Right, lets get started!
Where do we want to start then? suggestions
next thing we need to think about is what questions we want to ask the owner
Great suggestions so far and the general hx is very important. lets get some more information on Lily
Lots of you are saying a general physical exam which is great and should be done before your neuro exam. so here are the results of it:
Anything to worry about? (EENT= eyes, ears, nose and throat)
So we are worried about the pyrexia, next up is ortho exam and thats within normal limits. Lets get on with our neuro exam then. What do we want to do?
Great thoughts. This is how Pat did it and this is what he found
The aim of a neuro exam is
1-Neurologically normal or abnormal
2-Where is the lesion
Based on our neuro exam, the lesion could be anywhere from T3 to caudal spinal cord or cauda equina.
What are we going to include on our problem list?
Don't forget to keep the problem list short
So what are some differentials?
Some good differentials so far. We get a CBC next
If CBC shows infection, what next?
Suggestions included CSF tap, radiography and MRI.
Radiography is a great way to start
What are we thinking?
We see some lysis at L7-S1 which must be discospondylitits. What causes this?
Some great thoughts and lots of correct answers
Do we have any further diagnostic tests that may be useful?
Culture and senstitivity are great and ideally we would want to do it of urine and blood culture and even a disc aspirate if possible.
CSF culture wont be as useful and will show reactive inflammation only. The infective agent won't be in the subarachnoid space.
So what treatment and how long for?
If culture returns negative, cephalexin and amoxy/clav are both good choices
Usually its a 6 months course of antibiotics at least and you wouldn't stop until radiography shows resolution.
To assess resolution, we would aim to take radiographs every 3 months.
Thank you Pat for the great session tonight. Hope you all found it useful!