RM Clemmons, DVM, PhD, CVA, CVFT
Gainesville, FL

Anomalous




Hydrocephalus
COMS
Intracranial
arachnoid cyst
Dandy-Walker
Syndrome

Congenital


Outflow obstruction
De Novo

Brain disappears
Copyright 1999
University of Florida
DV
LAT
Copyright 1999
University of Florida
T2-horizontal
Copyright 1999
University of Florida
T1-coronal
T1-sagittal (lateral)
T1-sagittal (midline)
Copyright 1999
University of Florida

Medical Management


VentriculoPerotoneal
Shunt


Antioxidants and Steroids
Helpful when progressive
changes in neurologic
status
TCVM treatment
Copyright 1999
University of Florida

Cranial end of
shunt is placed
through bur hole
Copyright 1999
University of Florida

Tunnel is made to
bring shunt tubing to
the abdomen
Copyright 1999
University of Florida


Abdominal end is
pushed into
abdomen using
Kelly hemostats
Extra is left for
growth or
movement
Copyright 1999
University of Florida

Kidney jing deficiency

Fails to support the
development of
marrow

Does not nourish the
child (liver)

Does not control the
grandchild (heart)

Insults the
grandparent (spleen)

Kidney & Spleen Qi
Deficiency


Kidney & Liver
Yin/Blood Deficiency


Younger animals with
congenital
hydrocephalus
Older animals with
Canine Cognitive
Disease
Liver Qi Stagnation

Secondary to CNS
inflammatory disease
or cancer

Problem List



Shen Disturbance
Hydrocephalus
Diagnosis


Jing Deficiency
Yin deficient
 Confirmed ultrasound

Hepatoencephalopathy
 Confirmed BW


Overall poor development
TCVM

Tongue
 thin-red

Pulses
 Deep, weak fast particularly
on right side

Treatment



Hydrocephalus formula
Liu Wei Di Huang
Epimedium powder
Bai Zhi
Angelica
Bai Zhu
Atractylodes
Ban Xia
Pinellia
Bo He
Mentha
Cang Zhu
Atractylodes
Chan Tui
Cicada
Dang Shen
Codonopsis
Deng Xin Cao Juncus
Fu Ling
Poria
Huang Qi
Astragalus
Jie Geng
Platycodon
Jin Yin Hua Lonicera
Ju Hua
Chrysanthemum
Shan Yao
Dioscorea
Sheng Ma
Cimcifuga
Ze Xie
Alisma
Zhi Ban Xia Pinellia
Zhu Ling
Polyporous
Dispel Wind-Cold, relieve pain
Strengthen Spleen Qi
Transform Damp and stops vomiting
Dispel Wind-Heat
Dry up Dampness, strengthen Spleen Qi
Dispel Wind, move Qi to the head
Tonify Qi
Clear Heat, Drain Damp-Heat
Benefit the urination
Tonify Spleen Qi and dissipate swelling
Open to the Upper Jiao, transform phlegm
Clear Heat, detoxify
Clear Heat, detoxify
Tonify Spleen Qi
Clear Wind-Heat, move Qi to the head
Benefit the urination
Transform Damp and stops vomiting
Benefit the urination
Epimedium
Cuscuta
Cistache
Paeonia
Polygonum
Actinolite
Cynomorium
Psoralea
Dipsacus
Lycium
Condonopsis
Astragalus
Rehmannia
Angelica
Ophiopogon
Scrophularia
Citrus
Yin Yang Huo
Tu Si Zi
Rou Cong Rong
Bai Shao Yao
He Shou Wu
Yang Qi Shi
Suo Yang
Bu Gu Zhi
Xu Duan
Gou Qi Zi
Dang Shen
Huang Qi
Shu Di Huang
Dang Gui
Mai Men Dong
Xuan Shen
Chen Pi
Tonify Kid Yang/Jing, Promote Sexual Desire
Tonify Kid Yang, Jing & Yin
Tonify Kid Yang & Yin
Nourish Liver Yin & Blood
Nourish Blood & Jing, Benefit Hair
Tonify Kid Yang
Tonify Kid Yang
Tonify Kid Yang & Strengthen Bones
Tonify Kid Yang & Promote Fracture Healing
Nourish Liver Yin, Benefit Eyes
Tonify Qi
Tonify Qi
Nourish Kid Yin & Jing
Nourish Blood
Moisten & Nourish Yin
Cool Blood & Clear Heat
Move Qi & Relieve Pain
Copyright 1999
University of Florida
Copyright 1999
University of Florida




