Osmotic demyelination syndrome after primary hypoadrenocorticism crisis management

Background: Primary hypoadrenocorticism is a rare condition resulting from immune-mediated destruction of the adrenal cortices. It can also occur due to necrosis, neoplasms, infarctions, and granulomas. The clinical and laboratory changes are due to deficient secretion of glucocorticoids and mineralocorticoids, which leads to electrolyte disorders associated with hyponatremia and hyperkalemia. These disorders can cause hypotension, hypovolemia and shock, putting a patient’s life at risk if inadequate hydroelectrolytic supplementation and hormone replacement is provided. Nevertheless, rapid sodium chloride supplementation is contraindicated due to the risk of central pontine myelinolysis induction. The present study aims to describe a thalamic osmotic demyelination syndrome after management of a primary hypoadrenocorticism crisis in a 2-year-old, female West White Highland Terrier. Case: The patient had a presumptive diagnosis of hypoadrenocorticism already receiving oral prednisolone and gastrointestinal protectants in the last 2 days. After prednisolone dose reduction the dog presented a severe primary hypoadrenocorticism crisis treated with intravenous sodium chloride 0.9% solution along with supportive therapy. Four days after being discharged from the hospital, the patient showed severe neurological impairment and went back to the clinic where a neurological examination revealed mental depression, drowsiness, ambulatory tetraparesis and proprioceptive deficit of the 4 limbs, postural deficits, and cranial nerves with decreased response. Due to these clinical signs, a magnetic resonance imaging was performed. It showed 2 intra-axial circular lesions, symmetrically distributed in both thalamus sides, with approximately 0.8 cm in diameter each without any other anatomical changes on magnetic resonance imaging. The images were compatible with metabolic lesions, suggesting demyelination. Furthermore, liquor analysis did not show relevant abnormalities, except for a slight increase in density and pH at the upper limit of the reference range. After treatment, the patient had a good neurological evolution secondary to standard primary hypoadrenocorticism treatment, without sequelae. Discussion: In the present case report, primary hypoadrenocorticism gastrointestinal signs seemed to be triggered by a food indiscretion episode, not responsive to the symptomatic therapies employed. The patient´s breed and age (young West White Highland Terrier bitch) is in accordance with the demographic profile of patients affected by the disease, where young females are frequently more affected. Regarding the probable thalamic osmotic demyelination syndrome documented in this case, is important to notice that myelinolysis or demyelination is an exceedingly rare noninflammatory neurological disorder, initially called central pontine myelinolysis, which can occur after rapid correction of hyponatremia. It has already been observed in dogs after correction of hyponatremia of different origins, including hypoadrenocorticism and parasitic gastrointestinal disorders. Currently, the terms “osmotic myelinolysis” or “osmotic demyelination syndrome” are considered more suitable when compared to the term “central pontine myelinolysis” since it has been demonstrated in dogs and humans the occurrence of demyelination secondary to the rapid correction of hyponatremia in distinct regions of the central nervous system including pons, basal nuclei, striatum, thalamus, cortex, hypoppocampus, and cerebelum. The present case report emphasizes the difficulties for hormonal confirmation of primary hypoadrenocorticism in a patient already on corticosteroid treatment, as well as proposes that the current term osmotic demyelination syndrome replace the term “central pontine myelinolysis” in veterinary literature related to the management of hypoadrenocorticism crisis

Osmotic Demyelination Syndrome after Primary Hypoadrenocorticism Crisis Management

