Veterinary Neurocritical Care Videos

SPINAL TRAUMA MANAGEMENT A couple of weeks ago we posted the diagnostic images of the case below: 8yo Collie cross that was found tetraplegic after a suspected accident in the woods. As in any acutely tetraplegic patient, blood gas analysis was included into initial assessment. Normal ventilation was then confirmed and since a vertebral fracture/subluxation was one of the differentials, the neck was immobilized externally with a brace prior to anesthesia and any further manipulation. CT and MRI of the cervical spine revealed a ventral fracture of C3 vertebral body, collapse of C3-4 intervertebral disc space and associated C3-4 traumatic disc extrusion. According to the three-compartment theory of assessment of spinal trauma (dorsal compartment: spinous processes and supporting ligamentous structures; articular processes, laminae and pedicles; middle compartment: dorsal longitudinal ligament, dorsal vertebral body and dorsal annulus of the disc; ventral compartment: rest of the vertebral body, lateral & ventral aspects of the annulus, the nucleus pulposus and the ventral longitudinal ligament); if 2 or more compartments are damaged, the fracture is considered unstable. Thus, as the ventral vertebral body of C3 was fractured and the dorsal annulus of C3-4 disc ruptured as a consequence of the traumatic herniation, decision was made to treat surgically by means of spinal fixation using threaded screws embedded in polymethylmethacrylate (PMMA). Despite of the severity of the presenting clinical signs and intramedullary changes seen on MRI, the dog made a prompt improvement, recovering ambulation in 12 days and doing as well as shown on the video 5 weeks down the line. Luis Bosch Roberto José-López

MRI FINDINGS & CLINICAL MANAGEMENT OF INTRACRANIAL HYPOVOLEMIA AFTER CRANIOTOMY IN A DOG This interesting report of our colleague Ana Cloquell describes the case of a dog that deteriorated neurologically after we did a transfrontal craniotomy to remove a large fronto-olfactory meningioma. Immediate postsurgical MRI revealed complete gross resection with no evidence of early-onset complications such as edema, hemorrhage, mass effect or pneumocephalus. However, diffuse symmetric meningeal thickening and contrast enhancement were noted. These MRI findings and clinical deterioration were suspected to be caused by intracranial hypovolemia following the large tumor removal and post-operative CSF rhinorrhea. The dog showed a gradual response to medical treatment consisting of bed rest, gabapentin, and intravenous theophylline and was discharged 15 days after surgery with only moderate proprioceptive ataxia (see video on his progression below). Intracranial hypovolemia or hypotension is a well-characterized syndrome in human medicine that results from abnormally low intracranial volume, commonly secondary to CSF leakage, and is associated with variable neurological signs and typical MRI abnormalities. This report provides a great summary of normal and early postoperative MRI changes after brain surgery as well as a detailed description of the pathophysiology of intracranial hypovolemia. Hope you find it useful! https://doi.org/10.1111/vsu.13586 Luis Bosch Roberto José-López

VENTILATORY FAILURE IN ACUTE IDIOPATHIC POLYRADICULONEURITIS The 3-year-old French Bulldog in the attached video presented as an emergency to the Neurology Service at the University of Glasgow Small Animal Hospital due to acute respiratory failure following a period of rapidly progressive non-ambulatory tetraparesis and generalized reduced muscle tone and spinal reflexes. Acute idiopathic polyradiculoneuritis (AIP) was suspected. Deep sedation and mechanical ventilation were required for a 40h period, after which the dog was successfully weaned off mechanical ventilation. Two earlier attempts to wean were unsuccessful due to ongoing intercostal muscular paresis and, hence, hypercapnia. Non-ambulatory tetraparesis progressively improved and the dog was discharged 10 days following admission. The initial emergency approach of an animal with severe, non-ambulatory lower motor neuron (LMN) tetraparesis should be centred on assessing respiration. AIP or coonhound paralysis is one of the most common causes of acute LMN tetraparesis in dogs and, although less common, can also be seen in cats. Most severely affected patients might develop respiratory paresis or paralysis caused by intercostal or phrenic nerve involvement. Thus, it is crucial to identify and address hypoventilation promptly in these cases. If supported appropriately, as in the case presented here, most animals recover over a period of 3 to 6 weeks. For further information: https://pubmed.ncbi.nlm.nih.gov/25441630/ https://bvajournals.onlinelibrary.wiley.com/doi/10.1002/vrc2.9 Enjoy! Luis Bosch Roberto José-López

IDIOPATHIC CANINE LARYNGEAL PARALYSIS AS A SIGN OF DIFFUSE POLYNEUROPATHY
IDIOPATHIC CANINE LARYNGEAL PARALYSIS AS A SIGN OF DIFFUSE POLYNEUROPATHY Very often we see old dogs presenting for acute respiratory distress with marked stridor. Many of these dogs usually have a history of progressive pelvic limb weakness and exercise intolerance that their owners attribute to advanced age. However, a potential underlying cause for this might be a diffuse polyneuropathy causing laryngeal paralysis. In the most complicated cases, patients might also present with respiratory distress due to acute events of aspiration pneumonitis/pneumonia. Clinical management might be tricky and those patients with exercise intolerance may benefit from surgery to resolve the obstructive problem. The ideal approach depends mostly on the individual patient but traditional surgical solutions are uni/bilateral arytenoid lateralization, partial laryngectomy or permanent tracheostomy. The retrospective study we bring you today focused on dogs >7 years of age with a diagnosis of idiopathic laryngeal paralysis. It describes the most common comorbidities, postoperative survival and complications. Overall, dogs that underwent surgical correction had increased odds of survival and their quality of life assessed by owners increased substantially. However, median survival time after surgery was 8.5 months. Risks of complications increased with age and neurological comorbidities such as esophageal dysfunction or pelvic limb abnormalities. The most frequent complication was aspiration pneumonia. Hope you enjoy the reading! https://pubmed.ncbi.nlm.nih.gov/26757180/ Luis Bosch Roberto José-López

HEPATIC ENCEPHALOPATHY IN DOGS AND CATS

cat with intracranial hypertension

Tranexamic acid for traumatic brain injury

Feline permethrin intoxication