15 yr old M poodle
Owner went on
vacation
Boarded at facility
Upon return ataxia
that progressed to
coma in 8 hours

Problem List



Shen Disturbance
Hydrocephalus
Diagnosis

Liver & Kidney yin
deficiency
 Confirmed MRI/CT scan


TCVM


Tongue
 thin-red

Treatment
Pulses
 Deep, weak fast particularly
on right side


½ Dose Hydrocephalus
formula
Liu Wei Di Huang
½ Dose Epimedium
powder
Today’s Frontier

Common Types







Meningioma
Astocytoma
Oligodendroglioma
Choroid plexus
papilloma
Lymphoma
Neuroectodermal
tumors
Metastatic tumor

Dog has 1-18
months average
survival time




1-3 with nothing
6-9 with surgery
12-18 with radiation
treatment
All tumors are
invasive
(malignant)




Most common is
meningioma
Usually extra-axial
and benign
Seen in aged cats
Present with
depression and
dementia

MRI revealed mass in
the cerebral cortex

Prednisolone (0.250.5 mg/kg q12h)




Treats secondary
effects
Cover with
gastroprotectants
Chemotherapy
Radiation therapy

Lomustine
60 mg/M2 given
 Monitor CBC weekly
 If WBC and platelets
okay in 5 weeks, then
give 80 mg/M2
 Repeat every 5-8
weeks


Procarbazine



2-4 mg/kg/day for 1
week, then 4-6
mg/kg/day
Monitor CBC
Continue as long as
WBC levels are >
4000/µl & platelet
count is > 100,000/µl

5-hydroxyurea
Meningiomas
 50 mg/M2 given
 Monitor CBC weekly
 Repeat every 3-4
weeks


Melatonin



Gliomas
0.1-0.2 mg/kg once a
day in the evening
Reduces growth of
many tumors by 50%

Diet


Supplements


Low carbohydrate
Antioxidants & membrane
stabilizers
Herbal medications


Western- -Canine Cancer
formula
Traditional Chinese
medicine- -Stasis in the
Mansion of the Mind

Hz:

Acute Seizures
 Head Injury


Tongue


Pulse


red & greasy
Fast, wiry & slippery
Rx Principle

expel phlegm, extinguish
the wind, open the orifice,
stabilize the seizures and
invigorate blood
AP


CV-15, ST-40, PC-5, HT-7,
LI-11, LIV-3, An Shen, Da
Feng Men
TCM Herbal


Ding Xian Wan
TCVM Cancer Treatment
Angelica
Pinellia
Ligusticum
Salvia
Lumbricus
Ligusticum
Pueraria
Carthamus
Bombyx
Scorpion
Cimicifuga
Fritillary
Scolopendra
Bai Zhi
Ban Xia
Chuan Xiong
Dan Shen
Di Long
Gao Ben
Ge Gen
Hong Hua
Jiang Can
Quan Xie
Sheng Ma
Zhe Bei Mu
Wu Gong
Warm the Channel, relieve pain
Transform phlegm
Move Blood
Move Blood
Clear Wind, invigorate Channel
Relieve pain
Bring Qi upward
Break down Blood Stasis
Transform phlegm, resolve nodule
Break down Blood Stasis
Ascend Qi
Transform phlegm, resolve nodules
Detoxify, resolve nodules
Bai Zhi
Da Huang
Jie Geng
Mu Li(Shu)
Tian Hua Fen
Xia Ku Cao
Xuan Shen
Zhe Bei Mu
Angelica
Clear Wind-Cold and relieve pain
Rheum
Clear stagnation/stasis and clear Heat
Platycodon Open the Upper Jiao and transform phlegm
Ostrea
Soften hardness and clear mass
Trichosanthes Clear Heat and promote body fluids
Prunella
Clear Liver Heat and resolve nodules
Scrophularia Clear Heat and cool Blood
Fritillaria
Soften hardness and clear nodules
Bai Hua She She Cao
Ban Zhi Lian
Chen Pi
Dang Gui
Dang Shen
Huang Qi
Wu Yao
Xuan Shen
Oldenlandia
Scutellaria
Citrus
Angelica
Codonopsis
Astragalus
Lindera
Scrophularia
Inhibit cell mutation and tumor growth
Inhibit cell mutation, inhibit tumor growth
Move Qi and transform phlegm
Tonifies Blood
Tonify Qi and boost Wei Qi
Tonifies Qi in whole body and Wei Qi
Move Qi and clear stagnation
Cool Blood and nourish Yi
Bai Hua She She Cao Oldenlandia
Ban Zhi Lian
Scutellaria
E Zhu
Zedoaria
Mu Li(Shu)
San Leng
Ostrea
Sparganium
Zhe Bei Mu
Fritillaria
Inhibit cell mutation and tumor growth
Clear Heat-toxin, inhibit cell mutation,
inhibit tumor growth
Purge the interior, break Blood stasis and
clear mass
Soften hardness and clear mass
Purge the interior, break stasis and clear
mass
Soften harness and clear nodules


