The animal body needs a way to communicate with its billions of cells and organ systems and although there is a myriad of chemicals in the body that send messages through fluids such as the blood, the best way to get the information where it is needed is by direct connection and this is what the nervous system accomplishes. The brain sorts through the information collected, sends out responses and transmits the data to produce an animal’s awareness of its surroundings. The spinal cord transmits the information through millions of fibers (nerves) up and down the length of the body as well as the limbs and internal organs. This information can be collected or distributed to end organs such as the liver, heart, joints, brain and many many others. Those that are most important in the day-to-day life of a neurologist are the muscles.
Neurologic disease processes tend to have a predisposition for a specific area or areas of the nervous system. Therefore the brain is susceptible to recurring seizures, as is seen with epilepsy, or in older animals with brain tumors and infections such as meningitis.
Patients with spinal cord disease are most often presented for compressive problems, the most common by far being the result of intervertebral disc degeneration.
Peripheral nerves, connecting the spinal cord to the limbs, can be traumatically damaged and even attacked by the body’s own immune system.
The connections between the muscles and nerves can be compromised as is evident in the disease syndrome Myasthenia Gravis.
The muscles themselves can be traumatized, become infected, or lose function because of damage to their blood supply.
There are hundreds of diseases that are the result of genetic defects that cause the cell’s natural systems to run improperly and we are becoming increasingly aware of genetic markers that make an animal more prone to recognized diseases such as cancer.
Dr. Steve Steinberg has been a pioneer in the field of Veterinary Neurology in Maryland, but also the United States. He has been trained by virtually all the fathers and grandfathers of modern day veterinary neurology. The genetic markers that were unknown, when he was the first to describe a brain degeneration in Gordon Setters and Old English Sheepdogs. have been identified and more than twenty years later he is the co-author of a paper that describes this defect. Not only was he one of the first veterinarians to bring specialists out of the university and into private practice but he has also been on the faculty of the University of Pennsylvania, Johns Hopkins, and The Canine Rehabilitation Institute.
What should you expect?
A well-organized approach to any case is the key to finding a diagnosis.
We will work with your local Maryland veterinarian to gain their understanding of each case history, as well as to review their records and diagnostic results. We will then ask for a detailed history from the person who is best able to describe the patient’s clinical signs.
A complete examination will be performed including a comprehensive neurologic examination. Thoroughness and consistency are critical to arriving at the best course of action. Many orthopedic, cardiovascular, and medical abnormalities may appear similar to neurologic dysfunction.
We will recommend a course of action. The involvement of your regular veterinarian is always part of your pet’s diagnostic and treatment plan. We understand that it may be much more convenient for you to have some tests performed and follow-up examinations scheduled at your regular veterinarian.
With the advent of widespread availability of expensive equipment we recognize that veterinary medicine has become quite costly. Newer medications, MRI’s, CT’s, and very specialized testing (sometimes performed only at one facility in the entire world!) have added dramatically to the price of veterinary medicine today. We are 100% committed to treating your four-legged family member the best way available while staying within your budget. There will always be a “Plan B” if “Plan A” is financially out of reach.
What do we do?
We will clearly explain the most likely disease processes and describe a diagnostic plan to help confirm our suspicions, if necessary. We will give an estimate of the costs and discuss treatment options based on our assessment of likely diagnoses. We will share information about treatment costs and try to include any possible or likely complications in our discussion. Medicine is still not an exact science but with the experience of Dr. Steinberg and his well-trained neurology team, coupled with our state-of-the-art Gaithersburg Animal Hospital, we are very good at pinpointing the unexpected and forewarning you accordingly. We always include your veterinarian in the plan we propose and keep them appraised of your animal’s progress. We recognize that your veterinarian referred you because they have confidence in us but you came to our hospital because you have confidence in your veterinarian, so it is only natural you may wish to confer with them before making difficult decisions. After all, we recognize we are caring for one of your family.
Why choose VCA VRA’s Neurologic Services?
First and foremost, we totally recognize the importance of every patient we see, not only to his or her caregivers, but also as a special being on this planet.
