RM Clemmons, DVM, PhD, CVA, CVFT Gainesville,...
Transcript of RM Clemmons, DVM, PhD, CVA, CVFT Gainesville,...
RM Clemmons, DVM, PhD, CVA, CVFT
Gainesville, FL
Anomalous
Hydrocephalus
COMS
Intracranial arachnoid cyst
Dandy-Walker Syndrome
Copyright 1999 University of Florida
Congenital
Outflow obstruction
De Novo
Brain disappears
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DV LAT
Copyright 1999 University of Florida
T2-horizontal T1-coronal
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T1-sagittal (lateral) T1-sagittal (midline)
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Medical Management
Antioxidants and Steroids
VentriculoPerotoneal Shunt
Helpful when progressive changes in neurologic status
TCVM treatment
Copyright 1999 University of Florida
Cranial end of shunt is placed through bur hole
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Tunnel is made to bring shunt tubing to the abdomen
Copyright 1999 University of Florida
Abdominal end is pushed into abdomen using Kelly hemostats
Extra is left for growth or movement
Kidney jing deficiency
Fails to support the development of marrow
Does not nourish the child (liver)
Does not control the grandchild (heart)
Insults the grandparent (spleen)
Kidney & Spleen Qi Deficiency Younger animals with
congenital hydrocephalus
Kidney & Liver Yin/Blood Deficiency Older animals with
Canine Cognitive Disease
Liver Qi Stagnation Secondary to CNS
inflammatory disease or cancer
Problem List Shen Disturbance
Hydrocephalus Confirmed ultrasound
Hepatoencephalopathy Confirmed BW
Overall poor development
TCVM Tongue
thin-red
Pulses Deep, weak fast particularly
on right side
Diagnosis Jing Deficiency
Yin deficient
Treatment Hydrocephalus formula
Liu Wei Di Huang
Epimedium powder
Bai Zhi Angelica Dispel Wind-Cold, relieve pain Bai Zhu Atractylodes Strengthen Spleen Qi Ban Xia Pinellia Transform Damp and stops vomiting Bo He Mentha Dispel Wind-Heat Cang Zhu Atractylodes Dry up Dampness, strengthen Spleen Qi Chan Tui Cicada Dispel Wind, move Qi to the head Dang Shen Codonopsis Tonify Qi Deng Xin Cao Juncus Clear Heat, Drain Damp-Heat Fu Ling Poria Benefit the urination Huang Qi Astragalus Tonify Spleen Qi and dissipate swelling Jie Geng Platycodon Open to the Upper Jiao, transform phlegm Jin Yin Hua Lonicera Clear Heat, detoxify Ju Hua Chrysanthemum Clear Heat, detoxify Shan Yao Dioscorea Tonify Spleen Qi Sheng Ma Cimcifuga Clear Wind-Heat, move Qi to the head Ze Xie Alisma Benefit the urination Zhi Ban Xia Pinellia Transform Damp and stops vomiting Zhu Ling Polyporous Benefit the urination
Epimedium Yin Yang Huo Tonify Kid Yang/Jing, Promote Sexual Desire Cuscuta Tu Si Zi Tonify Kid Yang, Jing & Yin Cistache Rou Cong Rong Tonify Kid Yang & Yin Paeonia Bai Shao Yao Nourish Liver Yin & Blood Polygonum He Shou Wu Nourish Blood & Jing, Benefit Hair Actinolite Yang Qi Shi Tonify Kid Yang Cynomorium Suo Yang Tonify Kid Yang Psoralea Bu Gu Zhi Tonify Kid Yang & Strengthen Bones Dipsacus Xu Duan Tonify Kid Yang & Promote Fracture Healing Lycium Gou Qi Zi Nourish Liver Yin, Benefit Eyes Condonopsis Dang Shen Tonify Qi Astragalus Huang Qi Tonify Qi Rehmannia Shu Di Huang Nourish Kid Yin & Jing Angelica Dang Gui Nourish Blood Ophiopogon Mai Men Dong Moisten & Nourish Yin Scrophularia Xuan Shen Cool Blood & Clear Heat Citrus Chen Pi Move Qi & Relieve Pain
Copyright 1999 University of Florida
Copyright 1999 University of Florida