5 year old, German
Shorthair Pointer
History of seizures
starting 1 month prior

Responsive to
phenobarbital

Tongue: purple

Pulse: fast & wiry

Neurologic Exam




Mild dementia
CP deficits in both
hind legs
Babinski’s sign on
left side of the body
Localization

Cerebrum affecting
both side (>right)


Di Tan Tang
Stasis in Mansion
of Mind

Wei Qi Booster

Western herbs


10 year old, Mx
Progressive loss of
coordination and head
tilt

Personality change

Tongue: purple

Pulse: fast & wiry

Neurologic Exam





Left head tilt
Positional, vertical
nystagmus
Mild CP deficits in rear
L>R
Xextensor R -> L in rear
Localization

L Cerebellar pontine
angle with cerebral
signs

TCM Dx:


Liver Blood
Stagnation
TCM Rx:


Stasis in Mansion of
Mind
Wie Chi Booster



McKnight Brain
Institute at UF
High, single dose
radiotherapy
5 arcs of radiation
provide sphere of
death

Based upon the
focal size and tissue
treated


Treatment is applied
with LINAC unit at
UFBI
Cost of radiosurgery


procedure is around
$3000.00
plus workup &
conventional surgery



Overall ED50 is
around 13 months
Some patients
survive much
longer
Prognosis for
meningiomas is
better than others
1.
Low-Carbohydrate food (home prepared is best or use
Pedigree Weight Loss Formula)
2.
Canine basic antioxidant formula (Westlab
Pharmacy 1-800-4WESTLA)
3.
Canine arthritis formula (Westlab)
4.
Canine cancer formula (Westlab)- -use at 2 times
prevention dose
5.
COX-2 inhibitor (daily- -particularly for carcinomas)
6.
Melatonin at night (0.1-0.2 mg/kg)

Max Formula
or

Stasis in Mansion
of Mind
and

Wei Qi Booster
and

Western herbs
Transports to
Head



Acute or chronic
progressive
quadriparesis
Usually has neck pain
Often in older
animals
A Perspective on History



A chronic, progressive
neurodegenerative disease
Initial signs are due to TL
spinal cord disease
Represents an
autoimmune disorder

Breeds
German Shepherd dogs
 Belgium Shepherds
 Old English Sheepdogs
 Rhodesian Ridgebacks
 Weimaraner
 Probably Great Pyrenes



Age

> 5 years old (usually 89)
Sex


Onset


Equal
1 month to 1 year
Clinical Course

Paralysis within 3 to
6 month without
treatment

Axon and myelin loss




Swollen axons
Patchy demyelination
Astrocyte proliferation
Increase in vasculature

Physical and Neurologic Examination

Electrodiagnostic Examination

Neuroimaging

CSF tap & analysis

Exercise




20-30 minutes twice
a week
1 hour once a week
sustained aerobic
exercise is needed
 CNS O2 delivery

