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Patients with neurological disorders

image of Patients with neurological disorders
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Abstract

Disorders of the nervous system include a wide range of conditions with very different needs in terms of rehabilitation, support and palliative care. This chapter covers Principles of treating neurological cases; Managing recumbent dogs and cats; and Changes in demeanour. A variety of case scenarios in dogs and cats will be presented to illustrate the considerations to be made and the options available within a specific clinical setting. Tail pull injury in a cat; Brain tumour in a dog; Cervical disc herniation in a dog; Cervical myelopathy in a dog; Discospondylitis in a dog; Refractory epilepsy in a dog; Thoracolumbar disc protrusion in a dog.

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Figures

Image of These radiographs show wide separation between the first two caudal vertebrae. (Courtesy of Sorrel Langley-Hobbs)
These radiographs show wide separation between the first two caudal vertebrae. (Courtesy of Sorrel Langley-Hobbs) These radiographs show wide separation between the first two caudal vertebrae. (Courtesy of Sorrel Langley-Hobbs)
Image of A cystostomy tube placed percutaneously at laparotomy to drain the bladder.  The tube can be either connected to a closed collecting system, or emptied intermittently. (Courtesy of Stephen Baines)
A cystostomy tube placed percutaneously at laparotomy to drain the bladder.  The tube can be either connected to a closed collecting system, or emptied intermittently. (Courtesy of Stephen Baines) A cystostomy tube placed percutaneously at laparotomy to drain the bladder.  The tube can be either connected to a closed collecting system, or emptied intermittently. (Courtesy of Stephen Baines)
Image of The cat will need to feed at ground level as he must not jump up for at least 6 weeks. (© Samantha Elmhurst)
The cat will need to feed at ground level as he must not jump up for at least 6 weeks. (© Samantha Elmhurst) The cat will need to feed at ground level as he must not jump up for at least 6 weeks. (© Samantha Elmhurst)
Image of Safe and comfortable hiding areas should be provided. This cat also has some toys to hand for gentle play. (Courtesy of Lucy Hudson)
Safe and comfortable hiding areas should be provided. This cat also has some toys to hand for gentle play. (Courtesy of Lucy Hudson) Safe and comfortable hiding areas should be provided. This cat also has some toys to hand for gentle play. (Courtesy of Lucy Hudson)
Image of Gloves should be worn when emptying the urine bag. (Courtesy of Rachel Lumbis)
Gloves should be worn when emptying the urine bag. (Courtesy of Rachel Lumbis) Gloves should be worn when emptying the urine bag. (Courtesy of Rachel Lumbis)
Image of Toys with food hidden inside can provide stimulatory play. (Courtesy of Lucy Hudson)
Toys with food hidden inside can provide stimulatory play. (Courtesy of Lucy Hudson) Toys with food hidden inside can provide stimulatory play. (Courtesy of Lucy Hudson)
Image of (left) T1-weighted post-contrast transverse image of the brain at the level of the thalamus. The extra-axial contrast-enhancing mass is clearly visible. (right) T2-weighted image, highlighting the oedema extending beyond the borders of the mass (arrowed).
(left) T1-weighted post-contrast transverse image of the brain at the level of the thalamus. The extra-axial contrast-enhancing mass is clearly visible. (right) T2-weighted image, highlighting the oedema extending beyond the borders of the mass (arrowed). T1-weighted post-contrast transverse image of the brain at the level of the thalamus. The extra-axial contrast-enhancing mass is clearly visible. T2-weighted image, highlighting the oedema extending beyond the borders of the mass (arrowed).
Image of The lateral radiograph shows collapse of the C2/3 disc space, with a small amount of mineralized material visible in the canal. The nucleus of C3/4 is mineralized but there is no evidence of herniation at this site. The transverse CT scan at C2/3 shows a large mass of mineralized disc material on the floor of the canal.
The lateral radiograph shows collapse of the C2/3 disc space, with a small amount of mineralized material visible in the canal. The nucleus of C3/4 is mineralized but there is no evidence of herniation at this site. The transverse CT scan at C2/3 shows a large mass of mineralized disc material on the floor of the canal. The lateral radiograph shows collapse of the C2/3 disc space, with a small amount of mineralized material visible in the canal. The nucleus of C3/4 is mineralized but there is no evidence of herniation at this site. The transverse CT scan at C2/3 shows a large mass of mineralized disc material on the floor of the canal.
Image of The dog is allowed to step out of a ground-level cage and approached gently. (Courtesy of Rachel Lumbis and Catherine Kendall)
The dog is allowed to step out of a ground-level cage and approached gently. (Courtesy of Rachel Lumbis and Catherine Kendall) The dog is allowed to step out of a ground-level cage and approached gently. (Courtesy of Rachel Lumbis and Catherine Kendall)
Image of This dog’s incision is being cooled using a custom-made pack that can be cleaned and disinfected and is kept in the freezer between uses. A pack of frozen peas can be used in a similar way.
This dog’s incision is being cooled using a custom-made pack that can be cleaned and disinfected and is kept in the freezer between uses. A pack of frozen peas can be used in a similar way. This dog’s incision is being cooled using a custom-made pack that can be cleaned and disinfected and is kept in the freezer between uses. A pack of frozen peas can be used in a similar way.
