Spinal decompression and stabilisation in a cat with lumbar vertebral pathological fracture and subluxation, following discospondylitis and spinal epidural empyema.

Case series summary: A 1-year-old castrated male Maine Coon cat was referred because of a 1-week history of progressive spastic non-ambulatory paraparesis. An MRI examination of the thoracolumbar spine showed multiple lytic lesions, with the most aggressive one centred on the adjacent endplates of L1-L2 and its associated disc. Ventral new bone formation, L1 vertebral body shortening and mild dorsal displacement of the caudal aspect of L1 were noted. Contrast enhancement of both paravertebral soft tissue and extradural lesion was present. These findings were compatible with L1-L2 discospondylitis (DS), spinal epidural empyema (SEE), with secondary L1 pathological vertebral fracture, subluxation and spinal cord compression. CT of the thoracolumbar spine, abdomen and thorax confirmed these findings. The patient deteriorated to paraplegia with absent nociception, despite initial medical therapy. A right-sided L1-L2 hemilaminectomy and spinal decompression were then performed, followed by application of a unilateral construct comprising four smooth arthrodesis wires and polymethylmethacrylate (PMMA). Staphylococcus aureus was isolated from both epidural material, intraoperatively sampled and blood culture. Antibiotic therapy was continued for 6 weeks, based on susceptibility results. The outcome was excellent, with a gradual improvement and complete neurological recovery at the 8-week postoperative check. Repeated spinal radiographs showed an intact apparatus and marked signs of vertebral fusion. At the 14-month follow-up examination, the cat remained free of clinical signs. Relevance and novel information: To the authors' knowledge, this is the first case report of SEE and DS in a cat that required surgical stabilisation. The outcome was still optimal, despite the rapid neurological deterioration.

Clinical features, treatment and outcome of discospondylitis in cats.

OBJECTIVES: There is a paucity of information on feline discospondylitis. This study aimed to describe the signalment, clinical and laboratory findings, aetiological agents, treatment and outcome in cats affected by discospondylitis. METHODS: This was a retrospective review of the medical records of cats diagnosed with discospondylitis at four referral institutions. RESULTS: A total of 17 cats were identified. Most were domestic shorthair cats (76.5%) and male (58.8%), with a median age of 9 years (range 0.9-14) and a median duration of clinical signs of 3 weeks (range 0.3-16). All cats presented with spinal hyperaesthesia; 3/17 had pyrexia. Neurological dysfunction was found in 64.7% of cats, which was indicative of a T3-L3 or L4-S2 spinal segment, associated nerve root or associated nerve neurolocalisation. Haematology, serum biochemistry and urinalysis revealed occasional inconsistent non-specific changes. All cats underwent urine culture; 9/17 cats also had a distinct tissue cultured. Positive bacterial cultures were obtained in two cats (11.8%) for Staphylococcus species (urine, blood and intradiscal fine-needle aspirate) and Escherichia coli (urine); both presented with multifocal discospondylitis. Treatment was non-surgical in all cats, with sustained antibiotic therapy for a median of 3 months (range 1-9). Analgesia provided included non-steroidal anti-inflammatory drugs, alone or in combination with gabapentin. Restricted exercise was advised for a minimum of 4 weeks. Outcome information available in 12 cats was excellent in terms of pain control and neurological function in 10 cats (83.3%) at the time of stopping antibiotics. Recurrence occurred in one case, which had received a single antibiotic for 6 weeks, and relapsed 4 months after presentation. One other case failed to improve and was euthanased during the course of hospitalisation. CONCLUSIONS AND RELEVANCE: Feline discospondylitis is uncommon and no obvious signalment predisposition was found in this study. Spinal hyperaesthesia was universally present, with neurological dysfunction also highly prevalent. Bacterial culture was unrewarding in most cases. Amoxicillin-clavulanic acid or cephalosporins are reasonable choices for first-line antibiotics. Prognosis was favourable, with no long-term evidence of recurrence in cats on sustained antibiotic therapy, for a mean duration of 3 months.

Imaging features of discospondylitis in cats.

