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Other specific abnormalities included cervical hyperesthesia (13), diminished menace responses (7), positional strabismus (7), excessive scratching behavior (6), torticollis (3), abnormal mentation (2), “fly-biting” episodes (2), head tilt (2), chewing at the paws (2), excessive licking (1), eye rubbing (1), and generalized seizures (1).Mean duration of clinical signs prior to surgery was 32.19 wks (1-208 wks). One dog had worsening of a head tilt, which resolved in three weeks.All dogs underwent a FMD procedure that included either meningeal resection or marsupialization to the surrounding musculature.Fifteen of 16 dogs were receiving medical therapy for COMS prior to surgery. Diagnosis is best made by magnetic resonance imaging (MRI): fluid-filled cavity within the spinal cord and cerebellar tonsil herniation. The dogs either have progressive cranial (eg, facial deficits, seizures, vestibular syndrome) or spinal (eg, hyperesthesia with persistent scratching of shoulder and neck region) symptoms.
While occipital dysplasia alone is not thought to cause any clinical abnormalities, the dogs of this report suggest that intramedullary central nervous system abnormalities may be present concurrently with occipital dysplasia and should be considered as a possible cause of the clinical signs. Mechanical obstruction at the craniocervical junction, altering CSF flow dynamics, may lead to syrinx formation. Abnormalities compatible with such a malformation were identified by magnetic resonance imaging in 39 cavalier King Charles spaniels with neurological signs and in one neurologically normal cavalier King Charles spaniel that was examined postmortem. Vermeersch K, Van Ham L, Caemaert J, Tshamala M, Taeymans O, Bhatti S, Polis I. This technique is used with great success in human medicine. Quote: "Chiari type 1 malformation in humans is a congenital abnormality of the caudal occipital bone, resulting in overcrowding of the caudal fossa and compression at the level of the cervicomedullary junction.
Drugs were discontinued in all dogs with resolution of signs.
Four of the 6 improved dogs remained on medical therapy.
It is thought that syrinx formation in humans and dogs with CIM occurs secondary to partial obstruction of CSF flow at the cranio-cervical junction.
As therapeutic options medical treatment with corticosteroids, acetazolamide, NSAIDs or oral opioids may give an improvement but most often not a resolution of signs.