Paralysis

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Paralyzed French Bulldog in the waiting room

Paralysis is defined as the inability to actively move parts of the body. The paralysis can be flaccid or spastic.

Paralysis Dog/Cat
Paralysis is the partial or complete loss of voluntary motor skills, often in one or more limbs. Causes include neurological damage from herniated discs, spinal injuries, stroke, or toxins. Acutely occurring paralysis must always be clarified as an emergency.

Paralysis (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 absent. Paralysis can occur suddenly or gradually and affect different body regions. Depending on the location, a distinction is made between monoplegia (paralysis of one limb), paraplegia (paralysis of both hind legs), tetraplegia (paralysis of all four limbs) and hemiplegia (paralysis of one half of the body).

Paralysis can be flaccid or spastic. In flaccid paralysis, muscle tone is absent, while in spastic paralysis, muscle tone is increased. The distinction is important for the diagnosis of the underlying disease and therapy planning.

Paralysis is caused by damage to the central nervous system (brain and spinal cord), the peripheral nervous system, or the neuromuscular connections. Nerve damage can be caused by pressure, Inflammatory conditions, Circulatory disorders, toxic influences, or degenerative processes.

Causes

The causes can be diverse.

  • Damage to the brain and spinal cord due to traumas and inflammatory conditions (herniated disc, fractures)
  • Poisonings
  • Metabolic disorders
  • Specific infectious diseases
  • Tumors in the area of the nervous system
  • In cats, blood clots in the area of the large leg arteries (arterial occlusive disease, thrombosis)
  • Supplement
  • The causes of sudden paralysis in dogs and cats are varied and can be divided into different categories:

Trauma-related paralysis: Spinal injuries from accidents, falls, or bite injuries 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: Herniated discs are 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 prolapse 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. A blood clot blocks the aorta at its bifurcation to the hind legs. This disease often occurs in cats with heart diseases such as hypertrophic cardiomyopathy.

Infectious and inflammatory causes: Inflammatory conditions of the spinal cord (myelitis), nerve roots (radiculitis), or peripheral nerves (neuritis) can lead to paralysis. The cause can be bacterial or viral infections, but also autoimmune diseases.

Toxic causes: Poisoning from 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 the tick is removed.

Neoplastic causes: Tumors in the area of the brain, spinal cord, or peripheral nerves can lead to paralysis due to pressure or infiltration.

Metabolic disorders: Electrolyte disorders such as hypokalemia or hypocalcemia can impair nerve function and lead to muscle weakness or paralysis.

Congenital diseases: Certain breeds have genetic predispositions for neurological diseases that can lead to paralysis, such as degenerative myelopathy in the German Shepherd.

Symptoms

Paralysis in dogs and cats

Typical Symptoms:

  • Sudden loss of movement (affecting one or more limbs)
  • Unsteady gait, ataxia, Stumbling
  • possibly Pain, reduced reflexes, or spasticity

Alarm signs:

  • Paralysis with severe Pain (disc/ischemia/trauma)
  • Loss of deep pain sensation, urinary/fecal incontinence
  • Respiratory involvement or rapid escalation of the symptomatology
  • History of trauma (fall, accident)

Escalation/course:

  • Rapid deterioration within hours → emergency neurology
  • Newly occurring incontinence → escalation
  • Pain suddenly subsides with complete Paralysis → poor prognosis

 

The symptomatology of paralysis varies depending on the affected body region, severity, and underlying cause. The following signs may indicate paralysis: Mild (paresis) to complete Paralysis (Paralysis), in which no muscle contractions are possible. A partial spastic paralysis with increased muscle tone is possible. Paralysis can occur suddenly or progressively.

In the event of sudden paralysis, affected animals often show a clear Limited mobility up to complete immobility of the affected limbs. The animals can no longer stand, walk or run. In paresis, the ability to move is reduced, which can manifest as dragging of the paws, Coordination disorders or a staggering gait.

An important diagnostic feature is deep pain perception. If this is missing, it indicates severe damage to the spinal cord. The veterinarian checks this by applying a strong pinching stimulus to the toes. If the animal does not react with a conscious reaction (turning its head, vocalizing), the Prognose is less favorable.

In the case of paralysis of the hind limbs, there may be a loss of control over the bladder and intestines, which leads 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 in herniated discs or nerve entrapment. The animals show expressions of Pain such as whimpering, Panting, Restlessness or Aggressiveness when touching certain body regions. Some animals adopt a characteristic Protective posture / guarding posture, with a hunched back and lowered head.

In aortic thromboembolism (blood clot in the large artery) 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 Respiratory distress due to the underlying heart disease.

Depending on the cause, other neurological symptoms such as altered consciousness, Head tilted to one side, Circling, or Convulsions may occur. In the case of paralysis due to poisoning or systemic diseases, Vomiting, Diarrhea, or Atemwegsbeschwerden can also be observed.