Image of Hot packs can be made by filling disposable gloves with hot water.
Hot packs can be made by filling disposable gloves with hot water. Hot packs can be made by filling disposable gloves with hot water.
Image of Severe dorsal compression of the spinal cord is evident at C4/5 and C5/6 on this sagittal T2-weighted MRI. There is less severe compression at C6/7, but all sites of compression are associated with increased signal within the underlying spinal cord.
Severe dorsal compression of the spinal cord is evident at C4/5 and C5/6 on this sagittal T2-weighted MRI. There is less severe compression at C6/7, but all sites of compression are associated with increased signal within the underlying spinal cord. Severe dorsal compression of the spinal cord is evident at C4/5 and C5/6 on this sagittal T2-weighted MRI. There is less severe compression at C6/7, but all sites of compression are associated with increased signal within the underlying spinal cord.
Image of Passive movements to the carpus. (Courtesy of Brian Sharp.)
Passive movements to the carpus. (Courtesy of Brian Sharp.) Passive movements to the carpus. (Courtesy of Brian Sharp.)
Image of A dog using an underwater treadmill with the water at shoulder height; this gives buoyancy initially and increased resistance at later stages of recovery. (© Janet Van Dyke)
A dog using an underwater treadmill with the water at shoulder height; this gives buoyancy initially and increased resistance at later stages of recovery. (© Janet Van Dyke) A dog using an underwater treadmill with the water at shoulder height; this gives buoyancy initially and increased resistance at later stages of recovery. (© Janet Van Dyke)
Image of This tetraparetic Dobermann prefers to lie in lateral recumbency. Padding has been placed under her left shoulder and head, to maintain a more upright but still comfortable posture.
This tetraparetic Dobermann prefers to lie in lateral recumbency. Padding has been placed under her left shoulder and head, to maintain a more upright but still comfortable posture. This tetraparetic Dobermann prefers to lie in lateral recumbency. Padding has been placed under her left shoulder and head, to maintain a more upright but still comfortable posture.
Image of Large decubital ulcer over the elbow of a tetraparetic dog that was kennelled in a cage with no padding. His repeated abortive attempts to stand had caused severe injury to the soft tissues of both elbows.
Large decubital ulcer over the elbow of a tetraparetic dog that was kennelled in a cage with no padding. His repeated abortive attempts to stand had caused severe injury to the soft tissues of both elbows. Large decubital ulcer over the elbow of a tetraparetic dog that was kennelled in a cage with no padding. His repeated abortive attempts to stand had caused severe injury to the soft tissues of both elbows.
Image of ‘Doughnuts’ can be made using bubble wrap and adhesive bandage. They are placed to lift pressure points away from the ground.
‘Doughnuts’ can be made using bubble wrap and adhesive bandage. They are placed to lift pressure points away from the ground. ‘Doughnuts’ can be made using bubble wrap and adhesive bandage. They are placed to lift pressure points away from the ground.
Image of The dog had mutilated the third and fourth digits of her hindfeet, removing the nails and a part of the third phalanx. There were also severe decubital ulcers on the dorsal aspect of the tarsus.
The dog had mutilated the third and fourth digits of her hindfeet, removing the nails and a part of the third phalanx. There were also severe decubital ulcers on the dorsal aspect of the tarsus. The dog had mutilated the third and fourth digits of her hindfeet, removing the nails and a part of the third phalanx. There were also severe decubital ulcers on the dorsal aspect of the tarsus.
Image of The wounds were treated by the application of sugar, and a bandage that was changed twice daily to generate a healthy bed of granulation tissue.
The wounds were treated by the application of sugar, and a bandage that was changed twice daily to generate a healthy bed of granulation tissue. The wounds were treated by the application of sugar, and a bandage that was changed twice daily to generate a healthy bed of granulation tissue.
Image of Paraplegic or paraparetic animals can be walked with sling support, using something as readily available as a towel (left). A custom-made sling (right) has the advantage of supporting the dog’s entire pelvis and is more comfortable, so the dog is more likely to try to walk.
Paraplegic or paraparetic animals can be walked with sling support, using something as readily available as a towel (left). A custom-made sling (right) has the advantage of supporting the dog’s entire pelvis and is more comfortable, so the dog is more likely to try to walk. Paraplegic or paraparetic animals can be walked with sling support, using something as readily available as a towel (left). A custom-made sling (right) has the advantage of supporting the dog’s entire pelvis and is more comfortable, so the dog is more likely to try to walk.
Image of Passive range of motion of the pelvic limbs. (Reproduced from BSAVA Manual of Canine and Feline Neurology, 3rd edition)
Passive range of motion of the pelvic limbs. (Reproduced from BSAVA Manual of Canine and Feline Neurology, 3rd edition) Passive range of motion of the pelvic limbs. (Reproduced from )
Image of Animals with marked weakness may require assistance to stand and walk, using physiotherapy rolls. (Courtesy of Brian Sharp)
Animals with marked weakness may require assistance to stand and walk, using physiotherapy rolls. (Courtesy of Brian Sharp) Animals with marked weakness may require assistance to stand and walk, using physiotherapy rolls. (Courtesy of Brian Sharp)