15 yr old M poodle
Owner went on vacation
Boarded at facility
Upon return ataxia that progressed to coma in 8 hours
Problem List
Shen Disturbance
Hydrocephalus Confirmed MRI/CT scan
TCVM
Tongue thin-red
Pulses Deep, weak fast particularly
on right side
Diagnosis
Liver & Kidney yin deficiency
Treatment
½ Dose Hydrocephalus formula
Liu Wei Di Huang
½ Dose Epimedium powder
Today’s Frontier
Common Types Meningioma
Astocytoma
Oligodendroglioma
Choroid plexus papilloma
Lymphoma
Neuroectodermal tumors
Metastatic tumor
Dog has 1-18 months average survival time 1-3 with nothing
6-9 with surgery
12-18 with radiation treatment
All tumors are invasive (malignant)
Most common is meningioma
Usually extra-axial and benign
Seen in aged cats
Present with depression and dementia
MRI revealed mass in the cerebral cortex
Prednisolone (0.25-0.5 mg/kg q12h)
Treats secondary effects
Cover with gastroprotectants
Chemotherapy
Radiation therapy
Lomustine
60 mg/M2 given
Monitor CBC weekly
If WBC and platelets okay in 5 weeks, then give 80 mg/M2
Repeat every 5-8 weeks
Procarbazine
2-4 mg/kg/day for 1 week, then 4-6 mg/kg/day
Monitor CBC
Continue as long as WBC levels are > 4000/µl & platelet count is > 100,000/µl
5-hydroxyurea
Meningiomas
50 mg/M2 given
Monitor CBC weekly
Repeat every 3-4 weeks
Melatonin
Gliomas
0.1-0.2 mg/kg once a day in the evening
Reduces growth of many tumors by 50%
Diet Low carbohydrate
Supplements Antioxidants & membrane
stabilizers
Herbal medications Western- -Canine Cancer
formula
Traditional Chinese medicine- -Stasis in the Mansion of the Mind
Hz: Acute Seizures Head Injury
Tongue red & greasy
Pulse Fast, wiry & slippery
Rx Principle expel phlegm, extinguish
the wind, open the orifice, stabilize the seizures and invigorate blood
AP CV-15, ST-40, PC-5, HT-7,
LI-11, LIV-3, An Shen, Da Feng Men
TCM Herbal Ding Xian Wan TCVM Cancer Treatment
Angelica Bai Zhi Warm the Channel, relieve pain Pinellia Ban Xia Transform phlegm Ligusticum Chuan Xiong Move Blood Salvia Dan Shen Move Blood Lumbricus Di Long Clear Wind, invigorate Channel Ligusticum Gao Ben Relieve pain Pueraria Ge Gen Bring Qi upward Carthamus Hong Hua Break down Blood Stasis Bombyx Jiang Can Transform phlegm, resolve nodule Scorpion Quan Xie Break down Blood Stasis Cimicifuga Sheng Ma Ascend Qi Fritillary Zhe Bei Mu Transform phlegm, resolve nodules Scolopendra Wu Gong Detoxify, resolve nodules
Bai Zhi Angelica Clear Wind-Cold and relieve pain Da Huang Rheum Clear stagnation/stasis and clear Heat Jie Geng Platycodon Open the Upper Jiao and transform phlegm Mu Li(Shu) Ostrea Soften hardness and clear mass Tian Hua Fen Trichosanthes Clear Heat and promote body fluids Xia Ku Cao Prunella Clear Liver Heat and resolve nodules Xuan Shen Scrophularia Clear Heat and cool Blood Zhe Bei Mu Fritillaria Soften hardness and clear nodules
Bai Hua She She Cao Oldenlandia Inhibit cell mutation and tumor growth Ban Zhi Lian Scutellaria Inhibit cell mutation, inhibit tumor growth Chen Pi Citrus Move Qi and transform phlegm Dang Gui Angelica Tonifies Blood Dang Shen Codonopsis Tonify Qi and boost Wei Qi Huang Qi Astragalus Tonifies Qi in whole body and Wei Qi Wu Yao Lindera Move Qi and clear stagnation Xuan Shen Scrophularia Cool Blood and nourish Yi
