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Today’s Veterinary Practice May/June 201238
Acute SpinAl cord injurieSAdam Moeser, DVM, and
Charles Vite, DVM, PhD,
Diplomate ACVIM (Neurology)
Acute spinal cord
injury is a major
cause of neurologic
dysfunction in dogs and
somewhat less so in cats.
peer reviewed
Acute SpinAl cord inJurieS:
Step by Step1. History: When a dog or cat presents with evidence
of acute spinal cord injury, obtain a detailed history
and ascertain whether trauma may have occurred.
2. Stabilization: Whenever spinal cord injuries
secondary to trauma are suspected, manipulate the
patient as little as possible. Evaluate the patient’s
overall stability first; then address neurologic deficits.
3. neurologic examination: The findings from a
comprehensive neurologic examination are the most
important part of the diagnostic evaluation.
4. differentials: If no trauma or obvious instability
has occurred, consider differentials, such as
intervertebral disk disease and fibrocartilagenous
embolism.
5. radiographs: Spinal radiographs are essential in
order to identify spinal instability prior to extensive
manipulation of the patient.
6. ct & Mri: Advanced imaging is valuable in
diagnosis of acute spinal cord injury. If severe
neurologic deficits are present, refer the patient to a
hospital with appropriate diagnostic capabilities.
7. treatment: Depending on diagnosis, pursue medical
management (indicated for patients with pain or
minor deficits) or surgery (indicated in patients with
severe neurologic deficits, vertebral instability, or
significant extradural compression).
8. Secondary damage: Be prepared for secondary
damage and initiate treatment if necessary.
May/June 2012 Today’s Veterinary Practice 39
The most commonly encountered causes of
acute spinal cord injury in dogs are, in order
of incidence:1-4
•Intervertebraldiskdisease(IVDD)
•Trauma(automobiletrauma,gunshots)
•Infarction(fibrocartilagenousembolism).
Incats,themostcommoncausesofacutespinalcord
injuryrecordedfromapopulationofcatsthathadbeen
necropsied are, in order of incidence:5
•Trauma(fallingfromwindows,automobiletrauma)
•IVDD
•Ischemic disease (infarction, fibrocartilagenous
embolism[FCE]).
PATIENT ASSESSMENT
Stabilization
Wheneverspinalcordinjuriessecondarytotraumaare
suspected, it is important to manipulate the patient as
littleaspossible.
•Transport:Theuseofastretcherorboardcanbe
veryhelpfulfortransportation.Thepatientshould
berestrainedandpossiblystrappedtotheboard
duringtransport.
•Overall Stability:Whenevaluatingapatientwith
neurologic deficits due to suspect trauma,
evaluatethepatient’soverallstabil-
ity first (ie, evalu-
ationof pulmonary and cardiovascular systems).
Traumapatientsmaysuffersignificantdamageto
bodysystemsthatposemoreimmediatethreatsto
theirlivesthanneurologicdeficits.
Neurologic Examination
•Theneurologicexaminationisthefirstandmost
important tool used by the clinician to localize
the site of injury. Please refer to Chapter 3 ofA
Practical Guide to Canine & Feline Neurology
(Dewey CW, Wiley-Blackwell, 2003) for more
specifics on the neurologic examination. The
presenceofcertainexaminationfindingswillhelp
localize the lesion(Table 1,page40)anddirect
furtherdiagnostics.
•However,itisnotuncommontofindsomediscrep-
ancybetweenneurolocalizationbasedontheneuro-
logicexaminationandtheactualinjurylocalization.
