Spinal cord diseases in cats can be incredibly frustrating. The adventure starts with the uncooperative patient, winds its way through the dreaded neurologic examination interpretation, and ends in the sea of diseases that could be causing the clinical signs. It’s not easier for a board certified neurologist, but there are some things that we can share that might be helpful.
Tips on neurologic examination in cats
Cats essentially say, “I don’t want to play your game and I am not going to participate.” However, there are ways to get them to participate without their knowledge or even with their cooperation. If you need some reminders on the neurological examination, please see, “The Neurological examination of the cat” by Laurent Garosi in the Journal of Feline Medicine and Surgery, 2009 Volume 11. We would like to emphasize a couple of key points:
- Gait Analysis – This is incredibly important in cats. Since time is always crucial, let the patient walk around the room while you are getting the history from the owner. Break the cat down into three segments, the head, thoracic limbs and pelvic limbs with tail. Evaluate each one separately then try to put it all together. Don’t forget to watch the movement of the tail: Does it drag or does it appear to be straight up as if to aid with balance, as in a vestibular cat?
- Postural Reactions – In our experience, cats hate hopping and don’t like when you touch their feet. The best tests to perform are wheelbarrowing, extensor postural thrust and, especially, tactile placing using a table. Consistency is key in cats as one abnormal extensor postural thrust among four normal attempts means little.
- Cranial Nerves – In addition to routine tests, remember to perform a fundic exam. Since infectious disease is one of the most common causes of spinal problems in cats, this test can be extremely helpful.
- Spinal Reflexes and Appendicular Tone/Muscle Size – These tests are best performed with the patient lying in dorsal recumbency between your legs or by having a technician hold the cat so the pelvic limbs dangle for examination.
- Spinal Pain – This should always be saved for last in cats, since their fuse can be short. It is important to ask the owner how the pet reacted to being touched on the back in the past. Many cats are merely hyperreactive and not necessarily hyperesthetic to thoracolumbar spinal palpation.
- Orthopedic Versus Neurologic Disease – The more predictable an abnormal movement is, the more likely the cause is orthopedic. Cats that hold their limbs up are more likely to have orthopedic disease. Cats with difficulty holding their heads up usually have a neurologic disease.
Remember, the neuroanatomic localization is important because once you have it, you can utilize textbooks to help with your differential list. If you are uncertain where the problem is occurring, this is the time to refer. Localizing the problem correctly guides appropriate diagnostics, saves time and mitigates owner frustration.
Once you have your neuroanatomic localization, you can now consider the most likely differentials. There are a couple ways to look at this: first, based on categories (from most to least likely):
- Traumatic (including fracture, luxation, and Intervertebral Disc Disease)
- Congenital/Inherited Disease (i.e., Storage Disease)
- Vascular Disease
Or based on individual diseases:
- Feline Infectious Peritonitis
- Vertebral Tumors (with osteosarcoma most frequent)
- Traumatic (fractures and luxations)
- Vascular Disease
Or based on age: