Lapis ISSN 2398-2969

Paresis / paralysis: limb

Synonym(s): Paraparesis, Paraplegia, Quadriparesis, Quadriplegia, Tetraparesis, Tetraplegia

Contributor(s): Michelle Ward, Michelle Campbell-Ward, Lesa Longley, Lesa Thompson, Vicki Baldrey

Introduction

  • Definition: the terms paresis and paralysis refer respectively to the partial or complete loss of motor function in one or more limbs:
    • Paraparesis/paraplegia refers to the weakness or absence of voluntary movement in the pelvic limbs. This is the most common presentation in rabbits. 
    • Quadriparesis/quadriplegia (tetraparesis/tetraplegia) refers to the weakness or absence of voluntary movement in all limbs.
    • Hemiparesis refers to motor dysfunction of two limbs on the same side. 
    • Monoparesis refers to motor dysfunction of a single limb. 
  • Cause: may result from dysfunction of the central nervous system, peripheral nervous system, neuromuscular junction or muscle.  There are many etiologies; spinal trauma Spinal injury and encephalitozoonosis Encephalitozoonosis Encephalitozoonosis paralysis are the most common in pet rabbits.
  • Differential diagnosis: quadriparesis may be difficult to distinguish from generalized weakness associated with systemic illness.
  • Diagnosis: usually based on history, clinical signs, radiography, myelography and serology. 
  • Treatment: varies depending on underlying etiology.
  • Prognosis: generally guarded to grave depending on cause and severity of clinical signs.

Print-off the Owner factsheets on Care of the recumbent or paralysed rabbit  and Spinal injury to give to your clients.

Presenting signs

  • Variable depending on the underlying cause. 
  • Paresis or paralysis of one or more limbs may be the only presenting sign. 
  • Some cases, especially those that are chronic in nature, present with accumulation of uneaten cecotrophs at the perineum Sticky bottom syndrome, urine scald Perineum: urine scald , fly strike Fly strike or pododermatitis Ulcerative pododermatitis (Bumble foot).
  • Evidence of pain may be appreciated. 
  • Systemic signs of illness may occur concurrently, eg anorexia Anorexia, weight loss Weight loss

Acute presentation

  • Acute paresis or paralysis is most often a result of external trauma.
  • Slowly progressive signs are usually associated with inflammatory, degenerative or neoplastic disease.

Age/sex predisposition

  • Females are more likely to suffer from spinal deformity, eg kyphosis, scoliosis and lordosis, than males Spine: kyphosis - lateral radiograph .
  • Young rabbits (<1 year old) are more likely to present with paresis/paralysis of congenital or developmental origin than older rabbits. 

Public health considerations

  • A number of zoonotic diseases are associated with paresis or paralysis in rabbits.
  • The most common is Encephalitozoon cuniculi infection Encephalitozoon cuniculi, which can potentially pose a risk to immunocompromised people.
  • Zoonotic infections occurring in countries other than the UK:
    • Rabies - in areas where rabies is endemic, this serious zoonosis should remain a differential diagnosis in rabbits showing unexplained neurological signs, until proven otherwise. 
    • Baylisascaris procyonis (a racoon ascarid) may cause cerebral larval migrans.
    • Francisella tularensis Francisella tularensis may cause tularemia Tularemia.
    • West Nile virus may infect rabbits.

Cost considerations

  • Expensive if lesion localization and medical/surgical treatment to be attempted. 
  • Most cases carry a poor prognosis and necessitate long-term nursing care and treatment. Frequent veterinary visits or prolonged periods of hospitalization may be required. 
  • If significant financial constraints exist and/or appropriate nursing care cannot be provided, euthanasia should be considered Euthanasia.

Special risks

  • Rabbits that present with acute onset paresis or paralysis due to suspected spinal cord compression must be handled very carefully to avoid exacerbating the injury. This is especially true when animals are anesthetized for diagnostic evaluation.  
  • Efforts must be made to minimize stress, eg provide a dark, warm, quiet environment, minimize handling and limit contact with predator species. 
  • Trauma patients may have concurrent life-threatening injuries and/or be in hypovolemic shock. Adequate stabilization is required before considering anesthesia or surgical intervention.

Pathogenesis

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Diagnosis

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Treatment

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Prevention

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Sequelae

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Mancinelli E (2015) Neurologic examination and diagnostic testing in rabbits, ferrets and rodents. J Exot Pet Med 24 (1), 52-64 VetMedResource.
  • Meredith A L & Richardson J (2015) Neurological diseases of rabbits and rodents. J Exot Pet Med 24 (1), 21-33 VetMedResource.
  • Vernau K M, Osofsky A & LeCouteur R A (2007) The neurological examination and lesion localization in the companion rabbit (Oryctolagus cuniculus). Vet Clin North Am Exot Anim Pract 10 (3), 731-758 PubMed.
  • Keeble E (2006) Common neurological and musculoskeletal problems in rabbits. In Pract 28 (4), 212-218 VetMedResource.
  • Okonkwo D O, Reece T B, Laurent J J et al (2006) A comparison of adenosine A2A agonism and methylprednisolone in attenuating neuronal damage and improving functional outcome after experimental traumatic spinal cord injury in rabbits. J Neurosurg Spine 4 (1), 64-70 PubMed
  • St Claire M B, Kennett M J & Besch-Williford C L (2004) Vitamin A toxicity and vitamin E deficiency in a rabbit colony. Contemp Top Lab Anim Sci 43 (4), 26-30 PubMed.
  • Gök A, Uk C, Yilmaz M et al (2002) Efficacy of methylprednisolone in acute experimental cauda equina injury. Acta Neurochir (Wien) 144 (8), 817-821 PubMed
  • Liu M, Kato M & Hashimoto Y (2001) Neuromuscular blocking effects of the aminoglycoside antibiotics arbekacin, astromicin, isepamicin and netilmicin on the diaphragm and limb muscles in the rabbit. Pharmacology 63 (3), 142-146 PubMed
  • Karp B E, Ball N E, Scott C R et al (1999) Rabies in two privately owned domestic rabbits. JAVMA 215 (12), 1824-1827 PubMed
  • Drescher B & Loeffler K (1996) Scoliosis, lordosis and kyphosis in breeding rabbits. Tierarztl Prax 24 (3), 292-300 PubMed
  • Spickett A M, Elliott E G, Heyne H et al (1989) Paralysis of laboratory rabbits by nymphae of Ixodes rubicundus, Neumann 1904 (Acarina: Ixodidae) and some effects on the life-cycle following feeding under different temperature conditions. Onderstepoort J Vet Res 56 (1), 59-62 PubMed
  • Smith Baxter J (1975) Posterior paralysis in the rabbit. JSAP 16 (4), 267-271 PubMed

Other sources of information

  • Varga M (2014) Neurological and Locomotor Disorders. In: Textbook of Rabbit Medicine. Butterworth Heinmann, UK. pp 367-389.
  • Fisher P G & Carpenter J W (2012) Neurologic and Musculoskeletal Diseases. In: Ferrets, Rabbits and Rodents: Clinical Medicine and Surgery. 3rd edn. Eds: Quesenberry K E & Carpenter J W. Saunders, St Louis. pp 245-256.
  • Lorenz M D & Kornegay J N (2004) Oliver & Lorenzs Handbook of Veterinary Neurology. 4th edn. Saunders, USA.
  • Chrisman C, Mariani C, Platt S & Clemmons R (2003) Neurology for the Small Animal Practitioner. Teton NewMedia, USA. 
  • Percy D H & Barthold S W (2001) Pathology of Laboratory Rodents and Rabbits. 2nd edn. Iowa State University Press, USA. 
  • Storts R W (1995) Central Nervous System. In: Thomsons Special Veterinary Pathology. 2nd edn. Eds: Carlton W W & McGavin M D. Mosby, USA. pp 332-392.


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