Intracerebral haemorrhage in a dog with steroid-responsive meningitis arteritis

A one-year and six-month-old female neutered Boxer dog was presented with a four-day history of pyrexia, lethargy and neck pain. An intracerebral haemorrhage and a mediastinal mass were identified. Cerebrospinal fluid analysis revealed severe neutrophilic pleocytosis, and steroid-responsive meningitis arteritis (SRMA) was suspected. A significant improvement was observed with immunosuppressive steroid therapy and subsequent imaging revealed a reduction in size of the intracerebral haemorrhage and disappearance of the mediastinal mass. SRMA is a systemic disease with potential involvement of multiple organs. Intracerebral haemorrhage can occur secondary to SRMA and can have a successful outcome

Successful medical management of an epidural abscess in a dog

A seven-month-old entire male dobermann presented with acute onset neck pain and left thoracic limb lameness. The dog had a similar episode eight weeks before presentation that responded to meloxicam. A cervical spinal epidural abscess secondary to Staphylococcus pseudintermedius bacteraemia was diagnosed following investigations, including MRI of the cervical vertebral column and blood cultures. Treatment with cephalexin, gabapentin and meloxicam was started. The dog was doing clinically well one month later. A control MRI and radiographs of the cervical vertebral column showed evidence of discospondylitis and resolution of the primary lesion, therefore the treatment course with cephalexin was continued. Three months after initial presentation the clinical signs had resolved, radiographs showed improvement of the discospondylitis and antibiotics were stopped. Seven months later the dog continued doing well with no relapse

Intra-parenchymal brainstem haemorrhage secondary to iatrogenic needle injury after a parenteral injection in a cat

Case summary A 6-month-old female domestic shorthair cat was presented with acute onset non-ambulatory right hemiparesis and horizontal nystagmus following an injection attempt in the neck, during which the cat did not cooperate. Magnetic resonance imaging (MRI) revealed a well-defined intra-axial lesion on the right side of the myelencephalon. The lesion was T2-weighted hypointense and T1-weighted hypointense to isointense to grey matter, non-contrast enhancing, with perilesional oedema and signal void on T2*-weighted images. A linear hyperintense lesion in the muscles of the right dorsolateral aspect of the neck on short tau inversion recovery images was also observed. These MRI findings were consistent with iatrogenic brainstem haemorrhage and a muscle needle tract. The cat made a good recovery with just mild residual neurological deficits 6 weeks after the injury. Relevance and novel information To our knowledge, this is the first report of an iatrogenic brainstem needle injury in a cat and the first report of a central nervous system iatrogenic trauma after a parenteral injection. Care should be taken with neck parenteral injections, especially in the cranial cervical area

Factors affecting the prognosis following thoracolumbar spinal cord disease in the dog

Thoracolumbar spinal cord disease is common in dogs, with numerous processes affecting the T3 to L3 spinal cord segments. Being able to accurately predict the outcome is of critical importance for clinicians and owners, in order to inform the clinical decision making process. A large number of variables, including the signalment, findings of the clinical examination, the choice of diagnostic techniques and choice of therapy could potentially have an influence on the outcome. Although there are a large number of reports detailing the use of magnetic resonance imaging (MRI) in the investigation of canine thoracolumbar spinal diseases, little is known about the historic trends in the choice of imaging technique for investigating thoracolumbar spinal cord diseases in dogs and whether this altered choice has affected prognosis. In Chapter III, I demonstrate that the choice of myelography or MRI as diagnostic imaging modality does not significantly affect either the grade or speed of recovery in dogs with thoracolumbar spinal cord diseases. I also describe that the historical trend has been for MRI to progressively replace other diagnostic imaging techniques for investigation of spinal cord diseases. The age and weight of the patient on presentation are two variables that are easy to obtain and could have an influence on the outcome of dogs with thoracolumbar spinal cord diseases. In chapter IV, I show that neither age nor weight of the patient at presentation affects the neurological recovery, and that there is no significant difference even when comparing extreme groups of age or weight. The neurological examination remains an indispensable tool to localise and grade lesions affecting the spinal cord and is essential for accurate planning and interpretation of diagnostic imaging techniques and formulating the prognosis. In Chapter V, I demonstrate that the presence of a cutaneous trunci reflex is useful in further localising the maximal level of spinal cord lesion within the T3 to L3 spinal cord segments to an accuracy of up to four vertebrae. In addition the cutaneous trunci reflex can be used to rapidly segregate dogs with an ambulatory paresis into less and more severely affected populations on the basis of clinical severity

Computer-assisted radiographic calculation of spinal curvature in brachycephalic "screw-Tailed" dog breeds with congenital thoracic vertebral malformations: reliability and clinical evaluation

