Caldwell Marc, Passler Thomas, Purohit Ram C, Pascoe David, Wolfe Dwight F
J Am Vet Med Assoc. 2017 Mar 1;250(5):554-560. doi: 10.2460/javma.250.5.554.
CASE DESCRIPTION An 8-year-old Brahman-cross bull was evaluated for left hind limb lameness of 2 months' duration. The lameness was first noticed during a rodeo bucking performance, immediately after the bull appeared to land inappropriately on the affected limb. CLINICAL FINDINGS Physical examination findings revealed left hind limb lameness, ataxia, and left-sided epaxial muscle atrophy. Palpation per rectum along the lumbar portion of the vertebral column revealed evidence of exostosis of the ventral aspect. High-definition infrared thermal imaging revealed a pattern of reduced skin temperature in the area of the left lumbar and gluteal regions suggestive of a disruption in the sympathetic control of peripheral blood flow. Nuclear scintigraphy revealed a focal area of increased radioisotope uptake on the left ventrolateral aspect of the L2-3 intervertebral joint. A presumptive diagnosis of ventrolateral vertebral spondylosis resulting in spinal nerve impingement was made. TREATMENT AND OUTCOME 200 mg of methylprednisolone was epidurally injected at the site of the lesion, and treatment with polysulfated glycosaminoglycans was initiated (500 mg, IM, every 4 days for 7 treatments, then monthly thereafter). The lameness and ataxia observed in the left hind limb resolved within 1 week after treatment began. Subsequently, the bull was discharged from the hospital and was used successfully for semen collection and live-cover breeding. CLINICAL RELEVANCE Use of thermography for the bull of this report provided additional insight into neurovascular physiologic function that classical imaging modalities are unable to provide and, when combined with nuclear scintigraphy, aided in identifying the most critical lesion in a complex clinical case.
一头8岁的婆罗门杂交公牛因左后肢跛行2个月前来评估。跛行最初是在一场牛仔竞技表演中被发现的,当时这头牛似乎在受影响的肢体上着陆不当之后立即出现了跛行。
体格检查结果显示左后肢跛行、共济失调以及左侧轴后肌肉萎缩。经直肠沿脊柱腰椎部分触诊发现腹侧有外生骨疣迹象。高清红外热成像显示左腰部和臀部区域皮肤温度降低,提示外周血流的交感神经控制出现紊乱。核闪烁扫描显示L2 - 3椎间关节左外侧有一个放射性同位素摄取增加的局灶区域。初步诊断为腹侧椎体关节强硬导致脊神经受压。
在病变部位硬膜外注射200毫克甲泼尼龙,并开始用多硫酸化糖胺聚糖进行治疗(500毫克,肌肉注射,每4天一次,共7次治疗,之后每月一次)。治疗开始后1周内,左后肢观察到的跛行和共济失调症状消失。随后,这头牛出院,并成功用于采精和自然交配繁殖。
本报告中对这头牛使用热成像技术,为经典成像方式无法提供的神经血管生理功能提供了更多见解,并且与核闪烁扫描相结合时,有助于在复杂临床病例中识别最关键的病变。