Paralysis is defined as the inability to actively move parts of the body. The paralysis can be flaccid or spastic.
Paralysis
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Paralysis refers to the complete loss of voluntary muscle movement in one or more parts of the body. In partial paralysis (paresis), the ability to move is limited but not completely lost. Paralysis symptoms can occur suddenly or gradually and affect various regions of the body. Depending on the location, we distinguish between monoplegia (paralysis of one limb), paraplegia (paralysis of both hind legs), tetraplegia (paralysis of all four limbs), and hemiplegia (paralysis of one side of the body).
Paralysis can be flaccid or spastic. In flaccid paralysis, muscle tone is absent, while in spastic paralysis, there is increased muscle tone. This distinction is important for diagnosing the underlying condition and planning treatment.
Paralysis occurs due to damage to the central nervous system (brain and spinal cord), the peripheral nervous system, or neuromuscular junctions. Nerve damage can be caused by pressure, inflammation, circulatory disorders, toxic influences, or degenerative processes.
Causes
The causes can be diverse.
- Damage from trauma and inflammation to the brain and spinal cord (slipped disc, fractures)
- Poisonings
- Metabolic disorders
- Specific infectious diseases
- Tumors in the nervous system
- In cats, blood clots in the area of the major leg arteries (arterial occlusive disease, thrombosis)
- Supplement
- The causes of sudden paralysis in dogs and cats are diverse and can be categorized into different groups:Traumatic paralysis: Spinal injuries due to accidents, falls, or bite wounds can lead to compression or severing of the spinal cord. Car accidents, falls from great heights in cats, or injuries during play are particularly common.
Degenerative diseases: Intervertebral disc herniation is one of the most common causes of acute paralysis in dogs. Chondrodystrophic breeds such as Dachshunds, French Bulldogs, or Beagles are particularly susceptible. The disc can suddenly herniate and put pressure on the spinal cord, leading to neurological deficits.
Vascular causes: In cats, aortic thromboembolism (saddle thrombus) is a common cause of sudden paralysis of the hind limbs. Here, a blood clot blocks the aorta at its bifurcation to the hind legs. This condition often occurs in cats with heart diseases such as hypertrophic cardiomyopathy.
Infectious and inflammatory causes: Inflammation of the spinal cord (myelitis), nerve roots (radiculitis), or peripheral nerves (neuritis) can lead to paralysis. Bacterial or viral infections, as well as autoimmune diseases, can be causative.
Toxic causes: Poisoning by heavy metals, certain plants, or medications can damage the nervous system and cause paralysis.
Parasitic causes: Tick paralysis, caused by neurotoxins in the saliva of certain tick species, can lead to ascending paralysis, which is usually reversible after removal of the tick.
Neoplastic causes: Tumors in the brain, spinal cord, or peripheral nerves can cause paralysis symptoms through pressure or infiltration.
Metabolic disorders: Electrolyte disturbances such as hypokalemia or hypocalcemia can impair nerve function and lead to muscle weakness or paralysis.
Congenital diseases: Certain breeds have genetic predispositions to neurological diseases that can lead to paralysis, such as degenerative myelopathy in German Shepherds.
Symptoms
- Mild (paresis) to complete paralysis (paralysis), where no muscle contractions are possible anymore
- Partially spastic paralysis with increased muscle tone
- Occurring suddenly or progressively
The symptoms of paralysis vary depending on the affected body region, severity, and underlying cause. The following signs may indicate paralysis:
In a sudden paralysis, affected animals often show a significant limitation of movement up to complete immobility of the affected limbs. The animals can no longer stand, walk, or run. In paresis, movement ability is reduced, which can manifest as dragging of the paws, coordination disorders, or an unsteady gait.
An important diagnostic feature is deep pain perception. If this is absent, it indicates severe damage to the spinal cord. The veterinarian checks this by applying a strong pinch stimulus to the toes. If the animal does not respond with a conscious reaction (turning the head, vocalization), the prognosis is less favorable.
In paralysis of the hind limbs, loss of control over the bladder and bowel can occur, leading to involuntary urination and defecation or urinary retention. Owners often notice that the bladder is overfilled and hard, or that the animal is constantly dribbling.
Pain is a common accompanying symptom, especially with intervertebral disc herniations or nerve entrapments. The animals show pain expressions such as whimpering, panting, restlessness, or aggression when certain body regions are touched. Some animals adopt a characteristic protective posture, with an arched back and lowered head.