The objectives of this study were: To investigate computer-assisted digital radiographic measurement of Cobb angles in dogs with congenital thoracic vertebral malformations, to determine its intra- and inter-observer reliability and its association with the presence of neurological deficits. Medical records were reviewed (2009–2013) to identify brachycephalic screw-tailed dog breeds with radiographic studies of the thoracic vertebral column and with at least one vertebral malformation present. Twenty-eight dogs were included in the study. The end vertebrae were defined as the cranial end plate of the vertebra cranial to the malformed vertebra and the caudal end plate of the vertebra caudal to the malformed vertebra. Three observers performed the measurements twice. Intraclass correlation coefficients were used to calculate the intra- and inter-observer reliabilities. The intraclass correlation coefficient was excellent for all intra- and inter-observer measurements using this method. There was a significant difference in the kyphotic Cobb angle between dogs with and without associated neurological deficits. The majority of dogs with neurological deficits had a kyphotic Cobb angle higher than 35°. No significant difference in the scoliotic Cobb angle was observed. We concluded that the computer assisted digital radiographic measurement of the Cobb angle for kyphosis and scoliosis is a valid, reproducible and reliable method to quantify the degree of spinal curvature in brachycephalic screw-tailed dog breeds with congenital thoracic vertebral malformations

Owner's perception of seizure detection devices in idiopathic epileptic dogs

Accurate knowledge of seizure frequency is key to optimising treatment. New methods for detecting epileptic seizures are currently investigated in humans, which rely on changes in biomarkers, also called seizure detection devices. Critical to device development, is understanding user needs and requirements. No information on this subject has been published in veterinary medicine. Many dog health collars are currently on the market, but none has proved to be a promising seizure detector. An online survey was created and consisted of 27 open, closed, and scaled questions divided over two parts: part one focused on general questions related to signalment and seizure semiology, the second part focused specifically on the use of seizure detection devices. Two hundred and thirty-one participants caring for a dog with idiopathic epilepsy, were included in the study. Open questions were coded using descriptive coding by two of the authors independently. Data was analysed using descriptive statistics and binary logistic regression. Our results showed that the unpredictability of seizures plays a major part in the management of canine epilepsy and dog owners have a strong desire to know when a seizure occurs. Nearly all dog owners made changes in their daily life, mainly focusing on intensifying supervision. Owners believed seizure detection devices would improve their dog's seizure management, including a better accuracy of seizure frequency and the ability to administer emergency drugs more readily. Owners that were already keeping track of their dog's seizures were 4.2 times more likely to show confidence in using seizure detection devices to manage their pet's seizures, highlighting the need for better monitoring systems. Our results show that there is a receptive market for wearable technology as a new management strategy in canine epilepsy and this topic should be further explored

ACADM Frameshift Variant in Cavalier King Charles Spaniels with Medium-Chain Acyl-CoA Dehydrogenase Deficiency

A 3-year-old, male neutered Cavalier King Charles Spaniel (CKCS) presented with complex focal seizures and prolonged lethargy. The aim of the study was to investigate the clinical signs, metabolic changes and underlying genetic defect. Blood and urine organic acid analysis revealed increased medium-chain fatty acids and together with the clinical findings suggested a diagnosis of medium-chain acyl-CoA dehydrogenase (MCAD) deficiency. We sequenced the genome of the affected dog and compared the data to 923 control genomes of different dog breeds. The ACADM gene encoding MCAD was considered the top functional candidate gene. The genetic analysis revealed a single homozygous private protein-changing variant in ACADM in the affected dog. This variant, XM_038541645.1:c.444_445delinsGTTAATTCTCAATATTGTCTAAGAATTATG, introduces a premature stop codon and is predicted to result in truncation of ~63% of the wild type MCAD open reading frame, XP_038397573.1:p.(Thr150Ilefs*6). Targeted genotyping of the variant in 162 additional CKCS revealed a variant allele frequency of 23.5% and twelve additional homozygous mutant dogs. The acylcarnitine C8/C12 ratio was elevated ~43.3 fold in homozygous mutant dogs as compared to homozygous wild type dogs. Based on available clinical and biochemical data together with current knowledge in humans, we propose the ACADM frameshift variant as causative variant for the MCAD deficiency with likely contribution to the neurological phenotype in the index case. Testing the CKCS breeding population for the identified ACADM variant is recommended to prevent the unintentional breeding of dogs with MCAD deficiency. Further prospective studies are warranted to assess the clinical consequences of this enzyme defect

Prevalence and clinical characteristics of phenobarbitone-associated adverse effects in epileptic cats