Bai Hua She She Cao Oldenlandia Inhibit cell mutation and tumor growth Ban Zhi Lian Scutellaria Clear Heat-toxin, inhibit cell mutation, inhibit tumor growth E Zhu Zedoaria Purge the interior, break Blood stasis and clear mass Mu Li(Shu) Ostrea Soften hardness and clear mass San Leng Sparganium Purge the interior, break stasis and clear mass Zhe Bei Mu Fritillaria Soften harness and clear nodules
5 year old, German Shorthair Pointer
History of seizures starting 1 month prior Responsive to
phenobarbital
Tongue: purple
Pulse: fast & wiry
Neurologic Exam
Mild dementia
CP deficits in both hind legs
Babinski’s sign on left side of the body
Localization
Cerebrum affecting both side (>right)
Di Tan Tang
Stasis in Mansion of Mind
Wei Qi Booster
Western herbs
10 year old, Mx
Progressive loss of coordination and head tilt
Personality change
Tongue: purple
Pulse: fast & wiry
Neurologic Exam Left head tilt
Positional, vertical nystagmus
Mild CP deficits in rear L>R
Xextensor R -> L in rear
Localization L Cerebellar pontine
angle with cerebral signs
TCM Dx:
Liver Blood Stagnation
TCM Rx:
Stasis in Mansion of Mind
Wie Chi Booster
McKnight Brain Institute at UF
High, single dose radiotherapy
5 arcs of radiation provide sphere of death
Based upon the focal size and tissue treated
Treatment is applied with LINAC unit at UFBI
Cost of radiosurgery
procedure is around $3000.00
plus workup & conventional surgery
Overall ED50 is around 13 months
Some patients survive much longer
Prognosis for meningiomas is better than others
1. Low-Carbohydrate food (home prepared is best or use Pedigree Weight Loss Formula)
2. Canine basic antioxidant formula (Westlab Pharmacy 1-800-4WESTLA)
3. Canine arthritis formula (Westlab)
4. Canine cancer formula (Westlab)- -use at 2 times prevention dose
5. COX-2 inhibitor (daily- -particularly for carcinomas)
6. Melatonin at night (0.1-0.2 mg/kg)
Max Formula
Stasis in Mansion of Mind
Wei Qi Booster
Western herbs
or
and
and
Transports to Head
Acute or chronic progressive quadriparesis
Usually has neck pain
Often in older animals
A Perspective on History
A chronic, progressive neurodegenerative disease
Initial signs are due to TL spinal cord disease
Represents an autoimmune disorder
Breeds German Shepherd dogs
Belgium Shepherds
Old English Sheepdogs
Rhodesian Ridgebacks
Weimaraner
Probably Great Pyrenes
Age > 5 years old (usually 8-
9)
Sex
Equal
Onset
1 month to 1 year
Clinical Course
Paralysis within 3 to 6 month without treatment
Axon and myelin loss
Swollen axons
Patchy demyelination
Astrocyte proliferation
Increase in vasculature
Physical and Neurologic Examination
Electrodiagnostic Examination
Neuroimaging
CSF tap & analysis
Exercise
20-30 minutes twice a week
1 hour once a week
sustained aerobic exercise is needed
CNS O2 delivery
Dietary Considerations
Tofu
Fresh vegetables carrots
greens
peppers
broccoli
Ginger, garlic & mustard
Supplements
Antioxidants
Membrane stabilizers
Tonics
Anti-inflammatory
Medication
Aminocaproic acid (500 mg TID)
n-Acetylcysteine (25 mg/kg TID QD for 2 weeks, then TID QOD)
Signalment
8 yr F/S GSD
Weakness
Posterior Paresis
S
History
Seemed to be slower over last 6 months Trouble getting up
Vet checked for HD Minimal response to
NSAIDs
Worse over last 30 days
S
Neurologic Examination
Head- -NAF
CN- -NAF
Mild Neck Pain (C6)
Forelegs- -NAF (slight dysmetria)
Rear Legs- Slight hyperflexia L>R
CP deficits Bilaterally
Babinski L
Hypermetria
Mild Back Pain (TL)
O
Localization of Lesion D
A
M
N
N
I
I
I
T
T
V O
T3-L3 Spinal Cord
IVDD, GSDM
Myelitis
GME
Spinal Tumor
P
• Problem List Differential Dx ?
