20 Pelvic limb paresis and paralysis
Causes of Acute Nonambulatory Paraparesis/Paraplegia
Paraparesis and paraplegia most commonly occur as a result of a spinal cord lesion caudal to the C6–T2 segment (cervicothoracic intumescence). Spinal cord disorders that commonly cause paraparesis or paraplegia are listed in Box 20.1. In some cases spinal cord injury is due to a cause with an acute onset (e.g. traumatic disc injury, fibrocartilaginous embolism) while in others it occurs due to acute deterioration of a more chronic disease (e.g. neoplasia).
Approach to Acute Nonambulatory Paraparesis/Paraplegia
Signalment
Signalment may allow certain differential diagnoses to be viewed with a lesser or greater index of suspicion. For example, chondrodystrophic dog breeds (e.g. Dachshunds, Pekingese) are classically affected by Hansen type I intervertebral disc disease, inflammatory disease is more common in younger dogs and neoplasia is more common in older dogs. Spinal lymphoma is always a differential diagnosis in cats.
History
History may be useful with respect to establishing the likely differential diagnoses, in particular for traumatic causes. A chronic history of intermittent pelvic limb neurological abnormalities prior to acute deterioration may be more suggestive for example of neoplasia.
The owner should also be asked about urination following onset of clinical signs as this may help to localize the lesion more accurately.
Major body system examination
Clinical Tip
In the absence of traumatic injury, physical examination findings may help to raise the index of suspicion for certain differential diagnoses. For example, pyrexia may be more suggestive of an inflammatory cause rather than intervertebral disc disease. Gait assessment and testing of postural reactions are clearly not applicable to animals with nonambulatory paraparesis or paraplegia. Neurological examination of the pelvic limbs in such cases incorporates the following:

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