•One study showed an incorrect neuroanatomic
localizationwithinthecervicalcordin12/26dogs
withcervicaldiskdisease,mainlyduetoinconsis-
tent withdrawal reflexes.6 In addition, incorrect
neuroanatomic localization from L4 to S3 can
occur due to spinal shock in cases of T3 to L3
myelopathy(spinalcorddisease).7
Whenassessingapatientwithevidenceofamyelopa-
thy, thepresence/absenceofplegiaanddeeppainare
veryimportantindicatorsofprognosisregardlessofthe
etiology.Plegiaandlossofdeeppainareusuallyassoci-
atedwithseverelesionsthatarecausingpathologyto
asignificantpercentageofthewhitematter,while
patientsthatareonlypainfulandataxiclikelyhave
lesswhitematter involvement (Table 2, page
41).Atheoreticalprogressionofclinical signs
followingprogressionofpathologywouldbe:
Pain/ataxia/paresis Plegia Lossof
deep pain sensation
DIFFERENTIAL DIAGNOSIS
Intervertebral Disk Disease
IVDDisamajorcauseofacutespinalcordinjury
indogs; less so in cats. The intervertebral disk is
composedofanouterannulusfibrosisandaninner
nucleuspulposus(Figure 1,page40).Themajority
oftheannulusandtheentirenucleusisavascular;only
theperipheralpartsoftheannulusareinnervated.
Types of IVDD
•Fibrous metaplasia is part of the normal aging
processindogsandcats,whichresultsinweaken-
ingoftheannulusandfibrouscollagenizationof
thenucleuspulposus.Thiscanleadtobulgingof
theintervertebraldiskandaHansen Type II inter-
vertebraldisklesion(outermostlayersofannulus
fibrosusremainintact).
•Chondroid metaplasiaoccurswithinthenucleus
pulposus at an early age in chondrodystrophic
| AcuTE SPInAl corD InjurIES
Today’s Veterinary Practice May/June 201240
breeds, such as the dachshund.8 With chondroid
metaplasia,thenucleuspulposusbecomesabnor-
malandisnolongerabletodisperseforcesevenly,
leading to herniation. This herniation can occur
acutely and cause a Hansen Type I intervertebral
disklesion(completeperforationofannulusfibro-
sus with extrusion of nucleus pulposus into the
spinalcanal).Sincethenucleuspulposusiseccen-
tricallyplacedmoredorsallywithin theannulus,
the herniatedmaterial tends to herniate toward
thespinalcord.
•Traumatic noncompressive intervertebral disk
herniationoccurswhenthenucleuspulposusis
extruded and causes a concussive injury to the
spinalparenchyma(Figure 2).Insomecasesthis
extrudedmaterialcausesadural tear,whichcan
befoundbelowtheleveloftheduramater.9,10
Imaging•Plain radiographs can help determine the cor-
rect region of interest by identifying abnormali-
ties, suchasnarrowingof the intervertebraldisk
space,mineralopacitieswithinthecanal/foramen,
and the vacuum effect (area of radiolucency at
the levelof theaffected intervertebraldiskspace
causedbylossofdiskmaterial).
» However,plainradiographs(withoutcontrast)can-
not accurately diagnose IVDD with spinal cord
compression.
» Theaccuracyofidentifyingthecorrectsitebased
on plain radiographs alone is reported to range
from51%to61%,andadvancedimagingisneeded
foraccuratelocalizationanddiagnosisofIVDD.11
•Computed tomography (CT) and myelogra-
phyhaveasensitivityover80%forlocalizingthe
correct site, butmagnetic resonance imaging
(MRI)remainsthebestimagingmodalityforcases
ofIVDD(Figure 3,page42).12,13
» CT and/or myelogram may be appropriate for
youngandmiddle-agechondrodystrophicbreeds
whereIVDDisveryhighonthedifferentiallist.
» In older animals and nonchondrodystrophic
breeds, MRI should be recommended to the
ownerasanoptionsincemostareasnowhave
afacilitywithMRIwithinareasonabledistance.
» MRIhasbeenreportedtohavecompleteagree-
mentwithsurgicalfindings,withrespecttothe
siteofdiskextrusion.
» In cases of noncompressive traumatic interver-
tebral disk herniation, the affected disk space
mayhavedecreasedsignalonMRIT2weighted
images,alongwithmildextraduralcompression
seenattheleveloftheaffecteddiskspace.14,15
TreatmentOncespinalcordimagingiscomplete,adecisioncan
bemadewhethertopursuesurgicaldecompressionor
medicalmanagement.