First Aid

  1. Calm your pet. Do not encourage it to move.
  2. Some causes, such as damage to the spinal cord, can be very painful. Put a muzzle on as a precaution.
  3. Do not use medication on your own.
  4. Don’t wait. This is an emergency. Surgery may be necessary immediately.
  5. If a spinal instability is suspected after a trauma, transport your animal accordingly carefully.
  6. Wrap your animal in a blanket and take it to a veterinary hospital.
  7. If you suspect a spinal injury, do not carry your animal, but try to transport it lying down with immobilization of the spine.

When should you see a vet sooner?

→ Red for respiratory involvement, severe pain, rapid progression, or circulatory signs.

Treating paralysis in one or both hind legs in cats due to a blood clot requires immediate action. The condition is extremely painful for the cat.

Diagnosis

The diagnosis of paralysis begins with a thorough medical history, in which the veterinarian asks about the time course, possible traumas, previous illnesses, and other relevant factors. This is followed by a general clinical and a special neurological examination.

In the neurological examination, consciousness, posture, gait, postural and righting reactions, spinal reflexes, muscle tone, and pain perception are assessed. This examination helps to narrow down the location of the Lesions (brain, spinal cord, peripheral nerves, or muscles) and to assess the severity.

Imaging techniques are crucial for an accurate diagnosis. X-rays can show fractures, dislocations, or degenerative changes in the spine. The 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 imaging the spinal cord, nerve roots, and surrounding soft tissue. It is considered the gold standard in the diagnosis of herniated discs and other Lesions near the spinal cord.

If aortic Thromboembolie is suspected in cats, ultrasound examinations of the heart (echocardiography) and the large vessels are performed. Doppler sonography can show the blood flow in the affected arteries.

Laboratory tests such as blood count, serum chemistry, and urinalysis help to detect systemic diseases, infections, or metabolic disorders. If infections or Inflammatory conditions are suspected, an examination of the cerebrospinal fluid (CSF) (cerebrospinal fluid (CSF)) by Lumbalpunktion may be necessary.

Electrophysiological examinations such as electromyography (EMG) and nerve conduction velocity measurements can be helpful in the diagnosis of 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 very different causes, so different treatment strategies are necessary.
In veterinary medicine, the most common cause of paralysis in dogs is pressure on the spinal cord and the nerve roots emanating from it due to traumas or degenerative changes.
In cats, thromboembolism, which can partially or completely block the large arteries of the hind legs, is not uncommon due to an underlying heart disease.
In both cases, immediate, complex diagnostics (computed tomography (CT)) and therapy are indicated.
In dogs, conservative therapy with immobilization is sometimes possible. In many cases, however, surgery is indicated. If not treated in time, the paralysis will persist (Fig.)
When the blood supply to the hind legs of cats is interrupted, the therapy focuses on stopping the thrombus growth and accelerating the dissolution of the thrombus with medication.
This therapy begins even before further diagnostics such as ultrasound, fluoroscopy with angiography, and computed tomography (CT) with angiography (CT angiography). Pain therapy / analgesic therapy and volume substitution are also among the first measures.
The thrombus can be dissolved via a venous access or via the leg artery under fluoroscopic control with an advanced catheter.

Supplement

The treatment of paralysis depends on the underlying cause and the severity of the neurological deficits. In many cases, a multimodal therapy approach is necessary.

Emergency measures: In the case of acute paralysis, immediate veterinary care is crucial. Transport should be gentle, especially if spinal injuries are suspected. In the case of herniated discs or traumas, strict cage rest is often prescribed for several weeks to avoid further damage.

Surgical therapy: In the case of herniated discs with severe neurological deficits, surgery is usually the therapy of choice. The prolapsed disc material is removed and the pressure on the spinal cord is reduced. Various surgical techniques such as hemilaminectomy, ventral slot or fenestration are used depending on the location. In the case of vertebral fractures or dislocations, stabilization operations with plates, screws or pins may be necessary.

Drug 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. In aortic thromboembolism in cats, antiplatelet drugs and anticoagulants are used to dissolve the clot and prevent new clot formation.

Pain management: Adequate pain therapy / analgesic therapy is necessary and may include various analgesics such as opioids, NSAIDs, or gabapentin. Acupuncture can also have a supportive effect for chronic Pain.

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) enables controlled movement without full weight bearing. Massages and heat applications can relieve muscle tension.

Supportive measures: In the case of bladder paralysis, regular manual expression of the bladder or catheterization is necessary to avoid urinary congestion and infections. Incontinent animals require special hygiene measures such as diapers or more frequent cleaning. Aids such as walkers, wheelchairs 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 Prognose for paralysis is very 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 intervertebral disc disease 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 a full recovery decreases to below 50%.

In cats with aortic thromboembolism, the prognosis is guarded to poor. The survival rate is approximately 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 transection of the spinal cord leads to irreversible paralysis, while contusions or bruises may be partially or completely reversible.