Background: Primary hypoadrenocorticism is a rare condition resulting from immune-mediated destruction of the adrenal cortices. It can also occur due to necrosis, neoplasms, infarctions and granulomas. The clinical and laboratory changes are due to deficient secretion of glucocorticoids and mineralocorticoids, which leads to electrolyte disorders associated with hyponatremia and hyperkalemia. These disorders can cause hypotension, hypovolemia and shock, putting a patient's life at risk if inadequate hydroelectrolytic supplementation and hormone replacement is provided. Nevertheless, rapid sodium chloride supplementation is contraindicated due to the risk of central pontine myelinolysis induction. The present study aims to describe a thalamic osmotic demyelination syndrome after management of a primary hypoadrenocorticism crisis in a 2-year-old, female West White Highland Terrier. Case: The patient had a presumptive diagnosis of hypoadrenocorticism already receiving oral prednisolone and gastrointestinal protectants in the last 2 days. After prednisolone dose reduction the dog presented a severe primary hypoadrenocorticism crisis treated with intravenous sodium chloride 0.9% solution along with supportive therapy. Four days after being discharged from the hospital, the patient showed severe neurological impairment and went back to the clinic where a neurological examination revealed mental depression, drowsiness, ambulatory tetraparesis and proprioceptive deficit of the 4 limbs, postural deficits, and cranial nerves with decreased response. Due to these clinical signs, a magnetic resonance imaging was performed. It showed 2 intra-axial circular lesions, symmetrically distributed in both thalamus sides, with approximately 0.8 cm in diameter each without any other anatomical changes on magnetic resonance imaging. The images were compatible with metabolic lesions, suggesting demyelination. Furthermore, liquor analysis did not show relevant abnormalities, except for a slight increase in density and pH at the upper limit of the reference range. After treatment, the patient had a good neurological evolution secondary to standard primary hypoadrenocorticism treatment, without sequelae. Discussion: In the present case report, primary hypoadrenocorticism gastrointestinal signs seemed to be triggered by a food indiscretion episode, not responsive to the symptomatic therapies employed. The patient´s breed and age (young West White Highland Terrier bitch) is in accordance with the demographic profile of patients affected by the disease, where young females are frequently more affected. Regarding the probable thalamic osmotic demyelination syndrome documented in this case, is important to notice that myelinolysis or demyelination is an exceedingly rare noninflammatory neurological disorder, initially called central pontine myelinolysis, which can occur after rapid correction of hyponatremia. It has already been observed in dogs after correction of hyponatremia of different origins, including hypoadrenocorticism and parasitic gastrointestinal disorders. Currently, the terms "osmotic myelinolysis" or “osmotic demyelination syndrome" are considered more suitable when compared to the term "central pontine myelinolysis" since it has been demonstrated in dogs and humans the occurrence of demyelination secondary to the rapid correction of hyponatremia in distinct regions of the central nervous system including pons, basal nuclei, striatum, thalamus, cortex, hippocampus and cerebellum. The present case report emphasizes the difficulties for hormonal confirmation of primary hypoadrenocorticism in a patient already on corticosteroid treatment, as well as proposes that the current term osmotic demyelination syndrome replace the term “central pontine myelinolysis” in veterinary literature related to the management of hypoadrenocorticism crisis.Keywords: Addison Syndrome, hyponatremia, osmotic myelinolysis, magnetic resonance imaging

Aspectos citológicos do fluído seminal em um canino apresentando prostatite

A infecção bacteriana da próstata (prostatite) pode ser originária de uma infecção ascendente a partir da flora uretral normal ou secundária a algum distúrbio primário prostático. Os cães agudamente afetados apresentam hematúria, infertilidade e dor a palpação retal, enquanto que nas infecções crônicas os sinais sistêmicos são ocasionalmente observados. O diagnóstico é determinado através do exame clínico, exames de imagem e análise de citológica do líquido prostático. Nesse último, pode-se observar um elevado número de células inflamatórias, células vermelhas e bactérias extra ou intracelulares. O objetivo do presente relato foi demonstrar o uso da citologia do líquido seminal para o diagnóstico da prostatite em um canino com hiperplasia prostática. Para isso, reporta-se o caso de um canino, sem raça definida, macho não castrado, de idade avançada atendido no Hospital Veterinário da Universidade de Passo Fundo (HV-UPF) apresentando dermatopatia severa e urina em jatos. Constatou-se ao exame clínico, além da dermatopatia generalizada severa, prostatomegalia homogênea de aspecto liso e dor intensa. Através da análise do fluido seminal obtido por ejaculação foi constatada predominância de células inflamatórias (neutrófilos), macrófagos ativados, bactérias, algumas células prostáticas e de epitélio escamoso. As alterações encontradas foram compatíveis com inflamação prostática piogranulomatosa que após o tratamento indicado apresentou resolução constatada pela citologia do fluido seminal

Síndrome do cão tremedor

Background:  :  :  : The Shaker Dog Syndrome manifests itself as generalized tremors that usually affect the head and body of the patient. The tremors increase with movement and decrease at rest, and it may cease during sleep. The disorder develops mostly in 1-year to 5-year-old animals weighing below 15 kg. The diagnosis is based on the exclusion of other possible causes of tremors and a positive response to treatment with corticosteroids. The treatment consists of immunosuppressant doses of corticosteroids and it can be associated to decreasing diazepam doses during 8 to 12 weeks. Literature data are very rare and cannot be found in Brazil. Consequently, this study aimed at describing a Shaker Dog Syndrome case that is responsive to corticosteroids. Case: A 2-year-old mongrel female dog, weighting 7.5 kg, was referred to the Hospital de Clínicas Veterinárias da Universidade Federal do Rio Grande do Sul, presenting generalized tremors for 5 days, which would cease during sleep. In the neurological examination, the cranial nerve exam and the test for postural reactions were considered normal. The hematological and biochemical profile did not show alterations. The cervical spine radiography did not display bone alterations. A density of 1.016 was observed at the physical examination of the cerebrospinal fluid. The chemical examination revealed a glucose level of 100 mg/dL, negative bilirubin, negative ketones, absence of occult blood, pH 8.0, presence of protein traces, normal urobilinogen, negative reactive protein C (PCR), normal creatine kinase (CK) and aspartate aminotransferase (AST). The result of Pandy’s test was negative. Oral treatment with prednisone at a dose of 1.5 mg.kg-1 BID and diazepam at a dose of 0.5 mg.kg-1 BID was instituted, this latter during 4 days. The corticoid dose was maintained until total disappearance of the tremors, which occurred within 24 days. Afterwards, a gradual reduction of 50% of the dose was made every 7 days, during 4 weeks. Discussion: During anamnesis, tremors induced by trauma and medication were ruled out. Myelin abnormalities were also improbable, as they cause congenital tremors and do not quickly respond to corticosteroids. A colorless aspect and absence of occult blood and bilirubin was observed in the LCR analysis. The absence of turbidity and the presence of protein traces in this sample demonstrate normality (38.7 mg/dL ± 15.49). Chemical and physical exams did not demonstrate alterations – pH 8.0 (8.30 ± 0.34) and a density of 1.016 (1007 ± 1.83), respectively. The glucose concentration in the cerebrospinal fluid was not reduced. The results obtained from Pandy’s and reactive protein C tests were negative. The analysis of AST and CK enzymes was normal. Since the values obtained from enzymatic and protein evaluations of the cerebrospinal fluid were normal, they suggest an absence of infectious and degenerative processes. The immunosuppressant prednisone dose recommended by literature is variable; thus, the smallest corticosteroid dose indicated was selected, which is 1.5 mg.kg-1 BID. An association with diazepam was made to reduce tremors. Usually, clinical improvement can occur within a few days, but the remission of clinical signs can take weeks. In the present case, the reduction of tremors occurred on the fourth day, with the complete disappearance in 24 days, without recurrence within a clinical follow-up period of 2 years