Figure 1. Cross-sectional image of the interver-
tebral disk showing the annulus fibrosus and
nucleus pulposus.
TAble 1. examination Findings Related to
Spinal Cord lesion localization
lesion localization Clinical Findings
C1 to C5 • Crossedextensorreflex×4• Neckpain• Hornersyndrome• Proprioceptivedeficits×4• Increasedmyotaticreflexes×4• Tetraparesis/plegia• Increasedtone×4• Uppermotorneuronbladder
C6 to T2 • Absentcutaneoustruncireflex• Neckpain• Decreasedthoraciclimbtone/with-
drawal reflexes• Pelviclimbcrossedextensorreflexes• Proprioceptivedeficits×4• Hornersyndrome• Tetraparesis/plegia• Increasedpelviclimbmyotaticreflexes• Uppermotorneuronbladder• Increasedpelviclimbtone
T3 to l3 • Absentcutaneoustruncinearleveloflesion• Paraparesis/plegia• Pelviclimbcrossedextensorreflexes• Backpain• Proprioceptivedeficitsinpelviclimbs• Increasedpelviclimbmyotaticreflexes• Uppermotorneuronbladder• Increasedpelviclimbtone*
l4 to S3 • Decreasedanaltone/reflex• Lowermotorneuronbladder• Decreasedpelviclimbmyotaticreflexes• Lumbosacralpain• Decreasedpelviclimbtone/withdrawal
reflexes• Paraparesis/plegia• Pelviclimbproprioceptivedeficits• Limptail
*Potentially Schiff-Scherrington phenomenon if identified in thoracic limbs.
C = cervical; L = lumbar; T = thoracic
May/June 2012 Today’s Veterinary Practice 41
AcuTE SPInAl corD InjurIES |
Medical Management
Conservativemanagementtypicallyconsistsof:1,2,16
•Strictcagerestfor2to6weeks
•Anti-inflammatorydrugs
•Analgesics
•Physicaltherapy.
Alternative therapies, such as acupuncture, have
beendescribed,butnotenoughevidenceisavailable
todeterminetheirefficacy.
Arecentretrospectivereportdescribingtheuseof
medical management for suspected thoracolumbar
IVDDreportedasuccessrateofabout55%oncedogs
withepisodesofrelapsewerefactoredin17;ifdogswith
onlyminordeficits(ie,pain)areincludedinthesuccess
group, the success rate increases to 66%. A similar
retrospectivestudyshowedcomparableresultswhen
diskherniationwaslocalizedtothecervicalregion.18
Conservativemanagementisnotanidealchoicefor
patientswithsevereneurologicdeficits(severeparesis,
plegia, lossofdeeppain)or those thathavealready
failedconservativemanagement.However,iftheclient
cannotpursuesurgery,conservativemanagementisan
optionforthesepatients.
Surgical Management
In patients that have severe neurologic dysfunction
at time of presentation, significant compression of
thecordmaybepresent,whichhas thepotential to
severely impair local blood flow and cause progres-
sive secondary damage to the cord. Candidates for
surgery include:
•Significantvertebralinstability(luxation,fracture)
•Patientswithsignificantneurologicdeficits,such
assevereparesisorparalysis
•Deep-painnegativedogs.
Thelatterconditionhasasignificantlyworseprog-
nosisiftreatedwithmedicalmanagementalone.Seven
percentorlessofdeep-painnegativedogsrecoverwith
medicalmanagementalone.19
Surgicaltreatmentforacutediskextrusionsincludes:
•Cervical IVDD:Ventralslotorhemilaminectomy
•Thoracic/Lumbar IVDD: Hemilaminectomy or
dorsallaminectomy.
•Modifications of the typical hemilaminectomy,
such as a pediculectomy and mini-hemilaminec-
tomy,canalsobeperformed.