Aftercare plays a crucial role in the success of the therapy. After surgical procedures, strict immobilization is necessary for several weeks to promote healing and avoid complications. Regular check-ups serve to monitor the healing process and adjust the therapy.

Long-term physiotherapy is often necessary to strengthen the muscles, prevent joint stiffness, and improve coordination. In cases of permanent paralysis, owners must learn to manage their animal’s special needs, such as bladder management, pressure sore prophylaxis, 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 flooring, 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 varied, ranging from intervertebral disc disease and traumas to vascular occlusions and poisonings. The diagnosis is based on a thorough neurological examination and imaging techniques such as MRI or CT.

The therapy depends on the underlying cause and can be conservative with immobilization and medication or surgical. Early treatment is crucial for success, especially in cases of intervertebral disc disease 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 a full recovery, others have permanent limitations that require lifelong adaptation of the keeping conditions.

For pet owners, it is important to know risk factors and take preventive measures, especially in predisposed breeds. At the first signs of neurological disorders, a veterinarian should be consulted immediately, as time is a crucial factor for the success of the therapy.

Outlook on current research

Research in the field of neurological diseases in small animals is continuously advancing. Current studies focus on innovative therapy approaches to improve nerve regeneration and functional recovery after spinal cord injuries.

Stem cell therapy shows promising results in the treatment of spinal cord injuries. Mesenchymal stem cells can release anti-inflammatory factors and promote nerve regeneration. Initial clinical trials in dogs with intervertebral disc disease 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 the cell membrane and prevent nerve cell death.

Advances in neuroprosthetics and neuromodulation enable new approaches to restore motor function. Implantable electrodes can stimulate the spinal cord and thus improve mobility, even in 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 enable a more precise representation of nerve tracts and their damage, which improves diagnosis and prognostication.

Advances in rehabilitation include robot-assisted therapy systems and virtual reality, which enable more intensive and targeted training. These technologies are already used in human medicine and are increasingly being used in veterinary medicine.

The research of biomarkers in the blood or cerebrospinal fluid (CSF) could enable early diagnosis and better prognosis estimation in the future. Certain proteins or microRNAs could indicate the extent of nerve damage and support the therapy decision.

Frequently asked questions (FAQs)

  1. How do I recognize paralysis in my pet?
    Paralysis manifests as a sudden inability to move or severely Limited mobility of one or more limbs. Affected animals can no longer stand, walk or run, or show a clearly altered gait with dragging of the paws.
  2. Is sudden paralysis always an emergency?
    Yes, a sudden onset of paralysis is always to be regarded as an emergency and requires immediate veterinary assistance. Especially in the case of herniated discs or aortic thromboembolism, every hour counts for the Prognose.
  3. Which dog breeds are particularly susceptible to herniated discs?
    Chondrodystrophic breeds with short legs such as Dachshunds, French Bulldogs, Beagles, Shih Tzus, Pekingese and Pugs are particularly at risk. In these breeds, premature degeneration of the intervertebral discs occurs.
  4. Can my animal recover completely from paralysis?
    The chances of complete recovery depend heavily on the cause, severity, and duration of the paralysis. With timely treatment of herniated discs with preserved deep pain perception, the chances of success are good. In the absence of deep pain perception or complete spinal cord transection, complete recovery is unlikely.
  5. How can I help a paralyzed animal at home?
    Paralyzed animals require special care, including regular repositioning to avoid pressure sores, assistance with bladder emptying, soft and clean surfaces to lie on, and physiotherapy according to veterinary instructions. Aids such as wheelchairs can support mobility.
  6. How long does rehabilitation take after spinal cord surgery?
    The rehabilitation phase can last between several weeks and several months, depending on the severity of the injury and individual healing ability. In the first 4–6 weeks, strict cage rest is usually required, followed by a gradual increase in activity and accompanying physiotherapy.
  7. What preventive measures are there for herniated discs?
    Preventive measures include weight control to avoid Overweight, the use of harnesses instead of collars in predisposed breeds, avoidance of jumping and climbing stairs, and, if necessary, prophylactic disc fenestration in high-risk breeds.
  8. Can a tick really cause paralysis?
    Yes, certain tick species can cause ascending paralysis through neurotoxins in their saliva, which is known as tick paralysis. After removal of the tick, the symptoms usually subside within 24–72 hours.
  9. How high are the costs for the treatment of paralysis?
    The costs vary greatly depending on the cause, necessary diagnostics and therapy. A conservative treatment can cost a few hundred euros, while surgical interventions on the spinal cord with subsequent rehabilitation can cost several thousand euros.
  10. Can my animal live a happy life with permanent paralysis?
    Yes, many animals with permanent paralysis can live a happy and fulfilling life. With appropriate aids such as wheelchairs, an adapted environment and loving care, they can adapt well to their limitations and show joie de vivre.

Literature

  • Kirsch, A: Aortic thrombosis in the cat. 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 pp.
  • 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.