Pip diagnosis - Central cord syndrome

[CarolC]

Found this

Clinical signs may be more severe with an intact dens, as a normal but dorsally deviated dens causes a greater degree of spinal compression.

In Pip's case the dens is missing, and that is often congenital in chihuahuas.

[critters]

I've never heard of "dens," beyond the obvious, of course!

[CarolC]

I found an example in human medicine of dyspnea and dysphagia related to C1-C2 compression, not to the brain stem as in a previous article I quoted. Pip has both (trouble breathing and trouble swallowing).

we experienced a case of dyspnea and dysphagia after posterior C1-C2 fusion. [skip] So we did C1 posterior arch decompression and extended fusion to the occiput with neck extension position. Dyspnea and dysphagia gradually improved after the surgery and complete recovery was observed within a month.

[CarolC]

Pip had a CT yesterday. He has more compression than expected. He did OK with the anaesthesia, except he regurgitated twice. The first time he was still intubated so that should be OK, but the second time was when they were removing the tube, so the neurologist called in Clavamox to prevent aspiration pneumonia.

[CarolC]

The imaging report says

A dens type structure is present but appears dysplastic (abnormally shaped); this could be secondary to a congenital malformation or trauma.

[critters]

He's a most interesting fella, I have to say!

[CarolC]

I noticed he was constipated after his neurology appointment May 16, and thought maybe it was the prednisone. Then he was constipated again after the May 23 appointment, and by then he was on less prednisone (tapering). In each case he had to be fasted before the appointment, so that might have thrown his system off. Trying to stimulate him is hit-or-miss (more miss than hit) so I've been trying lactulose for him. I gave him 0.5 ml the first time and it worked the next day. But I thought I'd try getting him on it daily to see if we could get him regular. I started with 0.2, 0.25, 0.3, and yesterday was 0.35. At 0.25 and 0.3 he went in his bed after breakfast, which does not usually happen. This morning he went before breakfast (yay!) after getting 0.35 yesterday. Would love it if we could get him predictable. Tried 0.35 again. We'll see.

I also wonder if being backed up from the first appointment had anything to do with the regurgitation at the CT appointment. I think the appointments made him tense.

[critters]

I'd certainly think stress could make him pukey.

[CarolC]

Pip had surgery to stabilize his atlantoaxial joint at 4PM Wednesday, June 7. He was high risk for anaesthesia but did well. He came home yesterday. His incision is under his neck where his throat is. He has screws, pins, and bone cement. He is on tramadol, gabapentin, prednisone, and an antibiotic, Simplicef. The meds seem to be working well. He had cold pack treatments on his incision for 3 days and today he starts hot pack treatments. He is eating well. He can drink soy milk. He can bark. He has bladder control. He can get himself sternal. He seems more normal than I would have expected on his 3rd day. He is constipated but I started him on lactulose this morning. The surgeon said the surgery went about as well as possible and he is "rock solid" now. She said the bone in his dens was good and strong. She thinks it is highly unlikely he'll break his implants. She said he had a lot of scar tissue. He is on crate rest for 8 weeks. He has a recheck with the surgeon June 22. He'll have another neurology appointment after 8 weeks. Here is what the neurology report said after his CT/MRI 2 weeks ago.

Pip's CT/MRI study revealed severe spinal cord compression up to 90% at the Atlantoaxial joint (C1-2). This is the cause of Pip's paralysis.

The surgeon says it is wide open now.