PrognosisIndicatorsbydiseasetype/presentationinclude:
•Acute Hansen Type 1 Disk Herniation/Intact
Nociception:Patientshaveanexcellentprogno-
sis with surgery. One retrospective study found
that96%ofthesepatientswereambulatorywithin
3monthsofsurgery.19
•Loss of Deep Pain Sensation/Lack of Noci-
ception: Thesepatientshaveamoreguardedprog-
Figure 2. Transverse T2-weighted MRI image
showing a right-sided intramedullary hyperin-
tensity, along with a comparatively hypointense
nucleus pulposus at the C2 to C3 intervertebral
disk space. These findings are consistent with a
traumatic noncompressive disk herniation.
TAble 2. Neurologic Function Related to
Spinal Cord Tract
Function Tracts location
Proprio-
ception
• Cuneateandgracili
fascicles• Dorsal/ventral/cranial
spinocerebellar• Spinocuneocerebellar
Periphery of the white matter
Motor
Skills
• Corticospinal
• Reticulospinal
• Rubrospinal
• Tectospinal
• Vestibulospinal
Deeper within the white matter
Pin-Prick
Pain
• Spinothalamic Deeper within the white matter
Deep
Pain
• Spinoreticular Very deep within the white matter
Histologiccrosssectionof thecervical spinal cordofa
dog showing the approximate location of certain ascend-ing and descending tracts. Note: Tracts are not depicted
per actual size.
| AcuTE SPInAl corD InjurIES
Today’s Veterinary Practice May/June 201242
nosis.Decompressive
surgery allows about
62% of deep pain
negative dogs with
thoracolumbar disk
extrusions to regain
nociceptionandabil-
ity toambulatewith-
outassistance.20
•Noncompressive
Traumatic
Intervertebral Disk
Herniation: One
retrospectivestudy
reportedthat46/48
dogswiththiscondi-
tion made significant
improvementsand
allwereambulatory
withmedicalman-
agement.21Prognosis
maybeworseforpatientsthathavelostdeep
painsensation.Surgeryisapotentialtherapyfor
patientswithsuspectedduraltears,andprogno-
sisappearsgoodbasedonlimitedreports.22,23
trauma
Commoncausesoftraumainclude:
•Automobileaccidents
•Gun-shotwounds
•Verticalfallsincats,amongothers.
Incasesofacutespinalinjuryrelatedtotrauma,sta-
bilizationisthemostimportantaspectofinitialcare.
SeePatient Assessment,page39.
Imaging•Lateral and dorsal/ventral radiographs of the
entirevertebralcolumncanhelpidentifyanyfrac-
tures(Figure 4)or luxationswithoutmanipulat-
ingthepatientexcessively.
•Atlanto-axialluxationsmustbeconsideredindogs
with a lesion localized from theC1 toC5 spinal
cord after suffering suspected trauma; it is impor-
tanttominimizecervicalflexioninthesedogs.
•CT is the gold standard for detecting vertebral
fractures and instability, and should be recom-
mended for anypatientwith suspected vertebral
fracturesorinstability.24
•While anMRI provides good evaluation of the
spinalcord,aCTscanoffersmuchbettervisualiza-
tionofthevertebralcolumn’spathology.
•Insomepatientswithvertebralfracture(s)and/or
luxations,bothMRIandCTmaybeideal.Figure
5showsanatlanto-axialluxationforwhichtheCT
allowedpropersurgicalplanning.
TreatmentTreatment of trauma patientswith significant neuro-
logicdeficitsrangesfromresttoimmobilizationusing
externalbracestosurgicalintervention/stabilization.
•Rest: Rest is appropriate for a patientwith pain
and/orminor deficits andno evidenceof signifi-
cantinstabilityofthecord.
•Stabilization: Cervical lesions needmore rigor-
ous stabilization due to the inherentmobility of
this region. When using braces and/or bandage
material to decrease motion, significant cutaneous
lesionsduetorubbingormoisturecanoccur,and
respiratory status can be compromised by tight
neck bandaging. Frequent bandage changes and
rechecksmaybenecessary.
•Surgery: Surgery may be indicated for patients
withsignificantneurologicdeficitsandinstability.
Once stabilized, these patients should be trans-
ported toaveterinarian that is comfortablewith
suchproceduresforevaluationandtreatment.