OBJECTIVES: This study describes the imaging features of feline discospondylitis on MRI, comparing them with CT and radiographic findings where available. METHODS: The medical records of cats diagnosed with discospondylitis, presented to three referring institutions, were reviewed. MRI, CT and radiographic features were assessed by two of the authors independently. RESULTS: Fourteen sites of discospondylitis were retrospectively identified in 13 cats. The L7-S1 intervertebral disc space (IVDS) was affected in 7/14 (50%) cases. Characteristic MRI features included a hyperintense nucleus pulposus signal on T2-weighted (T2W) imaging (n = 10/14 [71%]) and short tau inversion recovery (STIR) imaging (n = 11/13 [85%]), with contrast enhancement in all (n = 11/11); involvement of adjacent vertebral endplates (n = 11/14 [79%]) and hyperintense neighbouring soft tissue on T2W (n = 11/14 [79%]) and STIR (n = 10/13 [77%]), with contrast enhancement in all (n = 11/11); and the presence of spondylosis deformans (n = 10/14 [71%]). Other features included narrowed or collapsed IVDS (n = 8/14 [57%]), contrast enhancement of vertebral bodies (n = 5/11 [46%]), epidural space involvement (n = 5/14 [36%]), compression of the spinal cord or nerve roots (n = 5/14 [36%]), paraspinal abscessation (n = 3/14 [21%]) and meningeal signal intensity abnormalities with contrast enhancement (n = 5/6 [83%]). These latter findings may indicate secondary focal meningitis. Radiographs were available covering five sites (in four cats) and CT covering three sites (in two cats). The most common radiological features were collapse or narrowing of the affected IVDS (80%) and endplate erosion (60%). No changes suggestive of discospondylitis were identifiable on radiography or CT in two sites (one cat), despite being identifiable on MRI. Repeated radiography in one case did not reveal complete radiological resolution following 9 months of treatment. CONCLUSIONS AND RELEVANCE: The results of this study indicate consistent MRI features of feline discospondylitis that should be considered in the diagnosis of this condition.

Extramedullary spinal cysts in dogs.

OBJECTIVE: To (1) synthesize the terminology used to classify extramedullary spinal cysts in dogs to clarify some of the commonly reported misconceptions, and (2) propose a classification scheme to limit confusion with terminology. STUDY DESIGN: Literature review. METHODS: An online bibliographic search was performed in January 2013 for articles relating to extramedullary spinal cysts in dogs using PubMed (http://www.pubmed.gov/) and Google Scholar (http://scholar.google.com/) databases. Only peer-reviewed clinical literature describing cystic lesions pertaining to the spinal cord and associated structures was included. RESULTS: From 1962 to 2013, 42 articles were identified; 25 (95 dogs) reported meningeal cysts, 10 (24 dogs) described 60 extradural cysts, 3 reports (18 dogs) described discal cysts or acute compressive hydrated nucleus pulposus extrusions (HNPE). Spinal cysts were categorized by location based on cross-sectional imaging as meningeal or extradural non-meningeal. Sub-classification was then performed based on surgical findings and pathology. Meningeal cysts included arachnoid diverticulae and Tarlov (perineural) cysts. Extradural non-meningeal cysts included intraspinal cysts of the vertebral joints, ligaments and discs. Discal cysts also fit this category and have been reported extensively in humans but appear rare in dogs. CONCLUSIONS: Extramedullary spinal cysts should be first classified according to location with a sub-classification according to pathologic and surgical findings. Previous canine cases of discal cysts appear to represent a different disease entity and the term acute compressive HNPE is therefore preferred.

Neurological manifestations of ear disease in dogs and cats.

There are four major neuroanatomical structures associated with the ear that, when damaged, result in different neurologic clinical signs. These structures are the facial nerve, the ocular sympathetic tract, the vestibular receptors, and the cochlea. The clinical signs associated with disorders of each structure are discussed, followed by a summary of the diseases that should be considered in each case. The article begins with a description of the neuroanatomy of each of these structures.

A canine BCAN microdeletion associated with episodic falling syndrome.

Episodic falling syndrome (EFS) is a canine paroxysmal hypertonicity disorder found in Cavalier King Charles spaniels. Episodes are triggered by exercise, stress or excitement and characterized by progressive hypertonicity throughout the thoracic and pelvic limbs, resulting in a characteristic 'deer-stalking' position and/or collapse. We used a genome-wide association strategy to map the EFS locus to a 3.48 Mb critical interval on canine chromosome 7. By prioritizing candidate genes on the basis of biological plausibility, we found that a 15.7 kb deletion in BCAN, encoding the brain-specific extracellular matrix proteoglycan brevican, is associated with EFS. This represents a compelling causal mutation for EFS, since brevican has an essential role in the formation of perineuronal nets governing synapse stability and nerve conduction velocity. Mapping of the deletion breakpoint enabled the development of Multiplex PCR and Multiplex Ligation-dependent Probe Amplification (MLPA) genotyping tests that can accurately distinguish normal, carrier and affected animals. Wider testing of a larger population of CKCS dogs without a history of EFS from the USA revealed that carriers are extremely common (12.9%). The development of molecular genetic tests for the EFS microdeletion will allow the implementation of directed breeding programs aimed at minimizing the number of animals with EFS and enable confirmatory diagnosis and pharmacotherapy of affected dogs.

Brain abscess in seven cats due to a bite wound: MRI findings, surgical management and outcome.

