Neurology News

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.
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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.

Treatment options:

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

 further signs.

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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