Neuro case - Schiff-Sherrington posture

Re: Neuro case - Schiff-Sherrington posture

Malcolm Ness — Tue, 06 Oct 2009 07:55:01 GMT

"In an ideal world myelography and/or MRI would be carried out, but if not all you have available is a full neurological exam to try and pinpoint a lesion and its severity". Not entirely true.

The key to managing any case like this is a proper neuro exam. This will allow you to localise the lesion (avoids the waste of a radiographic "fishing trip") and establish severity - most often on a 6 point scale with 0 being normal nd grade 5 as bad as it gets. Essential info because of prognosis - grade 5 lesions don't get better. All this can be done in the consulting room without significant expense.

Imaging is only relevant if surgical treatment is contemplated - there is no point taking plain rads just to see if its broken unless you and the client are in a position to do any appropriate surgery. Myelography can be useful but in fact often doesn't add any useful info to a case that has been properly assessed by clinical, neurological and plain radiographic examination. As a surgeon, MRI very rarely if ever adds useful information to trauma cases and the several hundred pounds that MRI will cost can always be better spent.

Neuro exam is a difficult skill to develop and retain in general practice because nobody sees enough cases to keep their skills up to speed but the evaluation and prognostication is much more of an exact science than is being implied in this thread.

Charlie Anne - I will be happy to discuss this case with you in more detail if you want to contact me direct.

Malcolm N

Re: Neuro case - Schiff-Sherrington posture

Charlie Lyon — Mon, 05 Oct 2009 13:36:02 GMT

He does indeed have deep pain in both hind limbs - a little progress today - whilst giving him a bath he moved his back legs a little bit when rubbing certain spots - had quite good flexion on one leg - the withdraws are getting stonger as well.

He also lifted his tail a bit as to pass faeces although usually his tail is pretty flaccid. Not a great deal of other progress though. Guess time will tell. Would proper physio on his hind legs be useful - we have been moving them for him a little bit to keep blood moving, but most of the staff don't know a lot about physio in these cases - just remember at uni all the post surgery spinal cases would get it.

Re: Neuro case - Schiff-Sherrington posture

Clive Ansell — Mon, 05 Oct 2009 07:43:19 GMT

In an ideal world myelography and/or MRI would be carried out, but if not all you have available is a full neurological exam to try and pinpoint a lesion and its severity

Does he have any bladder or bowel function, or anal tone?

Does he have deep pain sensation? as previously mentioned a withdrawal reflex indicates a complete reflex arc - is he aware of it? If not, it could indicate a more spinal cord lesion more cranially.

Does he have a normal patella reflex? an increased one could indicate a spinal cord lesion cranially

Is the panniculus reflex intact bilaterally? could help pinpoint the position of a spinal lesion

Re: Neuro case - Schiff-Sherrington posture

Niall Taylor — Sun, 04 Oct 2009 22:49:26 GMT

[quote user="Utlendigur"]I thought withdrawl is only a test of local relfex arcs - doesn't give any info on whether spinal cord is intact[/quote]

Correct - does the collie in the OP have deep pain - does it try to bite you if you squeeze its toes with artery clamps? If not then the prognosis has to be grave.

Niall

Re: Neuro case - Schiff-Sherrington posture

Utlendigur — Sun, 04 Oct 2009 22:10:26 GMT

Had a couple of similar ones. One was a labrador who had a head-on crash with his brother while playing. The other was a collie cross RTA (nice callout - got there to find 4 police officers trying to restrain the drunken owner from attacking the driver - whose fault it wasn't - and the owner's equally drunk wife lying on the ground cradling the dog, surrounded by pools of vomit - not sure whether dog's or hers...). Both dogs recovered enough to stand within a week but took 2-3weeks to get back to normal. I thought withdrawl is only a test of local relfex arcs - doesn't give any info on whether spinal cord is intact. Does the dog have deep pain sensation both sides?

Re: Neuro case - Schiff-Sherrington posture

Noweia — Sun, 04 Oct 2009 21:39:34 GMT

I'm no expert but we had a similar case a few weeks ago - staffie hit by car, hindlimbs affected but forelimbs fine. Patellar reflexes intact but no withdrawal reflex. Proprioception absent. X-rays were clear and we suspected spinal cord injury.

We maintained him on steroids for I think a week then the owner opted to take him home and continue working with him there. After a week the dog could get up by himself although the hindlimbs were still weak and the left one still showed no proprioception.

With your case, withdrawal is present albeit poor - this carries a better prognosis than absence of a withdrawal reflex altogether.

I too would be interested in how others manage these cases if they are hospitalised for a while?