PrognosisAccording to available literature, prognosis for acute
spinal cord injuries related to trauma seems to be
more guarded than for other types of acute spinal cord
injuries.
•Onereportevaluatingprog-
nosis for dogswith vertebral
fractures and/or luxations as
well as absent nociception
reported that 0/9 had return
of nociception.25 Therefore,
obvious vertebral instability
(ie,fracture,luxation),paraly-
sis, and no evidence of noci-
ception indicates a poor prog-
nosis.
•Abetterprognosisisindicat-
ed ifpatientswithsignificant
deficits but intact sensation
receive surgical stabilization.
Unfortunately, these patients
areofteneuthanized.
Figure 4. Lateral (A) and ventrodorsal (B) thoracic radiographs showing a
pathologic compression fracture at T7; a CT confirmed these findings.
bA
Figure 3. Transverse T2-weighted
MRI image at the level of the C3
to C4 intervertebral disk space
showing a left-sided extradural
compression consistent with a
Hansen type I herniated disk.
May/June 2012 Today’s Veterinary Practice 43
AcuTE SPInAl corD InjurIES |
Fibrocartilagenous embolism
FCE isencountered frequently indogs; catsarealso
affectedbyit,butmuchlessfrequently.
•An FCE occurs when material identical to the
nucleuspulposusoftheintervertebraldiskspace
forms an embolus that obstructs either arterial,
venous, or both types of vasculaturewithin the
spinalcord.
•FCE commonly affects large- and giant-breed
dogs,butmay also affect small-breedandchon-
drodystrophic dogs.14,15,26-28 Miniature schnauzers
appear tobeaffectedatahigher incidence than
othersmallbreeds.29
•Dogs typicallypresentwith ahistoryofperacute
neurologicdeficitsthatprogresswithina24-hour
period.15,26,27 History often involves some form of
physicalactivityatthetimeclinicalsignsdevelop.15
•Patients are usually not painful at presentation
andasubstantialpercentagewillhaveasymmetri-
calneurologicaldeficits.15,26
ImagingDiagnosis is usually made using advanced imaging.
MRI is the best antemortemdiagnostic tool, butCT
and myelography can also be used to make a pre-
sumptivediagnosis.
•MRIwillusuallyshowanintramedullaryhyperin-
tensityonT2-weightedimages(Figure 6,page44).
•In some instances, lesions detected byMRIwill
notbedetectablesincethechangesmayrequire
severaldaystodevelop.28
•ThemainfeaturethathelpsdifferentiateanFCE
from other common causes of acute spinal cord
injury is the lack of extradural compression. A
herniateddiskwillhaveextraduralcompression.
Histopathology
Definitive diagnosis of FCE is made using histopa-
thology.Embolifoundwithinthespinalcordvascu-
laturewillbehistologically identical to thenucleus
pulposus.
TreatmentTreatment of FCE usually includes physical therapy
andrest.Different treatments,suchassteroids,have
beenattempted,butnosignificantpositiveassociation
hasbeenfound.28
Prognosis•Prognosis is generally good, and most patients
will show signsof significant improvementwithin
2weeks,27,28butmaximal
improvement may take
months.15 When patients
aregiventimetorecover,
Figure 5. Lateral T2-weighted MRI saggital image of cervical spinal cord in a dog with an atlanto-axial luxation (A);
transverse CT image of the atlas used for surgical planning and pin placement (B); 3D reconstruction of the CT (C)
bA C
SurGery: tiMe iS
oF tHe eSSenceSurgery should be performed as early as possible in patients with severe deficits in an effort to minimize secondary damage from extradural compression.
Most papers regarding this subject show the following trend: once the patient loses deep pain sensation, as more time passes, the prognosis worsens. The recommended time frame for pursuing surgery varies but, for patients that have lost deep pain inthepast12to24hours,mostpublicationssupport
emergency surgery. As the time frame extends past 24hours,theevidencesupportingemergencysurgery
becomes weaker and these patients may be able to wait until the morning for surgery without worsening their prognosis.
