Affiliation(s)
- Mark E Epstein
- TotalBond Veterinary Hospitals PC, 3200 Union Road, Gastonia, NC 28056, USA
| | - Ilona Rodanm
- Cat Care Clinic and Feline-Friendly Consultations, 322 Junction Road, Madison, WI 53717, USA
| | - Gregg Griffenhagen
- Colorado State University School of Veterinary Medicine, 300 West Drake Road, Fort Collins, CO 80523, USA
| | - Jamie Kadrlik
- Pet Crossing Animal Hospital and Dental Clinic, 10861 Bloomington Ferry Road, Bloomington, MN 55438, USA
| | - Michael C Petty
- Arbor Pointe Veterinary Hospital/Animal Pain Center, 42043 Ford Road, Canton, MI 48187, USA
| | - Sheilah A Robertson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Wendy Simpson
- Morrisville Cat Hospital, 100 Keybridge Drive, Suite A, Morrisville, NC 27560, USA
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Association between the findings on magnetic resonance imaging screening for syringomyelia in asymptomatic Cavalier King Charles spaniels and observation of clinical signs consistent with syringomyelia in later life. Vet J 2015; 203:129-30. [DOI: 10.1016/j.tvjl.2014.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 10/28/2014] [Accepted: 11/15/2014] [Indexed: 11/18/2022]
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Epstein ME. Adjunctive, pain-modifying, analgesic drugs. Top Companion Anim Med 2014; 29:30-4. [PMID: 25454373 DOI: 10.1053/j.tcam.2014.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/30/2014] [Indexed: 01/21/2023]
Abstract
Outside the realm of nonsteroidal antiinflammatory drug(NSAID) and opioid exist a broad range of medications that exert an analgesic effect, or otherwise modify and protect against pain, by manipulating various targets along the nociceptive pathway. Strength of evidence for dogs and cats can vary widely, and this article will review the available literature that may guide clinical usage in these species.
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Affiliation(s)
- Mark E Epstein
- TotalBond Veterinary Hospitals, Gastonia, NC, USA; Carolinas Animal Pain Management, Gastonia, NC, USA; International Veterinary Academy of Pain Management, Nashville, TN, USA.
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Thøfner MS, Stougaard CL, Westrup U, Madry AA, Knudsen CS, Berg H, Jensen CSE, Handby RML, Gredal H, Fredholm M, Berendt M. Prevalence and heritability of symptomatic syringomyelia in Cavalier King Charles Spaniels and long-term outcome in symptomatic and asymptomatic littermates. J Vet Intern Med 2014; 29:243-50. [PMID: 25308931 PMCID: PMC4858089 DOI: 10.1111/jvim.12475] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/13/2014] [Accepted: 09/03/2014] [Indexed: 11/30/2022] Open
Abstract
Background Syringomyelia (SM) is common in the Cavalier King Charles Spaniel (CKCS). Dogs with syringes express clinical signs or might be clinically silent. Objectives To investigate the prevalence and heritability of symptomatic SM, the association between clinical signs and magnetic resonance imaging (MRI) findings, and long‐term outcome. Animals All CKCS registered in the Danish Kennel Club in 2001 (n = 240). Methods A cross‐sectional questionnaire‐based prevalence study validated by telephone interviews and clinically investigated clinical signs of SM. Dogs were 6 years at the time of investigation. A prospective observational litter study including clinical investigations, MRI and 5‐year follow‐up of symptomatic and asymptomatic siblings. Heritability was estimated based on the scale of liability in the study population and litter cohort. Results The cross‐sectional study estimated a prevalence of symptomatic SM at 15.4% in the population. Thirteen symptomatic and 9 asymptomatic siblings participated in the litter study. Spinal cord syringes were confirmed in 21 of 22 littermates (95%). Syrinx diameter and mean syrinx : spinal cord ratio were significantly correlated with clinical signs (P < .01). Estimated heritability of symptomatic SM was 0.81. Symptomatic SM motivated euthanasia in 20%. Dogs with syringes, which expressed no clinical signs at the age of 6, remained asymptomatic in 14/15 cases (93%). Conclusions and Clinical Importance The prevalence of symptomatic SM is high and genetics have a high impact on clinical disease expression. Further investigations of factors influencing the outbreak threshold of clinical signs of SM are desirable.
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Affiliation(s)
- M S Thøfner
- Department of Veterinary Clinical and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
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MacFarlane PD, Tute AS, Alderson B. Therapeutic options for the treatment of chronic pain in dogs. J Small Anim Pract 2014; 55:127-34. [PMID: 24467556 DOI: 10.1111/jsap.12176] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Chronic pain is a widely recognised problem in humans and is being increasingly recognised as a significant problem in dogs. Whilst a large number of therapies are described and utilised to treat chronic pain in dogs, there is a severe shortage of evidence to guide practitioners in selection of treatments. Until more evidence becomes available, practitioners should adopt a cautious approach, utilising licensed treatments first when possible. Non-pharmacological therapies should be incorporated into the chronic pain management plan whenever possible. Given the probable prevalence of chronic pain in dogs there is an urgent need for research to identify effective treatments.
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Affiliation(s)
- P D MacFarlane
- Langford Veterinary Services, The University of Bristol, Langford, BS40 5DU
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Driver CJ, Volk HA, Rusbridge C, Van Ham LM. An update on the pathogenesis of syringomyelia secondary to Chiari-like malformations in dogs. Vet J 2013; 198:551-9. [PMID: 23938004 DOI: 10.1016/j.tvjl.2013.07.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 06/19/2013] [Accepted: 07/09/2013] [Indexed: 11/16/2022]
Abstract
Syringomyelia (SM) is a spinal cord disease that can cause neuropathic pain in dogs. The pathogenesis of SM secondary to Chiari-like malformation (CM) has been the focus of intense research in recent years. The gulf in our understanding of CM/SM in dogs relative to the analogous human condition has progressively narrowed. CM is primarily a disease of abnormal geometric morphometry affecting the caudal cranial fossa and the brain parenchyma contained within it. This review describes how advanced imaging techniques have revealed a series of morphometric abnormalities associated with CM/SM. The series is presented in a logical order to help describe the pathogenesis of CM and the subsequent formation of syringes, with particular reference to the concepts of craniospinal compliance and cerebrospinal fluid pulse pressure timing.
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Affiliation(s)
- C J Driver
- Department of Veterinary Clinical Sciences, Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hertfordshire AL9 7TA, UK.
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