Table 1: Clinical signs of Chiari-like malformation-associated pain
Clinical signsFrequency (% affected dogs)Notes
Vocalisation65Yelping described by the owner as ‘out of nowhere’, spontaneous or when the dog is moving, while lying resting or asleep, when lifted under the sternum, or on rising
Spinal pain55Hyperaesthetic to palpation in the cervical, thoracolumbar or caudal lumbar / lumbosacral region
Activity change38Described as exercise intolerant, unwilling to exercise, lethargic or sleeping more
Refusal/hesitation/difficulty climbing stairs or jumping35Described as refusing/hesitating/difficulty or vocalisation when jumping or climbing stairs
Scratching or rubbing of the head or ears28Skin and ear disease should be excluded
Aversion to the ears/head/neck being touched or groomed25Owner reports that the dog has an aversion to touch of this body part, yet tolerates touch or grooming elsewhere
Sleep disruption22Described as being restless in the night or having disturbed sleep
Timid/anxious14Change in behaviour described by owner
Withdrawn13Change in demeanour described by owner
Forelimb hypermetria10‘Goose stepping’-type gait characterised by increased proximal joint movement giving a tendency to overshoot. May also have decreased distal joint movement due to increased muscle tone (due to cerebellar dysfunction or a spinocerebellar tract lesion)
Aggression8Change in behaviour or uncharacteristic belligerence to other dogs/people
Abnormal head/neck posture when awake8Head held down or reluctant to move neck
Vocalisation when greeting, refusal to rise to greet, or no longer greeting5Yelping during greeting or refusal to get up and greet owner
Sleeping with an elevated or unusual head posture5Brachycephalic obstructive airway syndrome could be an alternate explanation for this sign
Aversion to the sternum or flank being touched or groomed5Owner reports that the dog has an aversion to touch of this body part, yet tolerates touch or grooming elsewhere
Squinting/avoiding light5Described by the owner as avoiding looking at lights or closing eye in light. Schirmer tear test should be performed to eliminate a diagnosis of keratoconjunctivitis sicca
Vocalisation when scratching5Yelping while scratching
Licking limb/paw4Dog licks without evidence of skin or orthopaedic disease and does not respond to trial management for allergic skin disease
Pain face3Owner describes a grimacing facial expression, suggesting the dog is in pain
Aversion to the limb/paw being touched or groomed3Owner reports that the dog has an aversion to touch of this body part, yet tolerates touch or grooming elsewhere
Vocalisation when defecating2Yelping while defecating
Repetitive barking2Behaviour thought to reflect anxiety; not necessarily due to Chiari-like malformation-associated pain (CM-P)
  • Frequency is based on owner-reported and clinical examination findings in CM-P and syringomyelia affected Cavalier King Charles spaniels (Rusbridge and others 2019)