2 July 2014
From Milo's visit to the U of MN Neurologist. As collies can tend to do, Milo was very stoic for his exam.
Today, Milo was referred for a neurologic evaluation from
the Complementary Medicine service due to slowly progressive hind limb weakness.
No notable findings were seen on physical exam except decreased muscle mass overall.
Summary of Neurologic Exam:
Examination of Milo's cranial nerves and fore limbs revealed no abnormalities. No pain was noted on
palpation of the back or neck, or on neck flexion. In the hind limbs, the conscious proprioception test
(flipping the feet over to see if Milo knows where his feet are) was decreased to absent on the left side but
normal on the right, leading to a diagnosis of left pelvic limb monoparesis. Patellar reflexes were normal in
both hind limbs.
At this time Milo's neurologic signs localize to spinal cord segments between the third thoracic vertebrae and
the third lumbar vertebrae. His signs are mild enough that the lower lumber can not be excluded. The
primary rule outs for him include:
1. Intervertebral disc protrusion: Material from the intervertebral disc protruding into the spinal canal causes
compression on the spinal cord and results and neurologic symptoms. Depending on the location of the disc
protrusion, one or both limbs could be affected, which fits Milo's presentation today.
2. Lumbosacral Stenosis: This disease has many causes, but all result in compression of the nerve roots in
the lower spine near the tail and pelvic area, or cauda equina. Symptoms seen at this disease are similar to
those shown by Milo.
3. Neoplasia (cancer): A tumor on or near the spinal cord or vertebral column could cause symptoms like the
ones seen with Milo today, however this is very unlikely given the length of time with out lots more weakness.
We recommend that you continue treatment as previously discussed with the Complementary Medicine
service and contact us if his neurologic signs worsen. Further medical imaging such as MRI to localize
and/or diagnosis a causative lesion is a possibility, but is really only useful for guiding surgical decisions in
this situation. The treatment option chosen today was to continue with previous treatment and monitor for
At their request, I sent some video of Milo walking at home to demonstrate his challenges with walking at times and his slope backed stance.
Milo - video one
Milo - video two
Milo - video three