Similarly, patients that have become plegic in theprevious24hoursarealsoconsideredsurgical
emergencies in order to preserve an excellent prognosis, by intervening prior to development of extensive secondary damage to the spinal cord and loss of deep pain sensation (more guarded prognosis).
| AcuTE SPInAl corD InjurIES
Today’s Veterinary Practice May/June 201244
successratesashighas84%havebeencited.14
•Negative prognostic factors may include lack of
nociception,involvementofanintumescence(dis-
putedintheliterature),andintramedullaryhyper-
intensity on (1) T2-weighted images of the spinal
cord thatare longer thanthe lengthof twoL2or
twoC6 vertebral bodiesor (2) an intramedullary
hyperintensityontransversesectionthatisgreater
than66%theheightofthespinalcord.15,26-28
SecondAry dAMAGe
The pathology that results secondary to a primary
spinal cord injury (IVDD, trauma, infarct) is often
more serious than the primary injury.1-4,30 Secondary
pathology can result from changes in the local ion con-
centrations,disturbancestobloodflowandischemia,
productionoffreeradicals,andinflammation.1-4,30The
chemical environmentof an injured spinal cordmay
alsodelaytheregenerationofinjuredaxons.31
therapeutic recommendations
Currently, treatment is aimed at relieving the insult
causedbytheprimaryinjurywith:
•Surgery(ifindicated)
•Medical management (anti-inflammatory drugs
andanalgesics).
Potentialtherapiesforsecondaryinjuriesinclude:
•Calciumchannelantagonists
•Free-radical scavengers (ie, vitamin E, selenium,
methylprednisolone)
•N-methyl-D-aspartate(NMDA)antagonists
•Opioidagonistsandantagonists
•Thyroidreleasinghormone.2,3
Free-radical Scavengers
Most of these therapies are still being tested for
efficacy, but the free-radical scavenger methylpred-
nisolonehasbeenusedwithmodest success to treat
Figure 6. Sagittal T2-weighted MRI image
showing an intramedullary hyperintensity at the
level of C6 consistent with a FCE.
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AcuTE SPInAl corD InjurIES |
humanpatients.Itisbelievedtoexertaprotectiveeffect
through its free radical scavenging properties, which
may prevent further lipid peroxidation. In humans,
methylprednisolonemayoffersomebenefitagainstsec-
ondarydamagetothecordifusedwithin8hoursofthe
primary injury.32 Limited studies have beenperformed
in veterinary medicine, and mixed results have been
seeninsmallnumbersofdogs.22,23
Asweunderstandmoreaboutthesecondarydamage
thatoccurswithinthespinalcord followingaprimary
insult,hopefullynewandmoreeffectivetreatmentswill
becomeavailable.■
cT = computed tomography; FcE = fibrocartilagenous embolism; IVDD = intervertebral disk disease; MrI = mag-netic resonance imaging; nMDA = n-methyl-D-aspartate
References
1. olby n. current concepts in the management of acute spinal cord injury.
J Vet Intern Med 1999; 13:399-407.
2. olby n. the pathogenesis and treatment of acute spinal cord injuries in
dogs. Vet Clin North Am Small Anim Pract 2010; 40:791-807.
3. webb AA, ngan S, Fowler jd. Spinal cord injury i: A synopsis of the
basic science. Can Vet J 2010; 51:485-492.
4. webb AA, ngan S, Fowler d. Spinal cord injury ii: prognostic indicators,
standards of care, and clinical trials. Can Vet J 2010; 51:598-604.
5. Marioni HK. Feline spinal cord diseases. Vet Clin North Am Small Anim
Pract 2010; 40:1011-1028.
6. Forterre F, Konar M, tomek A, et al. Accuracy of the withdrawal reflex for
localization of the site of cervical disk herniation in dogs: 35 cases (2004-
2007). JAVMA 2008; 232:559-563.
Adam Moeser, DVM, is a
second-year neurology resident
at University of Pennsylvania
School of Veterinary Medicine.
