Cooper is a 9 year old Airedale Terrier referred to BVNS for the inability to walk and severe neck pain. The pain had been intermittent for 3 weeks and acutely worsened two days before presentation. Cooper had also been having difficulty rising and was non-ambulatory at the time of presentation.
• 3 weeks progressive neck pain which became severe
• 2 days progressive weakness in all 4 limbs resulting in an inability to rise upon admission
• Depressed and inappetent
• Non-ambulatory with severe tetraparesis; low head and neck carriage; proprioception slow in the thoracic limbs and absent in the pelvic limbs; hopping absent in all limbs; intense pain response with palpation of the cranial cervical region (between the occiput and C2); distended urinary bladder.
• Cranial cervicalmyelopathy with primary differentials being neoplastic, immune mediated or infectious disease process
• Bloodwork revealed leukocytosis and thrombocytopenia.
• MRI of the cervical spine showed a paraspinal abscess, primarily right-sided in the C1 region with probable extension of the mass into the epidural space. There was also evidence of meningitis from the posterior fossa through C2-C3.
• Fine-needle aspirate and cytology revealed cocci and neutrophils (both present in quantities too numerous to count)
Initial treatment with intravenous fluids, antibiotics and analgesics provided subtle improvement; however, Cooper remained non-ambulatory and the thrombocytopenia worsened. The decision was made to proceed with an exploratory surgery of the right paraspinal cranial cervical musculature together with a modified laminectomy of C1. Much of the tissue in the region was found to be necrotic and discolored. The abscess within the muscle was opened and flushed and a small tubular structure was removed from within; histopathology later revealed this to be foreign material resembling plant matter. After laminectomy, fibrin adhesions were detached from the dura and the spinal cord was decompressed. A drain was placed and Cooper was hospitalized for several days after surgery for continued supportive care. At the time of release, Cooper was able to walk with minimal support and was able to move his head and neck with improved range of motion and comfort. He went on to show continued improvement and made a full recovery over the following weeks.
Take Home Points:
1. Weakness and neck pain can be associated with cervical spinal cord disease.
2. Foreign body migration is an uncommon cause of spinal cord disease, but a favorable outcome can often be achieved with advanced diagnostics and surgical intervention.
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