Objectives: The study objective was to investigate the prevalence and clinical characteristics of phenobarbitone-associated adverse effects in epileptic cats. Methods: The medical records of two veterinary referral clinics from 2007 to 2017 were searched for cats fulfilling the inclusion criteria of a diagnosis of epilepsy, treatment with phenobarbitone and available follow-up information on the occurrence of adverse effects. Follow-up information was obtained from the medical records of the primary veterinarian and referral institutions and a questionnaire completed by the cats’ owners. Results: Seventy-seven cats met the inclusion criteria. Fifty-eight were affected by idiopathic epilepsy and 19 by structural epilepsy. One or more of the following adverse effects were reported in 47% of the cats: sedation (89%); ataxia (53%); polyphagia (22%); polydipsia (6%); polyuria (6%); and anorexia (6%). Logistic regression analyses revealed significant associations between adverse effect occurrence and both phenobarbitone starting dosage and administration of a second antiepileptic drug (AED). For each 1 mg/kg q12h increment of phenobarbitone, the likelihood of adverse effects increased 3.1 times. When a second AED was used, the likelihood of adverse effects increased 3.2 times. No association was identified between epilepsy aetiology and adverse effect occurrence. An idiosyncratic adverse effect, characterised by severe neutropenia and granulocytic hypoplasia, was diagnosed in one cat. This resolved following phenobarbitone discontinuation. Conclusions and relevance: The prevalence of phenobarbitone-associated adverse effects was 47%. Sedation and ataxia were most common. These are type A adverse effects and are predictable from phenobarbitone’s known pharmacological properties. In the majority of cases, adverse effects occurred within the first month of treatment and were transient. Idiosyncratic (type B) adverse effects, which were not anticipated given the known properties of the drug, occurred in one cat. Increased phenobarbitone starting dosage and the addition of a second AED were significantly associated with the occurrence of adverse effects

A SCN9A variant in a family of mixed breed dogs with congenital insensitivity to pain

BACKGROUND Congenital insensitivity to pain (CIP) and hereditary sensory and autonomic neuropathies (HSANs) are a rare group of genetic disorders causing inability to feel pain. Three different associated variants have been identified in dogs: 1 in Border Collies, 1 in mixed breed dogs, and 1 in Spaniels and Pointers. OBJECTIVES To clinically and genetically characterize CIP in a family of mixed breed dogs. ANIMALS Two mixed breed dogs from the same litter were independently presented: 1 for evaluation of painless fractures, and the other for chronic thermal skin injuries. METHODS Physical, neurological, and histopathological evaluations were performed. Whole genome sequencing of 1 affected dog was used to identify homozygous protein-changing variants that were not present in 926 control genomes from diverse dog breeds. RESULTS Physical and neurological examinations showed the absence of superficial and deep pain perception in the entire body. Histopathological evaluations of the brain, spinal cord and sensory ganglia were normal. Whole genome sequencing identified a homozygous missense variant in SCN9A, XM_038584713.1:c.2761C>T or XP_038440641.1:(p.Arg921Cys). Both affected dogs were homozygous for the mutant allele, which was not detected in 926 dogs of different breeds. CONCLUSIONS AND CLINICAL IMPORTANCE We confirmed the diagnosis of CIP in a family of mixed breed dogs and identified a likely pathogenic variant in the SCN9A gene. The clinical signs observed in these dogs mimic those reported in humans with pathogenic SCN9A variants causing CIP. This report is the first of a spontaneous pathogenic SCN9A variant in domestic animals

Spongiform leucoencephalomyelopathy in border terriers: clinical, electrophysiological and imaging features

A novel spongiform leucoencephalomyelopathy was reported in border terrier puppies in 2012 causing a shaking puppy phenotype, but no information regarding clinical progression, imaging or electrophysiological findings were available. The aim of the present study was to describe the clinical, electrophysiological and MRI features of this disease in seven dogs and compare them with human white matter disorders. All cases presented with cerebellar ataxia and severe generalised coarse body tremors, which started at three weeks of age. The three cases that were not euthanased showed slow but progressive improvement over several months. Brainstem auditory evoked response demonstrated a normal wave I, reduced amplitude of wave II and an absence of waves III-VII. MRI revealed bilateral and symmetrical T2-weighted hyperintensities affecting the brainstem and cerebellar white matter. Histological examination of the brain and spinal cord showed spongiform change affecting the white matter of the cerebellum, brainstem and spinal cord with decreased myelin content. In summary, this leucoencephalomyelopathy has a pathognomonic clinical presentation with defining MRI and electrophysiological characteristics, and it is the first report to describe a long-term improvement of this condition