Objective—To evaluate the signalment, neurologic examination and imaging findings, and outcome in dogs treated medically or surgically for osseous-associated cervical spondylomyelopathy (OACSM).
Design—Retrospective case series.
Animals—27 client-owned dogs.
Procedures—Medical records for dogs with OACSM (diagnosis made in 2000 through 2012) were reviewed. Collected data included signalment, neurologic examination findings (graded from 0 [normal] to 5 [tetraplegia]), imaging findings, treatment, and outcome. From MRI and CT images, measurements were obtained for subjective grading of spinal cord compression.
Results—Among the 27 dogs, the median age was 2 years; there were 15 Great Danes, 3 Mastiffs, 3 Newfoundlands, and 6 other large-breed dogs. For medically treated dogs (n = 7), the median initial neurologic grade was 2; for surgically treated dogs (20), the median initial neurologic grade was 3. Magnetic resonance imaging revealed dorsolateral spinal cord compression in 22 dogs and lateral spinal cord compression in 5 dogs. Dogs with more severe compressions were slightly more likely to undergo surgical than medical treatment. Median survival time of medically treated dogs was 43 months, and that of surgically treated dogs was 60 months. Fifteen of 19 dogs treated surgically had improved neurologic grades at 4 to 8 weeks after surgery and had a good to excellent long-term outcome.
Conclusions and Clinical Relevance—Surgical treatment of dogs with OACSM resulted in neurologic improvement and was associated with a good long-term outcome. For dogs that received medical treatment, neurologic deterioration continued but some patients did well for several years. (J Am Vet Med Assoc 2014;244:1309–1318)
Objective—To determine the percentage of cats with a phenobarbital (PB) concentration between 15 and 45 μg/mL that had a ≥ 50% reduction in the number of seizures and to investigate applicability of the 2011 International League Against Epilepsy (ILAE) classification system in cats.
Design—Retrospective case series.
Animals—30 cats with suspected or confirmed epilepsy.
Procedures—Medical records for 2004 to 2013 at 3 veterinary hospitals were searched. Information collected included signalment, duration of observation before treatment, frequency of seizures before PB administration, seizure phenotype, dose of PB, serum PB concentration, number of seizures after PB administration, duration of follow-up monitoring, and survival time. A modified 2011 ILAE classification system was applied to all cats.
Results—Seizure control was achieved in 28 of 30 (93%) cats with a serum PB concentration of 15 to 45 μg/mL. This comprised 10 of 11 cats with structural epilepsy, 14 of 15 cats with unknown epilepsy, and 4 of 4 cats with presumptive unknown epilepsy. Thirteen cats had no additional seizures after initiation of PB treatment.
Conclusions and Clinical Relevance—Seizure control was achieved in most cats with a serum PB concentration between 15 and 45 μg/mL, regardless of the cause of the seizures. A modified 2011 ILAE classification was applied to cats with seizures and enabled classification of cats without specific genetic testing and without identified structural or inflammatory disease. This classification system should be incorporated into veterinary neurology nomenclature to standardize communication between veterinarians and improve comparisons among species.
Case Description—A 7-year-old and a 10-year-old Congo African grey parrot (Psittacus erithacus erithacus; parrots 1 and 2, respectively) were evaluated because of neurologic deficits.
Clinical Findings—Parrot 1 had an 8- to 9-month history of lethargy and anorexia, with a recent history of a suspected seizure. Parrot 2 had a 6-month history of decreased activity and vocalizing, with an extended history of excessive water intake; a water deprivation test ruled out diabetes insipidus, and psychogenic polydipsia was suspected. Both birds had ophthalmologic asymmetry, with anisocoria detected in parrot 1 and unilateral blindness in parrot 2. Metal gastrointestinal foreign bodies were observed on whole-body radiographs of both birds, but blood lead concentrations were below the range indicated for lead toxicosis. Findings on CT of the head were consistent with hydrocephalus in both cases.
Treatment and Outcome—Parrot 1 received supportive care and died 3 months after the diagnosis of hydrocephalus. Parrot 2 was treated with omeprazole and prednisolone for 10 days without any improvement in neurologic deficits; euthanasia was elected, and hydrocephalus was confirmed on necropsy. No underlying or concurrent disease was identified.
Clinical Relevance—Hydrocephalus should be considered a differential diagnosis for parrots evaluated because of CNS signs. Computed tomography was an excellent screening tool to diagnose hydrocephalus in these patients. Compared with MRI, CT is more frequently available and offers reduced scanning times, reduced cost, and less concern for interference from metallic foreign bodies.
Case Description—A 7-day-old female alpaca was examined because of an acute onset of diffuse central neurologic deficits.
Clinical Findings—Diagnostic imaging with CT and MRI identified an intracranial cyst occupying approximately one-third to one-half of the dorsal portion of the cranial cavity, markedly displacing the cerebral hemispheres bilaterally.
