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CT myelography characteristics of spinal dysraphism in a young mixed breed dog. Spinal dysraphism is a congenital defect of the vertebral column and spinal cord secondary to imperfect closure of the caudal neuropore of the developing neural tube. Spinal espinsles is a developmental disorder that is characterized by several structural and functional abnormalities of the spinal cord, vertebral column, muscles and skin McGeady et al This congenital defect results from the failure of the neural tube closure with imperfect fusion of midline mesenchymal, neuroecotermal and cutaneous ectodermal components Hoskins Failure of neural tube closure may arise from faulty induction of the underlying notochord or from other genetic, teratogenic, metabolic and nutritional factors Hrubec et alMcGeady et al Lesions observed with spinal dysraphism include spina bifida defective fusion of the vertebral archhemivertebrae, fused vertebrae, vertebral canal stenosis, meningocele protrusion of meninges through the defectmyelocele protrusion of spinal cord through the defect and meningomyelocele protrusion of both meninges and spinal cord McGeady disrafoas alEsipnales Lahunta and Glass Pathological changes may also include spinal cord lesions such as myeloschisis spinal cord cleftamyelia, diastematomyelia split cord malformation type Idiplomyelia split cord malformation type IIabsent or misshapen dorsal and ventral horns, hydromyelia and syringomyelia Andro disgafias al Most lesions occur in the caudal lumbar, sacral and coccygeal regions of the vertebral column Hoskins In Weimaraners spinal dysraphism is transmitted by a co-dominant lethal gene with a reduced disrsfias and variable expressivity DisrafiaeDe Lahunta and Glass A 2 month old female mixed breed dog weighing 2.
Espina bífida – Síntomas y causas – Mayo Clinic
Physical examination revealed scars in the perineal area, a short tail and a palpable depression in the spinous process of the sixth lumbar vertebra. Neurological examination demonstrated mild ambulatory paraparesis, symmetric pelvic limb ataxia, proprioceptive deficits in both pelvic limbs, decreased patellar reflexes in both pelvic limbs, bunny-hopping gait symmetric bilateral protraction of pelvic limbsmild atrophy of the pelvic limb musculature, and hypoaesteshia in the perineal region and pelvic limbs.
Neurological findings indicated a LMN signs for the sciatic and pudendal nerve distribution and were consistent with a lesion at the lumbosacral L4-Cd5 spinal cord segments. Diagnostic imaging test included radiography, ultrasonography and computed tomographic myelography Myelo-CT.
Radiography revealed absence of the lamina and spinous process of the 6 th lumbar vertebra. Ultrasonographic evaluation at the lumbar area showed absence of spinous processes at L6 vertebral level.
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Examination at this area in transverse and sagittal planes showed a round hyperechoic dura mater, and a hypoechoic space corresponding to the subarachnoid space. However, no spinal cord anomalies were detected on the sonographic images.
Immediately prior to CT scanning, and injection of 0. Computed tomographic myelography images revealed incomplete vertebral arches in L6 consistent with spina bifida, and a small meningocele sac at L6. At the L5-L6 and cranial L6 vertebral levels a division of the spinal cord was observed consistent with a segmental type II split cord malformation diplomyelia. Both hemicords were located in a single dural cavity and the space between the hemicords was filled with a contrast material figure 1.
Caudally, absence of the spinal cord at the L6 vertebral level and reduced diameter of the spinal cord were evident with an increased size of the subarachnoid space at L7.
These characteristics were consistent with segmental spinal cord aplasia and hypoplasia respectively figure 2.
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After medical recommendation, the owner declined the use of surgical intervention since neurological signs were consider mild and stable.
Follow up telephonic conversations over the next 3 months revealed that the owner did not notice additional neurologic signs in the dog. There was no additional information available from the mother related to drugs that may have taken during her pregnancy or exposure to infectious agents or chemicals. Notochordal neural tube and dysraphic anomalies are congenital defects associated to imperfect closure of the cranial neuropore, the rspinales tube and the caudal neuropore McGeady Dysraphism conditions can occur in the cranium anencephalia, exencefalia, cranium bifidum, encephalocele, meningocele or in the spinal cord.
Spinal dysraphism includes dorsal midline defects derived from the secondary mal-development of ectoderm, mesoderm, and neurectoderm layers of tissue, and encompasses a variety of malformations including espunales bifida, meningocele, meningomyelocele, syringomyelia, split cord anomalies diplomyelia, diastematomyeliaand others De Lahunta and Glass Environmental, genetic, and nutritional factors have been reported to cause neural tube defects in laboratory mice including drugs, physical agents hyperthermiavitamin excess or deficiency folic acidmaternal infectious and metabolic diseases Gutierrez et alHrubec et al In the present case, Myelo-CT demonstrated severe soft tissue abnormalities that were not evident from radiography and ultrasonography.
These included duplication of the spinal cord with one dural sac diplomyeliasegmental aplasia and hypoplasia of the spinal cord. Pang et al classified split spinal cord malformation as type I or diastematomyelia where two individual dural tubes are found, sometimes separated by an osseous or cartilaginous septum.