In aortic thromboembolism in cats, the hind legs are often cold and pale, and the claws may be bluish in color. The affected animals show severe pain and shortness of breath due to the underlying heart disease.
Depending on the cause, additional neurological symptoms such as altered consciousness, head tilt, circular movements, or seizures may occur. In cases of paralysis due to poisoning or systemic diseases, vomiting, diarrhea, or respiratory problems may also be observed.
First Aid
- Calm your pet. Do not encourage it to move.
- Some causes, such as damage to the spinal cord, can be very painful. As a precaution, apply a muzzle.
- Do not administer medications on your own.
- Do not wait. This is an emergency. Surgery may be required immediately.
- If you suspect spinal instability after trauma, transport your pet with appropriate caution.
- Wrap your pet in a blanket and take it to a veterinary hospital.
- If you suspect a spinal injury, do not carry your pet, but try to transport it lying down while keeping the spine immobilized.
- Treatment for paraplegia in cats due to a blood clot cannot be delayed. The condition is extremely painful for the cat.
Diagnosis
The diagnosis of paralysis begins with a thorough medical history, where the veterinarian asks about the timeline of symptoms, possible traumas, pre-existing conditions, and other relevant factors. This is followed by a general clinical examination and a specific neurological examination.
The neurological examination assesses consciousness, posture, gait, postural and positional reactions, spinal reflexes, muscle tone, and pain perception. This examination helps to narrow down the location of the lesion (brain, spinal cord, peripheral nerves, or muscles) and estimate the severity.
Imaging techniques are crucial for accurate diagnosis. X-rays can show fractures, dislocations, or degenerative changes in the spine. Computed tomography (CT) provides more detailed images of bony structures and can detect herniated discs or bleeding. Magnetic resonance imaging (MRI) is particularly valuable for visualizing the spinal cord, nerve roots, and surrounding soft tissue. It is considered the gold standard for diagnosing herniated discs and other lesions close to the spinal cord.
If aortic thromboembolism is suspected in cats, ultrasound examinations of the heart (echocardiography) and major vessels are performed. Doppler sonography can visualize blood flow in the affected arteries.
Laboratory tests such as complete blood count, serum chemistry, and urinalysis help detect systemic diseases, infections, or metabolic disorders. If infections or inflammatory diseases are suspected, an examination of the cerebrospinal fluid (CSF) through a lumbar puncture may be necessary.
Electrophysiological examinations such as electromyography (EMG) and nerve conduction velocity measurements can be helpful in diagnosing diseases of the peripheral nerves and muscles.
In some cases, special tests are required, such as toxicological examinations if poisoning is suspected or genetic tests if hereditary diseases are suspected.
Further veterinary measures
Paralysis has various causes, necessitating different treatment strategies.
In veterinary medicine, the most common cause of paralysis in dogs is pressure on the spinal cord and its associated nerve roots due to trauma or degenerative changes.
In cats, it is not uncommon for underlying heart disease to cause thromboembolisms that can partially or completely block the large arteries of the hind legs.
In both cases, immediate extensive diagnostics (computed tomography) and therapy are indicated.
In dogs, conservative therapy through immobilization is sometimes possible. However, surgery is often indicated. If not treated in time, the paralysis may persist (Fig.)
For interruption of blood supply to the hind legs in cats, therapy focuses on stopping thrombus growth and accelerating the dissolution of the thrombus medically.
This therapy begins even before further diagnostics such as ultrasound, fluoroscopy with vascular imaging, and computed tomography with vascular imaging (CT angiography). Pain therapy and volume substitution are also among the first measures.
Dissolving the thrombus can be done via a venous access or through a catheter advanced into the leg artery under fluoroscopic guidance.
Supplement
The treatment of paralysis depends on the underlying cause and the severity of the neurological deficits. In many cases, a multimodal therapeutic approach is required.
Emergency measures: For acute paralysis, immediate veterinary care is crucial. Transportation should be gentle, especially if spinal injury is suspected. For intervertebral disc herniations or trauma, strict cage rest for several weeks is often prescribed to prevent further damage.
Surgical therapy: For intervertebral disc herniations with severe neurological deficits, surgery is usually the treatment of choice. The herniated disc material is removed to reduce pressure on the spinal cord. Various surgical techniques such as hemilaminectomy, ventral slot, or fenestration are used depending on the location. For vertebral fractures or dislocations, stabilization surgeries using plates, screws, or pins may be necessary.