UNLABELLED: PRESENTATION AND LESION LOCALISATION: Seven adult domestic shorthair cats were presented with a 1- to 6-day history of progressive neurological signs. A focal skin puncture and subcutaneous swelling over the dorsal part of the head were detected on physical examination. Neurological examination indicated lesion(s) in the right forebrain in four cats, multifocal forebrain in one cat, left forebrain in one cat, and multifocal forebrain and brainstem in the remaining cat. In all cats, magnetic resonance imaging revealed a space-occupying forebrain lesion causing a severe mass effect on adjacent brain parenchyma. CLINICAL APPROACH AND OUTCOME: All cats were managed with a combination of medical and surgical treatment. At surgery a small penetrating calvarial fracture was detected in all cats, and a tooth fragment was found within the content of the abscess in two cats. The combination of surgical intervention, intensive care and intravenous antimicrobials led to a return to normal neurological function in five cats. PRACTICAL RELEVANCE: As this series of cases indicates, successful resolution of a brain abscess due to a bite injury depends on early recognition and combined used of antimicrobials and surgical intervention. A particular aim of surgery is to remove any skull and foreign body (tooth) fragments that may represent a continuing focus of infection.

Surgical technique, postoperative complications and outcome in 14 dogs treated for hydrocephalus by ventriculoperitoneal shunting.

OBJECTIVE: To report frequency and type of complications, and outcome in dogs with severe neurologic signs secondary to internal, suspected obstructive hydrocephalus treated by ventriculoperitoneal (VP) shunting. STUDY DESIGN: Case series. ANIMALS: Dogs (n=14). METHODS: Medical records (2001-2006) was reviewed for dogs that had VP shunting. Inclusion criteria were complete medical record, progressive forebrain signs unresponsive to medical treatment, normal metabolic profile, negative antibody titers and/or cerebrospinal PCR for Toxoplasma gondii, Neospora caninum, and canine distemper virus, magnetic resonance images of the brain, confirmed diagnosis of VP shunting, and follow-up information. RESULTS: Hydrocephalus was idiopathic in 5 dogs and acquired (interventricular tumors, intraventricular hemorrhage, inflammatory disease) in 9 dogs. Four dogs developed complications 1 week to 18 months postoperatively, including ventricular catheter migration, infection, shunt under-drainage, kinking of the peritoneal catheter, valve fracture, and abdominal skin necrosis. Three of these dogs had 1 or more successful revision surgeries and 1 dog was successfully treated with antibiotics. All, but 1 dog, were discharged within 1 week of surgery, and had substantial neurologic improvement. Median survival time for all dogs was 320 days (1-2340 days), for dogs with idiopathic hydrocephalus, 274 (60-420) days and for dogs with secondary hydrocephalus, 365 (1-2340) days. CONCLUSIONS: VP shunting was successful in relieving neurologic signs in most dogs and postoperative complications occurred in 29%, but were resolved medically or surgically.

Cerebrovascular disease in dogs and cats.

Cerebrovascular disease is defined as any abnormality of the brain resulting from a pathologic process affecting its blood supply. Stroke or cerebrovascular accident (CVA) is the most common clinical manifestation of cerebrovascular disease, and can be broadly divided into ischemic stroke and hemorrhagic stroke. Ischemic stroke results from occlusion of a cerebral blood vessel by a thrombus or embolism, depriving the brain of oxygen and glucose, whereas hemorrhagic stroke results from rupture of a blood vessel wall within the brain parenchyma or subarachnoid space. Previously considered uncommon, CVA is being recognized with greater frequency in veterinary medicine since magnetic resonance imaging has become more readily available. Once the diagnosis of ischemic or hemorrhagic stroke is confirmed, potential underlying causes should be sought after and treated accordingly.

Comparison of a method using the HemoCue near patient testing device with a standard method of haemorrhage estimation in dogs undergoing spinal surgery.