Second, you will have a difficult time finding any neurology service with our experience. Hundreds of brain tumor surgeries, thousands of spinal surgeries, thousands of epileptics, and tens of thousands of non-surgically treated patients have passed through our animal hospital our doors in Gaithersburg. Dr. Steinberg has lectured all over the world on topics including brain disease, peripheral nerve disease, internal medicine, case management and business. We developed the first chemotherapeutic brain tumor protocol after scouring the halls of the NIH library for agents specifically tested in dogs over two decades ago. VRA was the first facility animal hospital to recognize the place of advanced radiology in the veterinary specialty hospital setting and we have one of the first true Critical Care Units established in a veterinary specialty hospital.
Our neurology service has never stood still. We promise the best in cutting-edge medicine, ground in the knowledge that can only be developed through experience and presented with compassion that will be evident the moment you step through our doors.
Frequently Asked Questions
- What Additional Training Does A Veterinary Neurologist Have?
A veterinarian who has been awarded this specialty status by the ACVIM will list the initials, 'DACVIM (Neurology),' after his or her veterinary degree. Or, the veterinarian may indicate that he or she is a 'Diplomate' of the ACVIM. The word 'Diplomate' typically means the specialist has achieved the following:
• Obtained a traditional 8 year veterinary degree (four years of college plus four years of veterinary school).
• Completed a one year internship and an additional two to three years of advanced training, including a residency at an approved program where the doctor will have trained with some of the best experts in the field and obtained hands on experience.
• Following this training, the aspiring veterinary neurologist must pass a series of examinations covering all aspects of general internal medicine and neurology.
After completing and passing all of these rigorous requirements, the veterinarian is then recognized by his or her peers as a board certified specialist in veterinary neurology. Many veterinary neurologists are also trained in neurosurgery, while others limit their practice to the medical aspects of the discipline and work with a surgeon on the cases requiring surgery. When your pet needs the care of a veterinary neurologist, years of intensive training and additional education will be focused on helping him or her to recover from his or her problem or enjoy the highest quality of life possible.
- What are Examples of Neurologic Diseases In Pets?
• Congenital deafness
• Viral infection (canine distemper, feline infectious peritonitis, feline leukemia, rabies)
• Fungal infection (Cryptococcus, Coccidioides)
• Tick-borne infections (Rocky Mountain Spotted Fever, Ehrlichia)
• Granulomatous Meningioencephalitis (GME)
• Myasthenia gravis
• Hepatoencephalopathy (brain dysfunction due to liver disease)
• Toxicity due to pesticides, lead, ethylene glycol (antifreeze), certain antibiotics
• Nutritional disorders, such as thiamine or vitamin E deficiency
• Traumatic brain or spinal cord injury
• Degenerative myelopathy
- What Problems Does A Veterinary Neurologist Diagnose and Treat?
Veterinary neurology is a challenging field in that some diseases are solely neurologic in origin while in other cases, the neurologic problem may be related to an underlying systemic disease. In the first case, the
veterinary neurologist may be able to treat the neurologic problem directly. In the second case, resolution of the neurologic problem may hinge on the correct diagnosis and treatment of the underlying disease. For example, certain viral infections may result in neurologic signs.
- What Is A Neurologic Veterinary Emergency?
• Complete loss of function of any or all limbs
• Recurrent or intractable pain, specifically of the back and neck
• Head trauma
• Spinal trauma
• Severe depression or inability of the patient to respond to its environment
- What Is Epilepsy In Pets?
Depending on the source, the incidence of epilepsy among the general pet population is estimated at between 0.5 and 2.3%. Epilepsy refers to chronic, recurrent seizures and can be inherited or acquired. Thus, epilepsy is a clinical condition, not a specific disease. Idiopathic epilepsy refers to recurrent seizures in which no identifiable cause is found to explain the seizures, such as metabolic disease, toxin exposure, encephalitis, or brain tumors. Seizure diagnosis involves ruling out common causes of seizures. Initially, your veterinary neurologist will likely order a series of blood tests to help rule out metabolic and toxic causes of seizures. Depending on the age of your pet, the course of the seizures, and the results of the neurological examination, the neurologist may recommend an MRI or CT scan of the brain and/or a spinal fluid tap to look for signs of encephalitis or brain cancer.
