Neurology

The CityU Veterinary Medical Centre (CityU VMC) Neurology Service is a specialized referral service committed to help you and your pet who is in need of advice, investigation and treatment of neurological diseases. We provide the expertise of board-certified veterinary neurologist, experienced staff veterinary technicians and assistants dedicated to neurology. By working with a team of experienced radiographers operating advanced imaging (MRI/CT) we are able to provide, in majority of cases, a same-day consultation and diagnostic imaging service to your pet. We work closely with specialists in other services within CityU VMC to ensure your pet receive the best level of care possible.

Our services include:

  • Diagnosis and management of brain diseases such as epilepsy, inflammatory and infectious brain diseases, brain tumors, hydrocephalus, vascular accidents, traumatic brain injury and other diseases.
  • Diagnosis and treatment of spinal diseases including decompressive surgery for intervertebral disc disease, spinal fractures, atlantoaxial subluxations, spinal tumors, inflammatory and infectious spinal diseases, malformations and other diseases.
  • Diagnosis and treatment of peripheral nervous system, neuromuscular junction and muscular diseases, including peripheral vestibular disease, myasthenia gravis, myositis and other diseases.
  • Electrodiagnostic studies of nerves and muscles, Brainstem auditory evoked potentials (BAER), muscle and nerve biopsy.
  • Magnetic resonance imaging (1.5T high field MRI) and computerized tomography (64-slice CT).
  • Cerebrospinal fluid tap and comprehensive analysis
  • Connection with CityU Veterinary Diagnostic Laboratory and local laboratory for specialized tests to be performed including genetic testing for degenerative myelopathy and other neurodegenerative diseases.

What to Expect

Upon arriving at the CityU VMC, after registration with the receptionist, you and your pet shall wait in the waiting area. Waiting time varies depending on day-to-day caseloads, thus allowing extra time for the consultation is highly recommended. If this is your first neurological consultation with us, the consultation time with the neurologist is expected to be around 30-45 minutes. You and your pet will be led to the neurological consultation room. The neurologist will take a history regarding your pet’s relevant past history and current issue, then a neurological examination will be performed: this involves observation of your pet’s behavior, posture and gait, hands-on examination checking reflexes and sensation, and examination of the head including fundic examination. The neurological examination will lead to evaluation of lesion-localization (i.e. to identify where the problem(s) locate in your pet’s nervous system), severity, and possible causes. Further diagnostic recommendations and therapy plans will be discussed with you, to help you and your pet to find a solution, ultimately to improve quality of life and strengthen your bond with your beloved pet.

Neurology evaluations often include a thorough neurological examination, and running tests depending on individual cases. Some cases require specialized blood test which may take up to 2 weeks and we will contact you by phone when these test results return, and discuss further treatment plans as necessary.

Other diagnostic procedures involve general anesthesia, such as MRI, CT and cerebrospinal fluid (CSF) tap. In majority of cases these procedures can be performed on the same day of consultation. In urgent spinal cases surgery will be performed so as to provide a best outcome for your pet.

Specialist in Neurology
ECVN Resident in Neurology and Neurosurgery

What should I bring to my pet’s Neurology consultation?

  • Your pet’s vaccination record card, blood test results, X-rays or other imaging studies (CT or MRI on CD-Rom)
  • Provide the name of the food brand and treats your pet is eating, preventive measures (de-flea/tick and/or deworming products), and all medications, including herbal and vitamins.
  • Seizure record and if possible, video-recording of your pet’s seizure if your pet has a history of seizures or other seizure-like activities you witnessed.
  • Video-recording of your pet’s behavior, posture, gait or activities you are concerned of: such as head tilting to one side; circling; wobbly or limping gait; head, limb or body tremor, abnormal behavior etc. This may provide the neurologist additional clues to diagnose your pet’s neurological disease.

How should I prepare my pet for the neurology consultation?

