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Ventricular pneumocephalus and septic meningoencephalitis secondary to dorsal rhinotomy and nasal polypectomy in a dog

Daniel J. Fletcher PhD, DVM1, Jessica M. Snyder DVM, DACVIM2,3, Jennifer S. Messinger DVM4,5, Alexander G. Chiu MD6, and Charles H. Vite DVM, PhD, DACVIM7
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  • 1 Department of Clinical Sciences, Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, PA 19104
  • | 2 Department of Clinical Sciences, Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, PA 19104
  • | 3 Veterinary Specialty Center of Seattle, 20115 44th Ave W, Lynnwood, WA 98036
  • | 4 Department of Clinical Sciences, Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, PA 19104
  • | 5 Alameda East Veterinary Hospital, 9770 E Alameda Ave, Denver, CO 80247
  • | 6 Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA 19104
  • | 7 Department of Clinical Sciences, Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, PA 19104

Abstract

Case Description—A 4-year-old sexually intact female French Bulldog was evaluated because of lethargy, anorexia, and chronic rhinitis-sinusitis. The dog had nasal discharge of 18 months' duration; dorsal rhinotomies were performed 3 months and 2 weeks prior to referral.

Clinical Findings—On initial evaluation, intraventricular pneumocephalus and sinusitis were diagnosed; CSF analysis revealed high total protein concentration and mononuclear pleocytosis. The dog's condition improved with treatment. Two weeks after discharge, it was treated by a local veterinarian because of upper airway obstruction; 3 days later, the dog was referred because of seizures. Computed tomography revealed a large fluid-filled, left lateral ventricle and a soft tissue mass protruding through a cribriform plate defect. The mass was histologically consistent with brain tissue. Findings of clinicopathologic analyses were unremarkable. Results of cytologic examination of a CSF sample were indicative of septic, suppurative inflammation, and bacteriologic culture of CSF yielded Escherichia coli.

Treatment and Outcome—Amputation of the herniated olfactory bulb and antimicrobial treatment resolved the septic meningoencephalitis, but neurologic deficits recurred 6 weeks later. Definitive correction of the cribriform plate defect with bone and fascial grafts was attempted. Postoperative rotation of the bone graft resulted in cerebral laceration and hemorrhage, and the dog was euthanized.

Clinical Relevance—Findings suggest that following dorsal rhinotomy and nasal polypectomy surgery, the dog developed herniation of the left olfactory bulb, intra-ventricular pneumocephalus, and septic meningo-encephalitis because of a cribriform plate defect. Care must be taken to prevent rotation of bone grafts used in cribriform defect repair.

Abstract

Case Description—A 4-year-old sexually intact female French Bulldog was evaluated because of lethargy, anorexia, and chronic rhinitis-sinusitis. The dog had nasal discharge of 18 months' duration; dorsal rhinotomies were performed 3 months and 2 weeks prior to referral.

Clinical Findings—On initial evaluation, intraventricular pneumocephalus and sinusitis were diagnosed; CSF analysis revealed high total protein concentration and mononuclear pleocytosis. The dog's condition improved with treatment. Two weeks after discharge, it was treated by a local veterinarian because of upper airway obstruction; 3 days later, the dog was referred because of seizures. Computed tomography revealed a large fluid-filled, left lateral ventricle and a soft tissue mass protruding through a cribriform plate defect. The mass was histologically consistent with brain tissue. Findings of clinicopathologic analyses were unremarkable. Results of cytologic examination of a CSF sample were indicative of septic, suppurative inflammation, and bacteriologic culture of CSF yielded Escherichia coli.

Treatment and Outcome—Amputation of the herniated olfactory bulb and antimicrobial treatment resolved the septic meningoencephalitis, but neurologic deficits recurred 6 weeks later. Definitive correction of the cribriform plate defect with bone and fascial grafts was attempted. Postoperative rotation of the bone graft resulted in cerebral laceration and hemorrhage, and the dog was euthanized.

Clinical Relevance—Findings suggest that following dorsal rhinotomy and nasal polypectomy surgery, the dog developed herniation of the left olfactory bulb, intra-ventricular pneumocephalus, and septic meningo-encephalitis because of a cribriform plate defect. Care must be taken to prevent rotation of bone grafts used in cribriform defect repair.

Contributor Notes

Address correspondence to Dr. Fletcher.