Image of This dog is lying on a thick rubber mat with easily removable absorbent pads underneath its hind end.
This dog is lying on a thick rubber mat with easily removable absorbent pads underneath its hind end. This dog is lying on a thick rubber mat with easily removable absorbent pads underneath its hind end.
Image of The owners of this chronically paralysed dog express their pet’s bladder regularly. To prevent small ‘accidents’ in the house, the dog wears this velcroed waist band on a daily basis. An absorbent pad is placed in the waistband over this dog’s penis and is changed regularly.
The owners of this chronically paralysed dog express their pet’s bladder regularly. To prevent small ‘accidents’ in the house, the dog wears this velcroed waist band on a daily basis. An absorbent pad is placed in the waistband over this dog’s penis and is changed regularly. The owners of this chronically paralysed dog express their pet’s bladder regularly. To prevent small ‘accidents’ in the house, the dog wears this velcroed waist band on a daily basis. An absorbent pad is placed in the waistband over this dog’s penis and is changed regularly.
Image of Hindlimb moved in a bicycling motion to simulate normal gait patterning; a useful technique for patients with neurological disease that are unable to walk.
Hindlimb moved in a bicycling motion to simulate normal gait patterning; a useful technique for patients with neurological disease that are unable to walk. Hindlimb moved in a bicycling motion to simulate normal gait patterning; a useful technique for patients with neurological disease that are unable to walk.
Image of An example of a seizure log. Owners are asked to note seizures and any additional treatment that is given. They are also asked to make notes on the severity of side effects. This helps the clinician balance seizure control and the impact of unwanted drug effects.
An example of a seizure log. Owners are asked to note seizures and any additional treatment that is given. They are also asked to make notes on the severity of side effects. This helps the clinician balance seizure control and the impact of unwanted drug effects. An example of a seizure log. Owners are asked to note seizures and any additional treatment that is given. They are also asked to make notes on the severity of side effects. This helps the clinician balance seizure control and the impact of unwanted drug effects.
Image of TL type II disc: A sagittal T2-weighted MRI of the lumbar spine shows protrusions of all the intervertebral discs. These are causing significant spinal cord compression at T12/13 (not shown), T13/L1 and L1/2.
TL type II disc: A sagittal T2-weighted MRI of the lumbar spine shows protrusions of all the intervertebral discs. These are causing significant spinal cord compression at T12/13 (not shown), T13/L1 and L1/2. TL type II disc: A sagittal T2-weighted MRI of the lumbar spine shows protrusions of all the intervertebral discs. These are causing significant spinal cord compression at T12/13 (not shown), T13/L1 and L1/2.
Image of A Labrador Retriever before (top) and after a weight loss programme. (Courtesy of The Royal Canin Weight Management Clinic, University of Liverpool)
A Labrador Retriever before (top) and after a weight loss programme. (Courtesy of The Royal Canin Weight Management Clinic, University of Liverpool) A Labrador Retriever before and after a weight loss programme. (Courtesy of The Royal Canin Weight Management Clinic, University of Liverpool)
Image of Application of NMES – shown here to the quadriceps and hamstrings – with the aim of achieving co-contraction of the two muscle groups. (Courtesy of Brian Sharp)
Application of NMES – shown here to the quadriceps and hamstrings – with the aim of achieving co-contraction of the two muscle groups. (Courtesy of Brian Sharp) Application of NMES – shown here to the quadriceps and hamstrings – with the aim of achieving co-contraction of the two muscle groups. (Courtesy of Brian Sharp)
Image of A therapist should assist the dog while he swims in the pool. (© Steven Steinberg; http://veterinaryneuron.blogspot.com)
A therapist should assist the dog while he swims in the pool. (© Steven Steinberg; http://veterinaryneuron.blogspot.com) A therapist should assist the dog while he swims in the pool. (© Steven Steinberg; http://veterinaryneuron.blogspot.com)
Image of Manual needling would include targeting the gluteals and longissimus muscles, depending on the patient’s distribution of pain.
Manual needling would include targeting the gluteals and longissimus muscles, depending on the patient’s distribution of pain. Manual needling would include targeting the gluteals and longissimus muscles, depending on the patient’s distribution of pain.
Image of Electroacupuncture is recommended if there is no response to manual acupuncture, or if a more potent or longer-lasting effect is needed.
Electroacupuncture is recommended if there is no response to manual acupuncture, or if a more potent or longer-lasting effect is needed. Electroacupuncture is recommended if there is no response to manual acupuncture, or if a more potent or longer-lasting effect is needed.
Image of Weight management clinics also offer the opportunity for the owner to discuss any other care-related issues. (Courtesy of The Royal Canin Weight Management Clinic, University of Liverpool)
Weight management clinics also offer the opportunity for the owner to discuss any other care-related issues. (Courtesy of The Royal Canin Weight Management Clinic, University of Liverpool) Weight management clinics also offer the opportunity for the owner to discuss any other care-related issues. (Courtesy of The Royal Canin Weight Management Clinic, University of Liverpool)

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