Clinical reasoning in feline non‐ambulatory tetraparesis or tetraplegia: Which combination of clinical information is useful?

Abstract Background Non‐ambulatory tetraparesis or tetraplegia in cats may constitute a diagnostic challenge for general practitioners. Therefore, this study aimed to evaluate if clinical variables from signalment, history, clinical examination and basic ancillary tests are associated with underlying diagnoses in cats with non‐ambulatory tetraparesis or tetraplegia. Methods This was a retrospective single‐centre study of cases presented between 2010 and 2023. Information on disease onset, progression, neurological and physical examination findings and ancillary tests was analysed across all diagnoses. Diagnostic categories comprising five or more cases were carried forward to univariate and/or multivariable analyses. Results Eighty‐one cats were included, with 82.7% of cases represented by six conditions: polyneuropathy (PN; n = 26), ischaemic myelopathy (IM; n = 15), spinal cord neoplasia ( n = 8), feline infectious peritonitis ( n = 7), intracranial neoplasia ( n = 6) and spinal cord contusion ( n = 5). On multivariable analysis, an age of below 3 years, progressive presentation, normal mentation, reduced spinal reflexes in the thoracic limbs and normal blood tests were statistically associated with PN. Age between 6 and 9 years or older than 9 years and peracute onset of clinical signs were associated with IM. Limitations This was a retrospective study with limited multivariable analysis in certain diagnostic categories. Furthermore, the study included only referral cases, which may not represent the animal population seen by general practitioners. Conclusions PN and IM were the most common causes for non‐ambulatory tetraparesis or tetraplegia in this population of cats. Attention to the neurological examination and easy to identify clinical features can be used to determine the most likely differential diagnoses and assist general practitioners in the formulation of a diagnostic plan.