  • Under normal circumstances, please fast your pet for 12 hours prior to the neurology consultation, in case same-day procedures requiring general anesthesia such as MRI/CT/CSF or surgery is necessary. You can give small amount of water to your pet up to 3 hours prior to the neurological consultation. If your pet is a kitten or puppy, or very small in size (<1 kg), we may ask you to fast your pet for shorter period of time.
  • If your pet is on anti-seizure medicines or heart medicines, please take them as routine. If you have to give them with food, please give only very small amount just enough to take the medicines.
  • If your pet is diabetic, please ask our veterinary assistant to give you further advice.
  • For brachycephalic dogs (short or flat nose, easily pants or snores) especially in summer time, please provide ice packs or other device to keep them cool during the journey to our hospital.

How long will my pet’s appointment take?

Usually a new consultation takes 30-45 minutes (excluding waiting time). As the length of the visit varies considerably, we recommended that you prepare to spend the day with us in the event that your pet needs advanced diagnostic imaging or other procedures requiring anesthesia.

What is Intervertebral Disc Herniation (IVDH)?

Intervertebral disc herniation (IVDH) is the most common spinal disease in dogs in Hong Kong. This is caused by protrusion of part of the disc dorsally into the vertebral canal and compressing the spinal cord, leading to spinal pain, weakness in the legs, or complete paralysis of your pet’s legs.
The severity of spinal disease can be graded to the following:

Grade 0 normal
Grade 1 spinal pain only.
Grade 2 walking but with abnormal gait, wobbly or weakness.
Grade 3 unable to stand or walk but there are voluntary movement in your pet’s legs (paresis), and if your pet has a tail: able to wag tail voluntarily.
Grade 4 unable to move the legs at all (paralysis), unable to wag tail, but has sensation in the paws when pinched with fingers or instruments. Please be aware that your pet may still have withdrawal reflexes but no sensation when you pinch his/her toes.
Grade 5 Paralysis without any sensation in the legs, urinary and fecal incontinence.

In general, the higher the grade, the poorer the prognosis and outcome is going to be, thus if your family veterinarian referred your pet to us, we will give you an appointment according to your family veterinarian’s initial assessment. We urge you to let us know if you are concerned that your pet has deteriorated since last seen your family veterinarian, so we could arrange an appointment to see you and your pet as soon as possible, so we could help your pet to walk again.

Our high-field MRI provides excellent image quality to help us find the problem disc(s). In the MR image shown below, the spinal cord is significantly compressed by calcified disc material (arrow).

MRI provides cross-sectional image to allow the neurologist to determine the surgical approach. As shown in the transverse images below: the left side is from a normal area, whereas the right image showed a midline to left-sided disc herniation (enclosed within dotted yellow line), compressing and deviating the spinal cord towards right.

Normal
RightLeft
Left-sided disc herniation
RightLeft

In our hospital, after spinal surgery, patients usually stay in for postoperative pain management and close monitoring, for a period of 3-5 days. You will receive a daily update of your pet’s condition and expected day to be discharged. Our neurology veterinary assistants will explain home care and demonstrate how to perform physiotherapy on your pet’s legs to promote recovery. Usually we would advise you to provide a safe, well-padded area for your pet to rest after the big surgery, and non-slip floor or area to walk on.

What is meningoencephalitis/ meningomyelitis?

Meningoencephalitis is inflammation of the membrane covering the brain (meninges) and inflammation of the brain itself.

Meningomyelitis is inflammation of the meninges and the spinal cord.

  • MUE (meningoencephalitis of unknown etiology) is the most common type of inflammatory central nervous system (CNS) disease we encountered in Hong Kong. The cause is unknown.
  • Other infectious agents causing CNS inflammation include virus (e.g. FIP in cats, distemper in dogs), protozoa (e.g. toxoplasmosis, neosporosis), fungus, bacteria, rickettsia etc.
  • Neurological signs vary depending on location of the inflammation, however patients usually show several clinical signs due to the multifocal location of the inflammatory lesions in CNS (such as concurrent neck pain, head tilt, seizures or leg weakness).
  • Diagnosis for this group of inflammatory/infectious disease usually involves general anesthesia, MRI and a CSF tap.
  • Treatment for MUE can be life-long. Initial treatment usually involve injections, oral medications, and suitable candidates receive cytarabine injections to manage their MUE.
  • Regular revisit with our neurologist is expected during the treatment course of your pet’s MUE.