Medication therapy: Anti-inflammatory drugs such as corticosteroids or non-steroidal anti-inflammatory drugs (NSAIDs) can reduce swelling and relieve pain. Antibiotics or antifungals are used for infectious causes. Muscle relaxants can help with spastic paralysis. For aortic thromboembolism in cats, platelet aggregation inhibitors and anticoagulants are used to dissolve the clot and prevent new clot formation.
Pain management: Adequate pain therapy is necessary and may include various analgesics such as opioids, NSAIDs, or gabapentin. For chronic pain, acupuncture can also be supportive.
Physiotherapy and rehabilitation: After the acute phase, physiotherapy is crucial for restoring mobility. Passive range of motion exercises prevent muscle atrophy and joint stiffness. Underwater treadmill training (hydrotherapy) allows controlled movement without full weight-bearing. Massages and heat applications can relieve muscle tension.
Supportive measures: For bladder paralysis, regular manual expression of the bladder or catheterization is necessary to prevent urinary retention and infections. Incontinent animals require special hygiene measures such as diapers or more frequent cleaning. Aids such as walking aids, wheeled carts, or specially adapted orthoses can support mobility.
Alternative Therapies: Acupuncture, laser therapy, or magnetic field therapy can be used as complementary treatments to relieve pain and promote nerve regeneration.
Prognosis and aftercare
The prognosis for paralysis is highly variable and depends on several factors. Crucial factors include the underlying cause, the location and extent of nerve damage, the duration of symptoms before treatment begins, and the presence of deep pain perception.
In cases of herniated discs with preserved deep pain perception, the prognosis after surgical intervention is usually good to very good, with success rates of 80-95%. If deep pain perception has been absent for more than 48 hours, the probability of complete recovery drops to less than 50%.
In cases of aortic thromboembolism in cats, the prognosis is guarded to poor. The survival rate is about 30-50%, and relapses are common. The prognosis is further worsened by the underlying heart disease.
In traumatic spinal cord injuries, the prognosis depends on the extent of the damage. Complete severing of the spinal cord leads to irreversible paralysis, while bruises or contusions may be partially or fully reversible.
Aftercare plays a crucial role in the success of treatment. After surgical procedures, strict rest for several weeks is necessary to promote healing and avoid complications. Regular follow-up examinations are used to monitor the healing process and adjust therapy.
Long-term physiotherapy is often required to strengthen muscles, prevent joint stiffness, and improve coordination. In cases of permanent paralysis, owners must learn to deal with their pet’s special needs, such as bladder management, pressure sore prevention, and mobility aids.
The living environment should be adapted to allow the paralyzed animal to live as normal a life as possible. This includes non-slip floor coverings, ramps instead of stairs, and easily accessible food and water stations.
Summary
Sudden paralysis in dogs and cats is a medical emergency that requires immediate veterinary action. The causes are diverse and range from herniated discs to trauma, vascular occlusions, and poisonings. Diagnosis is based on a thorough neurological examination and imaging techniques such as MRI or CT.
Treatment depends on the underlying cause and can be conservative with immobilization and medication or surgical. Early initiation of treatment is crucial for success, especially in cases of herniated discs and aortic thromboembolism. Rehabilitation with physiotherapy plays a central role in restoring mobility.
The prognosis depends on the cause, the extent of nerve damage, and the presence of deep pain perception. While some animals achieve full recovery, others may have permanent limitations that require lifelong adaptation of their living conditions.
It is important for pet owners to be aware of risk factors and take preventive measures, especially for predisposed breeds. At the first signs of neurological disorders, a veterinarian should be consulted immediately, as time is a critical factor for successful treatment.
Outlook on current research
Research in the field of neurological diseases in small animals is continuously advancing. Current studies focus on innovative therapeutic approaches to improve nerve regeneration and functional recovery after spinal cord injuries.
Stem cell therapy shows promising results in treating spinal cord injuries. Mesenchymal stem cells can release anti-inflammatory factors and promote nerve regeneration. Initial clinical studies in dogs with herniated discs show positive effects on motor function and pain reduction.
Neuroprotective substances such as polyethylene glycol (PEG) are being researched to minimize secondary damage after acute spinal cord injuries. These substances can stabilize cell membranes and prevent nerve cell death.
Advances in neuroprosthetics and neuromodulation enable new approaches to restore motor function. Implantable electrodes can stimulate the spinal cord, improving mobility even in cases of severe paralysis.
