Solution for Case 13

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Radiographic findings: Complete fracture of caudal aspect of L6 and ventral displacement of caudal part of L6 and L7. Complete fracture of the left wing of the ilium. A lateral and VD radiographs of thoracic vertebrae were also taken and all appeared unremarkable. 

Diagnosis: Spinal cord trauma due to Fracture of L6/L7 (UMN damage to the spinal cord).

Differentials for the signs presented:

• Lumbar or sacral spinal trauma
• Trauma and fracture of any portion of pelvis

Treatment: Establish an IV catheter and place on twice the maintenance at 4ml/kg/hr fluid rate with lactated ringer solution. Administer buprenophine 0.2mg/kg IV for pain. Treatment options are spinal surgery and devices such as a doggie carts along with possible complications of urinary and fecal incontinence. After all diagnostics were evaluated, all the treatment options including euthanasia were discussed with the owner and the patient was euthanized with pentobarbital (390mg/kg). 

Case 13

Presentation:

A 9 to 10 month old intact female, mixbreed was presented to AcaseAweek Clinic around 2:30pm after being hit by a car approximately 6:40am that morning. Owner said that the patient started biting at her vulva and so blood was seen around the vulva and mouth. The patient was in lateral recumbency and manual manipulation was painful. 

Physical exam:

• Weight = 10kg, 
• TPR all WNL, 
• MM pink
• CRT<2 >
• EENT all normal 
• Thoracic auscultation was nonremarkable. 
• A mild lymphadenopathy was noted in all lymph nodes. 
• When palpating the caudal vertebrae an obvious defect of the vertebrae could be felt just cranial to the sacrum. 

Neurological exam: Hyperreflexia in both right and left hindlimbs. Withdrawl reflex was absent in both. Ischial groove reflex of the left hindlimb produces a reflex in the right limb that was hyperreflexive. Anus was flaccid and showed no tone. 

Radiographs of lumbosacral and pelvis region were taken as shown below (Click on image to enlarge):

What are the radiographic findings and diagnosis?

What are differentials for the signs presented?

How will you treat and manage this case?

Solution to this case