OBJECTIVE: To compare an estimate of blood loss obtained using measurements from the Hemocue photometer with a standard estimate in dogs undergoing spinal surgery. STUDY DESIGN: Prospective clinical study. ANIMALS: Twenty-nine client-owned dogs. METHODS: During surgery, blood and all lavage fluids were collected in the suction container and on to swabs. To prevent blood clot formation in the suction container, 10 mL citrate-phosphate dextrose adenine (CPDA) was added. At the end of the procedure, the total volume in the suction container was recorded. It was shaken to ensure uniformity and a 5 mL sample tested with the HemoCue photometer. Blood loss in the suction container was calculated as follows: Blood in suction (mL) = volume in bottle (mL) x [suction haemoglobin (Hb) concentration (g dL(-1))/pre-operative Hb concentration (g dL(-1))]. This volume was added to the estimated volume of blood on the swabs (weight of soaked swabs minus that of dry swabs) to provide the Hemocue estimate of total blood loss. A standard haemorrhage estimate was performed using the volume of fluid in the suction container at the end of surgery in excess of the total volume of lavage fluid available, minus 10 mL CPDA. This volume was added to the estimated volume of blood on the swabs to provide the standard estimate of total blood loss. Data were analyzed with a paired t-test. Retrospective power calculations demonstrated an 80% power to detect a mean difference of 25 mL between the two methods with a level of significance of 0.05. RESULTS: There was no significant difference in calculated blood loss between the two methods (p = 0.8, mean difference: -2 mL, 95% CI: -20 to 16 mL). CONCLUSIONS AND CLINICAL RELEVANCE: The HemoCue may be used to help estimate blood loss in dogs undergoing spinal surgery.

Magnetic resonance imaging features of spinal epidural empyema in five dogs.

Spinal epidural empyema is defined an accumulation of purulent material in the epidural space of the vertebral canal. Spinal epidural empyema should be considered as a differential diagnosis in dogs with pyrexia, spinal pain, and rapidly progressing myelopathy. Magnetic resonance (MR) imaging is the imaging test of choice in humans. Here, we describe the MR imaging features of five dogs with confirmed spinal epidural empyema. The epidural lesions appeared as high or mixed signal masses in T2-weighted (T2W) images. Increased signal within the spinal cord gray matter at the site of the lesion was detected in T2W images in all dogs. Two patterns of enhancement were detected on postcontrast T1-weighted (T1W) images. Mild to moderate peripheral enhancement was seen in three dogs and a diffuse pattern of enhancement was seen in one. Discospondylitis was identified in three dogs on T1W postcontrast images. Decompressive spinal surgery was performed in all dogs. Bacteria isolated from the abnormal epidural tissue were Enterobacter cloacae, coagulase-positive Staphylococci, Pasteurella multocida, and Escherichia coli. In one dog bacteria were not isolated. These MR imaging features, along with appropriate clinical signs, can allow prompt diagnosis and appropriate treatment planning.

Magnetic resonance imaging in the diagnosis of canine inflammatory myopathies in three dogs.

In humans affected with inflammatory myopathies, regions of altered signal intensity are found on magnetic resonance (MR) images of affected muscles. Although electromyography (EMG) is more practical for muscle disease evaluation, and a muscle biopsy is the only manner in which a definitive diagnosis can be made, MR imaging has proven useful if a specific anatomic localization is difficult to achieve. Three dogs with focal inflammatory myopathy diagnosed with the assistance of MR imaging are discussed and the findings are compared with those found in humans. MR images of the affected muscles in each dog were characterized by diffuse and poorly marginated abnormal signal on T1- and T2-weighted images. Marked enhancement was noted in these muscles after contrast medium administration. An inflammatory myopathy was confirmed histologically in all three dogs. A good association existed between the MR images and muscle inflammation identified histopathologically. MR imaging may be a useful adjunctive procedure for canine inflammatory myopathies.

Intramedullary intervertebral disk extrusion in a cat.

Intervertebral disk extrusion is rarely reported in the cat. In this case, the clinical, radiologic, and magnetic resonance imaging findings of an acute intramedullary intervertebral disk extrusion in a 5-year-old domestic shorthaired cat are described. Radiographically, there was mineralized disk material within the vertebral canal. On magnetic resonance images, the disk material was found to be within the spinal cord. A linear disk trail extending from the disk space into the spinal cord may be specific for intramedullary disk extrusion.

Imaging of a spinal nephroblastoma in a dog.

An 8-month-old German Shepherd dog was presented for investigation of pelvic limb gait abnormality. Neurolocalization indicated a T3-L3 spinal cord lesion. The myelographic appearance was of an intramedullary lesion at T9/10, but upon subsequent magnetic resonance imaging it was determined that the mass was extramedullary. A diagnosis of nephroblastoma was made on histological examination. The imaging features of this rare tumor and the differentiation of intradural-extramedullary and intramedullary masses are discussed.

Review of diagnostic imaging of ear diseases in the dog and cat.

Diagnostic imaging techniques (conventional radiography, computed tomography and magnetic resonance imaging) are an essential tool in the diagnostic work-up of ear diseases. Conventional radiography is commonly used, but often lacks sensitivity. Computed tomography (CT) and magnetic resonance (MR) are complementary imaging studies of the middle ear, labyrinth, internal auditory canal and their contents. CT provides excellent images of bony structures and is indicated where osseous changes are of greatest diagnostic importance. MR is superior in imaging soft tissue components including intralabyrinthine fluid. Therefore, more than one of these imaging techniques may be required in order to make a diagnosis.