Dietary Considerations


Tofu
Fresh vegetables





carrots
greens
peppers
broccoli
Ginger, garlic & mustard

Supplements




Antioxidants
Membrane stabilizers
Tonics
Anti-inflammatory

Medication

Aminocaproic acid
(500 mg TID)

n-Acetylcysteine (25
mg/kg TID QD for
2 weeks, then TID
QOD)

Signalment



S
8 yr F/S GSD
Weakness
Posterior Paresis

History

Seemed to be slower
over last 6 months
 Trouble getting up

Vet checked for HD
 Minimal response to
NSAIDs

S
Worse over last 30
days

Neurologic Examination





Head- -NAF
CN- -NAF
Mild Neck Pain (C6)
Forelegs- -NAF (slight
dysmetria)
Rear Legs




O
Slight hyperflexia L>R
CP deficits Bilaterally
Babinski L
Hypermetria
Mild Back Pain (TL)

Localization of Lesion



T3-L3 Spinal Cord







O

D
A
M
N
N
I
I
I
T
T
V
IVDD, GSDM
Spinal Tumor
Myelitis
GME
• Problem List

Differential Dx

1. Posterior Paresis
? 1. GSDM
2. IVDD
3. Infect/Inflamm
4. Neoplasia
2. Foreleg Hypermetria
3. Neck & Back Pain

Diagnostic Approach


Treatment

P
?
?

MDB






CBC
Chemistry Profile
UA
Chest & Abdominal
Radiographs
Abdominal Ultrasound
Neurologic Tests
EMG
 CSF Analysis

 Cisternal
 Lumbar


P
MRI (Whole Spine)
Client Education




P
May expect gradual return to function
expecting 80% of recovery in 3 months
May continue to progress over 12-18 months
Need to monitor spleen and blood work every
6 months
Reassess as needed, changing medications
when appropriate

Tongue



Pulse


Pale
Wet
Weak bilaterally
Sensitivity



GB 21
BL 18
BL 23

TCVM Diagnosis

Combined Qi/Yin
Deficiency with
Stagnation

AP


Cervical points
 BL10
 GB 21


GV 14
Bai Hui (EA & Moxa)
BL40
BL62
Other points




ST 36
SP 6
LI 10
LIV 3
Hu Qian Tang
 Walking Tiger Formula
 Jing Tang
Lumbar points





Herbal

Di Huang Yin Zi
 Rehmannia Formula for
Paralysis
 Jing Tang
Bai Shao Yao
Chen Pi
Gan Jiang
Gui Ban
Huang Bai
Niu Xi
Shu Di Huang
Suo Yang
Zhi Mu
Paeonia
Citrus
Zingiberis
Chinemys
Nigricans,
Plastrum
Nourish Blood
Move Qi and Relieve Pain
Strengthen Stomach and Promote Appetite
Nourish Yin, anchors Yang, tonify Blood,
Nourish Heart
Phellodendron Clear Heat, Nourish Yin
Achyranthes
Strengthens the Kidney and benefit the
knees
Rehmannia
Nourish Yin, Blood and Jing
Cynomorium Tonify Kidney Yang, Nourish Blood, Tonify
Essence, Strengthen Sinews
Anemarrhena Nourish Yin, Clear Heat
Ba Ji Tian
Fan Shi Hu
Morinda
Descurainiae
Herba
Fu Ling
Fu Zi
Mai Men Dong
Rou Cong Rong
Rou Gui
Shan Zhu Yu
Shi Chang Pu
Poria
Aconite
Ophiopogon
Cistanche Salsa
Caulis
Cinnamomum
Cornus
Acorus
Shu Di Huang
Wu Wei Zi
Yuan Zhi
Rehmannia
Schisandra
Polygala
Tonify kidney, strengthen yang
Nourish Yin, clear deficient heat, nourish
stomach Yin
Drain Damp, Strengthen Spleen
Warm Spleen
Nourish Yin
Tonify kidney, strengthen yang
Tonify Kidney Yang
Nourish Yin
Open orifices, vaporize phlegm, quiet
spirit,harmonize middle burner
Nourish Blood and Yin
Consolidate and Nourish Lung Yin
Calm spirit, quiet heart, clears orifices