He received his DVM from
University of Wisconsin –
Madison and completed a
rotating internship at the VCA
Aurora/Berwyn veterinary hos-
pitals in the Chicago, Illinois, area.
Charles Vite, DVM, PhD,
Diplomate ACVIM (Neurology),
is an assistant professor in the
section of neurology and neu-
rosurgery in the Department of
Clinical Sciences at University
of Pennsylvania School of
Veterinary Medicine. His clini-
cal interests include epilepsy
as well as neurodegenera-
tive and neurodevelopmental processes. He also
has specific interests in vestibular dysfunction and
myotonia congenita. Dr. Vite received his DVM from
Purdue University and completed a residency in
neurology at UPenn, followed by a fellowship in
neuromagnetic resonance. He received his PhD
from the same university.
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(continued on page 84)
Today’s Veterinary Practice May/June 201284
| PracTice To PracTice
cOnTinuing eDucaTiOn
Manyofthelatestoculardiagnostic,treatment,andsurgi-
cal recommendations are best presented by a specialist. A
great venue for continuing education in ophthalmology
is the ACVO Annual Conference, which offers a general
practitioner’s course that provides 8 hours of CE. After
attending the 2011 conference, I can attest that the board-
certified instructors provide helpful visuals and practical
advice. The ratio of attendees to speakers fosters discus-
sion with other practitioners and provides time to ask the
presenters specific questions.
You can also combine the ACVO general practitioner’s
course with general registration. The resident’s workshops,
research presentations, and exhibit hall provide additional
opportunities to pursue your interest in veterinary ophthal-
mology. The 2012 conference will be held October 17 to 20
in Portland, Oregon (acvoconferance.org).
Finally, another great way to obtain ophthalmic CE is to
see what courses your local veterinary school offers. You
canalsovisittheAmericanVeterinaryMedicalAssociation’s
MeetingsandCECalendar(avma.org/meetings/calendar/
default.asp), which provides a complete list of CE oppor-
tunities across the country and is searchable by keyword.n
BNP = bacitracin/neomycin/polymyxin B; KcS = kerato-conjunctivitissicca;PDS=polydioxanonesuture;STT=
Schirmer tear test
References
1. Moore PA. Examination techniques and interpretation of ophthalmic
findings. Clin Tech Small Anim Pract 2001; 16(1):1-11.
2. Ollivier FJ, Plummer CE, Barrie KP. The eye examination and diagnostic
procedures. In Gelatt KN (ed): Veterinary Ophthalmology, 4th ed. Ames. IA:
Blackwell Publishing, 2007, pp 438-483.
3. Willis M, Bounous DI, Hirsh S, et al. Conjunctival brush cytology: Evaluation
of a new cytological collection technique in dogs and cats with a
comparison to conjunctival scraping. Vet Comp Ophthalmol 1997; 7:74-81.
4. Weigt A. General practitioners course: ocular pharmacology. ACVO Conf
Proc, 2011.
5. Martin CL. Prolapse of third eyelid gland (cherry eye). Ophthalmic Disease
in Veterinary Medicine. London: Manson Publishing, 2005, pp 206-209.
6. Morgan R, Duddy JM, McClurg K. Prolapse of the gland of the third eyelid in
dogs: A retrospective study of 89 cases (1980 to 1990). JAAHA 1993; 29:56-60.
Elizabeth Barfield Laminack,
DVM, practices at Companion
Animal Hospital in Athens,
Georgia. She received her
DVM from University of
Georgia and her undergradu-
ate degree in biology from
Reinhardt University. Dr.
Laminack continues to study
small animal ophthalmology at
the UGA Veterinary Teaching
Hospital and recently presented an abstract on
canine glaucoma at the Association for Research in
Vision and Ophthalmology (ARVO) Annual Meeting.
She wishes to thank Drs. Denise Weaver and Troy
Pickerel and the practice team of Companion Animal
Hospital for their support of her ophthalmic pursuits;
she also extends gratitude to her mentors, Drs.
Anthony Moore and Kate Myrna of UGA–VTH.
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(Acute Spinal Injuries continued from page 45)
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