Intussuscepção jejunoileal dupla em um cão

Intussuscepção é uma afecção digestiva relativamente comum na clínica veterinária. Caracteriza-se pela invaginação de um segmento intestinal em outro adjacente, de maneira anterógrada ou retrógrada. No presente estudo descreve-se um caso de intussuscepção jejunoileal dupla em um cão. Os sinais clínicos são inespecíficos e incluem vômito, dor abdominal, fezes mucóides e sanguinolentas e pela existência de massa abdominal palpável. O diagnóstico se dá pelos sinais clínicos e exames complementares, como radiografias e ultra-sonografia. Através de celiotomia mediana ventral foi empregada técnica de enteroanastomose término-terminal para tratamento da afecção em questão. Um segmento de aproximadamente 80 cm do intestino delgado foi ressectado. Radiografias contrastadas pós-operatórias realizadas ao redor do vigésimo dia de evolução cirúrgica evidenciaram o trânsito intestinal normal no sítio anastomosado. O ganho de peso demonstrado pelo animal e a ausência de qualquer alteração de origem gastrintestinal confirmaram o sucesso do tratamento instituído

Substituição do ligamento redondo por membrana biológica e pino transarticular na redução de luxação coxofemoral bilateral em cães

A luxação coxofemoral é a mais freqüente nos pequenos animais, sendo geralmente causada por trauma, levando a ruptura do ligamento redondo e da cápsula articular. O exame clínico identifica o tipo de luxação e a severidade da lesão, sendo de fundamental importância também para a avaliação sistêmica do animal traumatizado. O diagnóstico definitivo é realizado através de radiografia simples, que ajuda a direcionar o tratamento. Este trabalho tem o objetivo de relatar a redução de luxação coxofemoral bilateral com ruptura de cápsula e ligamento redondo de um cão. Para tanto, esse ligamento foi substituído por um “flap” de fáscia lata autógena no membro esquerdo e fixada a articulação com pino transarticular no membro direito, na premissa tentativa de redução. Com a reluxação do membro esquerdo, o “flap” de fáscia lata autógena foi substituído por centro frênico eqüino conservado em glicerina 98%. O centro frênico permitiu o uso funcional do membro 15 dias após a cirurgia, enquanto o pino transarticular em apenas 40 dias de pós-operatório. Sugere-se que o centro frênico eqüino conservado possa ser uma alternativa viável na redução de luxação coxofemoral

Implante de traquéia de Gallus domesticus na microanastomose arterial em cães

Os animais são pouco sujeitos a distúrbios vasculares primários, porém todas as lesões envolvem trauma vascular e são representadas por hemorragias mais ou menos intensas. Em geral as lesões de vasos sangüíneos maiores podem ser reparadas por sutura direta, por anastomose ou por implantes de condutos prostéticos. Este trabalho teve como objetivo testar a traquéia de Gallus domesticus na substituição de um segmento da artéria femoral em cães. Para isso, foram utilizados 16 cães adultos, sem raça definida, hígidos, de ambos os sexos. Nas anastomoses microcirúrgicas foram utilizados fios sintéticos inabsorvíveis de polipropileno, com pontos simples interrompidos. O sucesso cirúrgico foi avaliado pela verificação da patência dos vasos nos vinte minutos após o término da anastomose por teste de patência e também aos 60 ou 120 dias pós-operatórios. A traquéia de Gallus domesticus pode ser utilizada como substitutivo segmentar da artéria femoral em cães, independende do meio de conservação, porém a manutenção da patência está estatisticamente relacionada com o tempo de observação do implante

Nanopartículas lipídicas sólidas preparadas a partir de manteiga de cupuaçu (Theobroma grandiflorum)

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Nanopartículas lipídicas sólidas preparadas a partir de manteiga de cupuaçu (Theobroma grandiflorum)

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