Idiopathic epilepsy is most common in purebred dogs, with an age of onset between one and five years of age (often before three years). Dogs and cats with idiopathic epilepsy are completely normal between seizures and have a normal neurological examination.
If your pet's first seizure occurs before 1 year of age or after 5 years of age, is not normal between seizures, or if there are any abnormalities on neurological examination, the veterinary neurologist may recommend advanced diagnostics, such as an MRI of the brain, to help determine the cause of the seizure
- What are Signs of Neurologic Disease In Pets?
• Behavior changes
• Altered consciousness (e.g., depression, disorientation, coma
• Complete or partial paralysis
• Neck or back pain
• Generalized weakness or weakness in one area of the body
• Incoordination or imbalance
• Gait or stance abnormalities (e.g., straddling or shuffling of rear limbs; crouched position)
• Loss of sensory function (sight or hearing)
• Head tilt
• Fecal or urinary incontinence
In some cases, your veterinarian may be able to simply consult with the veterinary neurologist about your pet's care. In other cases, it is necessary to actually refer you to the specialist. Veterinary neurologists are trained in state of the art diagnostic techniques and will utilize advanced imaging such as CT or MRI scans to look at the structures of the nervous system. With electrodiagnostic tests, a neurologist can examine the function of the peripheral nervous system, particularly the nerves and muscles. Spinal fluid analysis can provide clues to such infectious diseases as encephalitis or meningitis. Veterinary neurologists also will be able to make appropriate recommendations for your pet's rehabilitation period, especially after such major procedures as back surgery. Lengthy recuperation times can be necessary, and your pet may be referred to rehabilitation facilities offering such services as water or physical therapy. Pain management will also be addressed.
- What are Veterinary Neurological Exam Basics?
Neurological examinations typically proceed from head to tail, with all areas of the body being given systematic attention in that order. In addition, your pet may be videotaped for future reference and to help train other veterinarians.
Mental status: The pet will be observed to determine whether it interacts normally with its owner, other people and animals, and the environment.
Gait and body posture: The veterinary neurologist will watch the animal walk around the room, in the hallway, or up and down stairs. Additionally, the neurologist will make observations regarding the animal's body posture.
Cranial nerve examination: The pet's senses of sight, smell, and hearing will be checked, as well as its ability to chew, swallow, and move its tongue, eye, and facial structures normally. Response to pain will also be checked.
Physical examination: The pet's body will be palpated for any signs of pain or muscle atrophy. The veterinary neurologist will also perform a number of tests with the pet's limbs to check reflexes and reactions, such as turning a pet's paw over to see if the pet will reposition it to the normal stance, and lifting a pet up off the ground and lowering it back down to see how it positions its legs upon contact with the ground.
Reflex testing: Just as in humans, a veterinary neurologist may check a pet's reflexes as part of the examination process.
- What Neurological Diagnostic Tests are used?
• Myelogram: Contrast dye radiographic study of the spine.
• CSF tap: Cerebral spinal fluid removed from the spinal cord and analyzed.
• Electromyography: Electrical impulses are used to diagnose the function of nerves and muscles.
• Imaging techniques such as MRI and CT.
Services Offered in Neurology
- Multimodal analgesia
- Comprehensive peri-operative monitoring
- Blood chemistry analyzer
- Hematology analyzer
- In-house STAT laboratory
- Magnetic Resonance Imaging (MRI)
- Computed Tomography (CT scanning)
- Digital radiography
- Ultrasound-guided fine needle aspiration
- Pulse oximetry and end tidal capnography
- Aggressive analgesia
- Seizure diagnosis and management
- Non-surgical spinal cord disease diagnosis and management
- Neuromuscular disease diagnosis and management
- Electromyography (EMG)
- Cerebrospinal fluid collection and analysis
- Brain and spinal MRI
- Spinal radiography and fluoroscopy
- Physical Rehabilitation
- Advanced anesthetic monitoring
- Brain and spinal surgery
- Stem cell therapy
- Ventral slot surgery
- Dorsal laminectomy (cervical and lumbosacral)
- Craniotomy/craniectomy-diagnostic and therapeutic
- Spinal distraction and stabilization