Diagnostic Approach ?
Treatment ?
1. Posterior Paresis
2. Foreleg Hypermetria
3. Neck & Back Pain
1. GSDM
2. IVDD
3. Infect/Inflamm
4. Neoplasia
MDB CBC
Chemistry Profile
UA
Chest & Abdominal Radiographs
Abdominal Ultrasound
Neurologic Tests EMG
CSF Analysis Cisternal
Lumbar
MRI (Whole Spine)
Client Education
P
May expect gradual return to function expecting 80% of recovery in 3 months
May continue to progress over 12-18 months
Need to monitor spleen and blood work every 6 months
Reassess as needed, changing medications when appropriate
P
Tongue Pale
Wet
Pulse Weak bilaterally
Sensitivity GB 21
BL 18
BL 23
TCVM Diagnosis
Combined Qi/Yin Deficiency with Stagnation
AP Cervical points
BL10
GB 21
Lumbar points GV 14
Bai Hui (EA & Moxa)
BL40
BL62
Other points ST 36
SP 6
LI 10
LIV 3
Herbal
Hu Qian Tang
Walking Tiger Formula
Jing Tang
Di Huang Yin Zi Rehmannia Formula for
Paralysis
Jing Tang
Bai Shao Yao Paeonia Nourish Blood Chen Pi Citrus Move Qi and Relieve Pain Gan Jiang Zingiberis Strengthen Stomach and Promote Appetite Gui Ban Chinemys Nigricans, Plastrum Nourish Yin, anchors Yang, tonify Blood, Nourish Heart Huang Bai Phellodendron Clear Heat, Nourish Yin Niu Xi Achyranthes Strengthens the Kidney and benefit the knees Shu Di Huang Rehmannia Nourish Yin, Blood and Jing Suo Yang Cynomorium Tonify Kidney Yang, Nourish Blood, Tonify Essence, Strengthen Sinews Zhi Mu Anemarrhena Nourish Yin, Clear Heat
Ba Ji Tian Morinda Tonify kidney, strengthen yang Fan Shi Hu Descurainiae Herba Nourish Yin, clear deficient heat, nourish stomach Yin Fu Ling Poria Drain Damp, Strengthen Spleen Fu Zi Aconite Warm Spleen Mai Men Dong Ophiopogon Nourish Yin Rou Cong Rong Cistanche Salsa Caulis Tonify kidney, strengthen yang Rou Gui Cinnamomum Tonify Kidney Yang Shan Zhu Yu Cornus Nourish Yin Shi Chang Pu Acorus Open orifices, vaporize phlegm, quiet spirit,harmonize middle burner Shu Di Huang Rehmannia Nourish Blood and Yin Wu Wei Zi Schisandra Consolidate and Nourish Lung Yin Yuan Zhi Polygala Calm spirit, quiet heart, clears orifices