Genetic research is increasingly identifying genes associated with hereditary neurological diseases such as degenerative myelopathy. This enables the development of genetic tests for breeding animals and could lead to gene therapy approaches in the long term.
New imaging techniques such as functional MRI and diffusion tensor imaging allow for more precise visualization of nerve tracts and their damage, improving diagnosis and prognosis.
Advances in rehabilitation include robot-assisted therapy systems and virtual reality, enabling more intensive and targeted training. These technologies are already used in human medicine and are increasingly finding their way into veterinary medicine.
Research into biomarkers in blood or cerebrospinal fluid could enable early diagnosis and better prognosis estimation in the future. Certain proteins or microRNAs could indicate the extent of nerve damage and support therapy decisions.
Frequently asked questions (FAQs)
- How do I recognize paralysis in my pet?
Paralysis manifests as a sudden inability to move or severely restricted mobility of one or more limbs. Affected animals may no longer be able to stand, walk, or run, or they may show a significantly altered gait with dragging of the paws. - Is sudden paralysis always an emergency?
Yes, sudden onset paralysis is always considered an emergency and requires immediate veterinary attention. Especially with intervertebral disc herniations or aortic thromboembolism, every hour counts for the prognosis. - Which dog breeds are particularly prone to intervertebral disc herniations?
Chondrodystrophic breeds with short legs are particularly at risk, such as Dachshunds, French Bulldogs, Beagles, Shih Tzus, Pekingese, and Pugs. These breeds experience early degeneration of the intervertebral discs. - Can my pet fully recover from paralysis?
The chances of full recovery depend greatly on the cause, severity, and duration of the paralysis. With timely treatment of intervertebral disc herniations where deep pain perception is still present, the prospects for success are good. If deep pain perception is absent or there is complete spinal cord transection, a full recovery is unlikely. - How can I help a paralyzed animal at home?
Paralyzed animals require special care, including regular repositioning to prevent pressure sores, assistance with bladder emptying, soft and clean bedding, and physiotherapy as directed by a veterinarian. Assistive devices such as wheelchairs can support mobility. - How long does rehabilitation take after spinal cord surgery?
The rehabilitation phase can last from several weeks to several months, depending on the severity of the injury and individual healing capacity. Strict cage rest is usually required for the first 4-6 weeks, followed by a gradual increase in activity and accompanying physiotherapy. - What preventive measures are there for intervertebral disc herniations?
Preventive measures include weight control to avoid obesity, using harnesses instead of collars for predisposed breeds, avoiding jumps and stair climbing, and, if necessary, prophylactic disc fenestration in high-risk breeds. - Can a tick really cause paralysis?
Yes, certain tick species can cause an ascending paralysis through neurotoxins in their saliva, known as tick paralysis. After removing the tick, symptoms usually resolve within 24-72 hours. - How high are the costs for treating paralysis?
Costs vary greatly depending on the cause, necessary diagnostics, and therapy. Conservative treatment can cost a few hundred euros, while surgical procedures on the spinal cord with subsequent rehabilitation can amount to several thousand euros. - Can my pet lead a happy life with permanent paralysis?
Yes, many animals with permanent paralysis can lead happy and fulfilled lives. With appropriate aids such as wheelchairs, adapted environments, and loving care, they can adjust well to their limitations and show joy in life.
Literature
- Kirsch, A: Aortic thrombosis in cats. Veterinär Spiegel 2008; 18(02): 84-90, Georg Thieme Verlag, Stuttgart
- Spinal trauma. Merck Manual Professional Edition. https://www.merckmanuals.com/professional/injuries_poisoning/spinal_trauma/spinal_trauma.html?qt=spinal trauma&alt=sh. Accessed Dec. 27, 2018.
- Löwe, G. and Löwe, O. (2021). Emergencies in Dogs and Cats – A Veterinary Guide. Kynos-Verlag. 208 p.
- Lewis MJ, Olby NJ. Sudden-onset neurological problems in cats: a systematic review. Journal of Feline Medicine and Surgery. 2020;22(8):716-731.
- Fenn J, Laber E, Williams K, et al. Associations between anesthetic variables and functional outcome in dogs with thoracolumbar intervertebral disk extrusion undergoing decompressive hemilaminectomy. Journal of Veterinary Internal Medicine. 2020;34(3):1214-1222.
- Granger N, Carwardine D. Acute spinal cord injury: tetraplegia and paraplegia in small animals. Veterinary Clinics of North America: Small Animal Practice. 2020;50(6):1361-1387.
Paralyzed French Bulldog in the waiting room