Treatment and Outcome—Initial surgical management via trephination and needle drainage was only transiently effective at resolving the neurologic signs. Craniotomy and drainage and removal of the cyst lining resulted in a sustained improvement in neurologic status, and the cria remained clinically normal and well grown at follow-up 5 months after surgery.
Clinical Relevance—This report represented the first description of the successful treatment of an intracranial cyst in a New World camelid.
Case Description—An approximately 8-month-old female Miniature Lop rabbit (Oryctolagus cuniculus) was evaluated because of an acute onset of progressive paraparesis.
Clinical Findings—The rabbit was ambulatory paraparetic, and results of neurologic examination were consistent with a myelopathy localizing to the T3-L3 spinal cord segments. Evaluation with CT myelography revealed focal extradural spinal cord compression bilaterally at the level of the articular process joints of T12-L1.
Treatment and Outcome—A Funkquist type A dorsal laminectomy was performed at T12-L1, and the vertebral column was stabilized with pins and polymethylmethacrylate-based cement. Multiple vertebral synovial cysts were confirmed on histologic evaluation of the surgically excised tissues. The rabbit was nonambulatory with severe paraparesis postoperatively and was ambulatory paraparetic at a recheck examination 7 weeks after surgery. Fourteen weeks after surgery, the rabbit appeared stronger; it walked and hopped slowly but still fell and dragged its hindquarters when moving faster. Thirty-seven weeks after surgery, the neurologic status was unchanged.
Clinical Relevance—Although thoracolumbar myelopathy in rabbits is commonly secondary to vertebral fracture, vertebral synovial cysts should be considered a differential diagnosis for rabbits with slowly progressive paraparesis. Decompressive surgery and stabilization can result in a good outcome for rabbits with this condition.
To describe the prevalence of postoperative bacteriuria, clinical course of subclinical bacteriuria in the absence of antimicrobial intervention, clinical signs of bacteriuria that trigger antimicrobial treatment, and outcomes for dogs with subclinical bacteriuria following surgical decompression of acute intervertebral disc herniation (IVDH) Hansen type I.
Twenty client-owned dogs undergoing hemilaminectomy for acute (≤ 6 days) IVDH Hansen type I affecting the thoracolumbar spinal cord segments between August 2018 and January 2019.
In this prospective study, dogs were serially evaluated at presentation, hospital discharge, 2 weeks postoperatively, and between 4 and 6 weeks postoperatively. Dogs were monitored for clinical signs of bacteriuria, underwent laboratory monitoring (CBC, biochemical analyses, urinalysis, urine bacterial culture), and were scored for neurologic and urinary status. In the absence of clinical signs, bacteriuria was not treated with antimicrobials.
Four of the 18 dogs developed bacteriuria without clinical signs 4 days to 4 to 6 weeks after surgery. In all 4 dogs, bacteriuria resulted in lower urinary tract signs 13 to 26 weeks postoperatively. No dogs had evidence of systemic illness despite delaying antimicrobial treatment until clinical signs developed. New-onset incontinence was the only clinical sign in 3 dogs. All bacterial isolates had wide antimicrobial susceptibility. Bacteriuria and clinical signs resolved with beta-lactam antimicrobial treatment.
Postoperative bacteriuria occurs in some dogs with IVDH Hansen type I and, when present, may lead to clinical signs over time. Clinical signs of bacteriuria may be limited to new-onset urinary incontinence, inappropriate urination, or both. Delaying antimicrobial treatment until clinical signs of bacteriuria developed did not result in adverse consequences or systemic illness.
Case Description—A 9-year-old dog was evaluated for traumatic cervical myelopathy after a surgical attempt to realign and stabilize the C2 and C3 vertebrae.
Clinical Findings—The dog could not ventilate spontaneously and was tetraplegic; positive-pressure ventilation (PPV) was maintained. Myelography and computed tomography revealed spinal cord compression with subluxation of the C2 and C3 vertebrae and extrusion of the C2-3 intervertebral disk.
Treatment and Outcome—Surgically, the protruding disk material was removed and the vertebrae were realigned with screws and wire. For PPV, assist control ventilation in volume control mode and then in pressure control mode was used in the first 6 days; this was followed by synchronized intermittent mandatory ventilation until 33 days after the injury; then only continuous positive airway pressure was provided until the dog could breathe unassisted, 37 days after the injury. Physical therapy that included passive range of motion exercises, neuromuscular electrical stimulation, and functional weight-bearing positions was administered until the dog was discharged 46 days after injury; the dog was severely ataxic and tetraparetic but could walk. Therapy was continued at home, and 1 year later, the dog could run and had moderate ataxia and tetraparesis.
Clinical Relevance—Hypoventilation with tetraparesis in traumatic spinal cord injury can be successfully treated with PPV exceeding 30 days, surgery, and physical therapy.