Split cord malformation type II or diplomyelia consists of two hemicords housed within a single dural sac separated by a fibrous septum Pang et al Previous human studies have also demonstrated that the severity of spinal disraias lesion may be underestimated with radiography and ultrasonography, and have recommended that patients should also be evaluated using MRI or Myelo-CT to delineate spinal cord lesions, the position of neural structures and associated anomalies Orakdogen et al Imaging techniques can also aid in the planning of surgical interventions Bailey and Morgan Ultrasound evaluation has been useful in detecting split cord malformations in human fetuses and infants and also young animals Dick et alTestoni et al However, the sonographic evaluation on this case was unable to provide additional information about the spinal cord anomaly probably due to advance stage of vertebral ossification in the dog.
Computed tomographic myelography findings in the dog of this report were consistent with type Espibales split cord malformation. These spinal cord lesions most likely occurred during primary neurulation and are uncommon in domestic animals. Spinal cord duplications are often associated with vertebral anomalies such as spina bifida, as seen in this case.
Computed tomography without contrast can be used to demonstrate bone lesions defects and malformations Thrall In humans, method of choice for evaluation of vertebral anomalies is high resolution CT scan with bone window and thin or utltrathin section in the area of interest Schijman Additionally, three-dimensional CT reformatting software tools can be used to more clearly visualize the surface appearance of the vertebral column defects including spina bifida, hemivertebrae and others.
Computed tomographic myelography can also detect variations in the shape, size and split defects of spinal cord and in this case it was helpful in determining the location and extent of the spinal dysraphism, the spinal cord malformation type II and spinal cord hypoplasia.
Magnetic resonance imaging has been described as the preferred imaging modality for disraias of spinal dysraphism, meningoceles, myelomeningoceles in small animals Da Costa This is the first report assessing spinal cord duplication in dogs using CT myelography. sepinales
Resonancia magnética fetal en el estudio prequirúrgico de disrafia espinal – ScienceOpen
Clinical signs in this case were consistent with a lumbosacral L3-Cd4 spinal cord lesion. The neurologic localization was supported by the Myelo-CT findings.
Spinal cord myelodysplastic lesions are frequently found on thoracic, lumbar, sacral and caudal segments and lower motor signs in the distribution of the sciatic, pudendal and caudal nerves are predominant Hoskins Mild paraparesis, bunny hopping, decreased flexor reflexes in pelvic limbs epsinales decreased perineal reflex and urinary-fecal incontinence are common neurologic findings HoskinsDewey Usually these neurologic signs are nonprogressive and present from birth Dewey The cause of these clinical signs is believed to be a microscopic alteration in the ventral commissural interneurons in the lumbosacral intumescence that are involved with gait De Lahunta and Glass The dimpling of the skin and abnormal pattern of the haircoat over L6 in epinales dog of this report is also consistent with previous reports Mattos et al Scar at the perineal area were probably due to previous decubitus ulcers or skin irritation associated to decrease sensation at the visrafias area.
In utero surgical repair of spina bifida has been successful in preventing or minimizing neurologic deficits in humans and sheep Meuli et alEspinalrs Prevention of NTDs in humans has been reported from maternal periconceptional supplementation with folic acid, although the protective mechanism remains unclear Blencowe et al Humans patients who are ambulatory with non-progressive signs may have an acceptable adult life.
Because of the mild neurologic dysfunction, owners of the dog from this report declined espunales and chose to keep the dog as pet. Split cervical spinal cord malformation and vertebral dysgenesis. Orthop Traumatol Surg Res 95, Folic acid to reduce neonatal mortality from neural tube disorders. Int J Epidemiol 1, Clinical syndromes in disrafuas neurology. Spina bifida in a German shepherd puppy. Vet Rec Advanced imaging of the spine in small animals. De Lahunta A, E Glass. Veterinary Neuroanatomy and Clinical Neurology.
Canine and feline neurology. Spinal ultrasound in infants. Br J Radiol 75, Aortic and ventricular dilation and myocardial reduction in gestation day 17 ICR mouse fetuses of diabetic mothers.
Valproic acid-induced fetal malformations are reduced by maternal immune stimulation with granulocyte-macrophage colony-stimulating factor or interferon-gamma. Blackwell Publishing, Oxford, UK. Spina bifida in a dead stillbirth mongrel dog. In utero surgery rescues neurological function at birth in sheep with spina bifida. Nat Med 1, Spina bifida in three dogs. Braz J Vet Pathol 1, Spinal Dysraphisms of the Cervicothoracic Region in Childhood. Turkish Neurosurgery 19, Split spinal cord malformations: Report of 22 cases and review of the literature.
Childs Nerv Syst 19, Surgical treatment of tethered spinal cord syndrome in a dog with myelomeningocele.
A possible mode of inheritance for spinal dysraphism in the dog with a more complete description of the clinical syndrome. Fetal surgery for neural tube defects. Imaging diagnosis-ultrasonographic diagnosis of espina,es in a calf.
Vet Radiol Ultrasound 51, Textbook of veterinary radiology. SUMMARY Spinal dysraphism is a congenital defect of the vertebral column and spinal cord secondary to imperfect closure of the caudal neuropore of the developing neural tube. Myelo-CT findings of spinal dysraphism abnormalities in a two month old mixed breed dog. Absence of vertebral arch, abnormal triangular shape of the spinal cord and mild meningocoele white arrow at cranial L6 vertebral segment C: A fine radiopaque line of contrast medium is observed between the two hemicords black arrow.
Hallazgos espibales mielo-TAC de un disrafismo espinal en un perro mestizo de dos meses de edad. Computed tomographic espnales image of the caudal lumbar spine in a two month old dog with spinal dysraphism, displayed using dorsal planar reformatting.