opisthotonus

Re: opisthotonus

ilanit — Tue, 13 Sep 2011 15:07:44 GMT

She was walking today!

thanks again

Re: opisthotonus

Evelyn Barbour-Hill — Tue, 13 Sep 2011 12:31:56 GMT

Thank you.

Re: opisthotonus

Utlendigur — Tue, 13 Sep 2011 12:27:58 GMT

[quote user="Evelyn Barbour-Hill"]what does FCE stand for?[/quote]

Fibro-cartillagenous embolism

Re: opisthotonus

Evelyn Barbour-Hill — Tue, 13 Sep 2011 11:56:44 GMT

[quote user="Mark Lowrie"]Having said this I wouldn’t rule –out a cranial cervical FCE causing signs similar to what you have observed and of course this would also improve over time.[/quote]

Sorry, not a neurologist and too lazy to look it up – what does FCE stand for?

Re: opisthotonus

Mark Lowrie — Tue, 13 Sep 2011 08:53:27 GMT

Dorsal deviation of the neck is possible with very high cervical lesions e.g. a-a luxations etc. However, the persistent hyperextension and obvious opisthotonus you describe would mean a cervical lesion is less likely. Having said this I wouldn’t rule –out a cranial cervical FCE causing signs similar to what you have observed and of course this would also improve over time.

Re: opisthotonus

ilanit — Tue, 13 Sep 2011 05:51:25 GMT

Many thanks for your clear explanation!!

Can I just ask you one more thing? Can you ever get opisthotonus or dorsal neck deviation with a cervical leasion?

Re: opisthotonus

Mark Lowrie — Mon, 12 Sep 2011 17:42:33 GMT

Great news to hear the dog is improving. Hopefully it will be walking soon although it may be one of those patients that takes several days to a few weeks before showing major improvements due to the severity of signs.

The decerebellate thing is always a bit tricky – I agree that the ‘classic’ decerebellate posture seen in textbooks is with the hindlimbs flexed. However, the theory behind this posture is that loss of the cerebellum removes inhibition on the vestibulospinal tracts ultimately causing increased tone to all four limbs. Sometimes this causes flexion of the pelvic limbs due to increased tone in the iliopsoas muscles but often we may see extended OR alternating flexed/extending himdlimbs – either way, the tone is increased and the mentation remains normal making it decerebellate.

Keep us updated!

Re: opisthotonus

ilanit — Mon, 12 Sep 2011 16:54:58 GMT

Thank you all for your posts, much appreciated.

Things are looking a bit better! The rigidity is gone and so it the opisthotonus, although there is still a slight dorsal deviation of the neck. She's managing to support her body a bit to lie in a more upright position, but is still quadriparetic/paralytic. Eating/drinking very well when supported. No other treatment than supportive/nursing care and synulox were given.

They took plain x-ray of neck this weekend, which was unremarkable.

I am happy with the improvement, but frustrated that we don't have a diagnosis and still feel unsure even about the original neurological location (neck/brainstem/cerebellum). Don't think it was decerebellate rigidity, because those should have flexion of the knees rather than extension. Thought about strychnine too, but owner claims not to use any pesticide around the house and dog is not left of the lead outside.

Hopefully she'll continue to improve. Just have to accept we won't get diagnosis.

Thanks again!

Re: opisthotonus

Mark Lowrie — Mon, 12 Sep 2011 11:57:42 GMT

The description you give fits well with a decerebellate rigidity. The main difference between decerebellate and decerebrate rigidity is the patient’s mentation with the former remaining normal and the latter having a severely depressed/comatose mental status.

Therefore your patient had an acute onset of a severe cerebellar lesion. A vascular problem would be high on my list of causes given the lack of pain. If advanced imaging is unavailable I would monitor the dog (no specific treatment necessary) and hopefully there should be an improvement over the coming days/weeks. How are things looking now?

Re: opisthotonus

Mark Lowrie — Mon, 12 Sep 2011 11:57:42 GMT

Re: opisthotonus

Stephen Courtney — Mon, 12 Sep 2011 00:28:35 GMT

As far as I can remember decerebrate rigidity is the result of catastrophic brain injury, these cases are pretty much dying. I'd strongly suspect tetanus...but there are other possibilities too. just try cover the odds and treat for the treatable, and try to control clinical signs to make the animal more comfortable. urinary catheters, enemas etc if it cannot toilet, physiotherapy, attention to nutrition etc.

Re: opisthotonus

Laurence Webb — Sun, 11 Sep 2011 19:20:26 GMT

You're not based in the UK. Is strychnine used where you work, legally or illegally? As student I saw a few cases whilst seeing practice in Northumberland. Gamekeepers used to use their old stock after it was banned. Opisthotonus, extensor rigidity that would be exacerbated by noise or touching the animal. No loss of conciousness or seizuring. From memory it prevents upper motor neurone downregulation of local reflexes but doesn't affect the brain.

It was largely a waiting game with sedation (diazepam worked OK in milder cases) and flid/nutritional support until the animal died or recovered.

Re: opisthotonus

Gerry Henry — Sun, 11 Sep 2011 19:01:02 GMT

Ditto above; always give penicillin and antitoxin, tetanus can't be ruled out. Are the 3rd eyelids prolapsed or spasming?

Re: opisthotonus

Stephen Courtney — Sun, 11 Sep 2011 00:00:22 GMT

I'm not entirely sure what you are describing, but have had a few glasses of wine so please forgive me if i've missed something salient.

1. Paralysis = flaccid muscles

2. Sounds more like muscle contraction to me. Is there any evidence of tetanus - raised ears, sardonic expression etc?

Fill the animal full of penicillin, refer if you can. if you can't , wait and see, guarded prognosis. I've seen 3 cases of tetanus in dogs in 20 years. 2 were mild and did just fine with antibiotics, viscotears ( couldn't blink!) and time.One was far more severe and needed a feeding tube for weeks, urinary catheters, physiotherapy and took about 6 weeks to come right. I have heard of some cases that have never come right, or relapsed after intensive high end treatment. the antitoxin may help but by the time clinical signs are evident it's usually too late for that. the original puncture wound that caused all the trouble is usually never in evidence.

Re: opisthotonus

Anonymous — Sat, 10 Sep 2011 22:48:34 GMT

Sounds like you know what you're talking about, so don't think I'll have anything helpful to add, but describe what you mean by opisthotonus (I've heard vets use the in different ways before) - if just hyperextension of the neck in addition to the limb rigidity, then I would be putting a cervical spinal lesion top of my differential list. If whole spine curved, then I'd be thinking CSF tap might be indicated? I'm guessing referral out on cost grounds, so diagnostic imaging would be an option, but diagnostic yield of plain radiographs might not be that rewarding.

If finance limited then I might take a 'see how it goes' approach and just nurse for 24-72hrs, but I'm sure someone will suggest corticosteroids are the cure.

Interesting that tail wagging. Any idea if conscious bladder control?