Feline vestibular disorders. Part II: diagnostic approach and differential diagnosis

Results of a neurological examination usually permit localisation of a vestibular disorder to either the central or peripheral parts of the vestibular system. Many different disorders located in the same part of the vestibular system will produce similar clinical signs. Therefore, additional diagnostic tests beyond a neurological examination are required in order to make an accurate diagnosis. The objectives of this review are to outline a diagnostic approach for disorders affecting the feline vestibular system, and to summarise the clinically important features of frequently diagnosed diseases affecting the vestibular system of cats.     

Cerebral phaeohyphomycosis caused by Cladosporium spp. in two domestic shorthair cats

Two domestic shorthair cats presented for clinical signs related to multifocal central nervous system dysfunction. Both cats had signs of vestibular system involvement and anisocoria, and one had generalized seizure activity. Cerebrospinal fluid analysis revealed a neutrophilic pleocytosis with protein elevation in one cat and pyogranulomatous inflammation in the second. Electroencephalography and brain-stem auditory-evoked potentials in the first cat confirmed cerebral cortical and brain-stem involvement. Euthanasia was performed in both cats, and postmortem diagnoses of phaeohyphomycosis secondary to Cladosporium spp. were made based on histopathology and fungal culture in both cats.     

Review of idiopathic feline vestibular syndrome in 75 cats

Idiopathic feline vestibular syndrome, a peripheral vestibular deficit of unknown cause, was diagnosed in 75 cats at the New York State College of Veterinary Medicine Teaching Hospital from July 1975 to October 1984. Review of the medical records of these cats indicated that the syndrome was seen in more cats in July and August (P less than 0.001) than in other months. Clinical signs included head tilt, ataxia, rolling, rotatory or horizontal nystagmus, and occasional vomiting.     

Cognitive dysfunction in cats: a syndrome we used to dismiss as 'old age'

PRACTICAL RELEVANCE: Cognitive dysfunction syndrome (CDS) is a widely accepted diagnosis in dogs, with established treatment options. In cats, however, our understanding of cognitive dysfunction is still being shaped by ongoing research in the field, and limited treatment options are available. Recent clinical studies indicate that old age in the cat is accompanied by increased behavioural signs such as wandering, vocalization and night-time activity that are not attributable to identifiable medical problems. It is essential, therefore, that veterinarians include behavioural well-being in the routine care of senior cats. PATIENT GROUP: While the exact age of onset is not established, studies suggest that age-related behavioural changes consistent with cognitive dysfunction are prevalent in cats as early as 10 years of age and that prevalence increases significantly in older cats. CLINICAL CHALLENGES: The diagnosis of cognitive dysfunction requires the identification of geriatric behavioural changes that are not caused by other medical problems, although the two may not be mutually exclusive. Therefore, the practitioner must rely heavily on owner reports and history to ensure prompt diagnosis and treatment. The absence of any approved dietary or pharmaceutical interventions for cognitive dysfunction adds a further challenge, although several possibilities exist. EVIDENCE BASE: This article draws on recent research that has produced neuropathological, cognitive and behavioural evidence for cognitive dysfunction in aging cats. As an impetus to further our understanding of this disease and potential treatment options, the authors propose a behavioural checklist that might aid in the clinical diagnosis of feline CDS and discuss treatment options that have proven successful in the canine counterpart of this disease.     

Experimental transmission of Cytauxzoon felis from bobcats (Lynx rufus) to domestic cats (Felis domesticus)

Freshly collected blood and/or spleen homogenate from an experimentally infected Florida bobcat (Lynx rufus floridanus), which had died of feline cytauxzoonosis, was inoculated into domestic cats. All inoculated cats had clinical signs of feline cytauxzoonosis and died within 2 weeks after they were inoculated. Similar material collected from an eastern bobcat (Lynx rufus rufus) carrying an experimentally infected Cytauxzoon felis parasitemia was inoculated into domestic cats. All inoculated cats developed a parasitemia, but none developed clinical signs of disease and none died of the disease. Cats subinoculated with parasitemic cat blood also developed parasitemias and they too did not develop clinical signs of infection nor died. After carrying the blood phase of Cytauxzoon felis for various periods, the domestic cats were then challenge exposed with proven lethal Cytauxzoon inoculum of domestic cat origin. All cats died of cytauxzoonosis.     

CNS disease in the cat: current knowledge of infectious causes

PRACTICAL RELEVANCE: Neurological disease is a relatively common reason for referral, constituting approximately 10% of the feline referral caseload. Nearly one-third to one-half of these cases may be infectious in origin. As such, an awareness of infectious diseases causing central nervous system (CNS) signs in cats, and their clinical diagnosis and management, is relevant to anyone dealing with cats on a regular basis. GLOBAL IMPORTANCE: Some conditions (eg, rabies) are more common in certain countries than others. Conditions such as feline infectious peritonitis (FIP) and toxoplasmosis are of global significance. PATIENT GROUP: Many infectious diseases may affect any feline population. Some, such as FIP, are more common in pedigree households, whereas others such as toxoplasmosis, feline immunodeficiency virus (FIV) or feline leukaemia virus (FeLV) infections, are more likely to affect a single cat with an outdoor lifestyle. EQUIPMENT: All patients benefit from thorough history taking and clinical, neurological and ophthalmic examinations, which all require minimal equipment. Infectious diseases may often be diagnosed on blood samples; however, definitive diagnosis may require more extensive investigation involving cerebrospinal fluid analysis or advanced imaging necessitating access to computed tomography or magnetic resonance imaging. EVIDENCE BASE: The information in this review, which summarises current knowledge of infectious diseases affecting the CNS, is collated from publications on the infectious diseases comprising previous research papers, review articles, case series, case reports and textbooks, supplemented by the clinical experience of the authors.     

Feline spongiform encephalopathy: fibril and PrP studies.

The brains from 18 cats were examined for the presence of the fibrils and modified PrP protein which are molecular diagnostic markers for scrapie-like diseases. Thirteen cats were referred with clinical neurological signs potentially indicative of feline spongiform encephalopathy (FSE). Of these, five had histopathological changes of FSE, five had other lesions of the central nervous system, and in three the brain was normal. The remaining five cats had no clinical neurological signs and were selected as controls. Fibrils and modified PrP protein were found in the brains of the five cats with FSE and in one of the cats with neurological signs but no histopathological changes in the central nervous system. Fibrils were present in the absence of modified PrP in the brains of two cats, one with neurological signs and a histologically confirmed meningioma, and one with no neurological signs and a histologically normal brain.     

Humoral immunity in cats infected with feline immunodeficiency virus or leukaemia virus

The humoral antibody responses of 82 domestic cats to the common commensal bacteria Pasteurella multocida and Staphylococcus aureus were measured by an indirect immunofluorescence assay to give a subjective quantification of specific IgG in serum. There was no significant difference in specific serum IgG levels between sick cats which tested antibody-positive to feline immunodeficiency virus or antigen-positive to feline leukaemia virus and sick, virus-negative cats. This finding suggested that there was no change in immune status, as measured by this method, in both feline leukemia and feline immunodeficiency virus infections, although, based on clinical signs shown by the virus-positive cats, overall immunosuppression was indicated. Feline immunodeficiency virus and feline leukemia virus infection may have an effect on cellular immunity, as is the case with human immunodeficiency virus.     

Clinical, hematologic, and survival data from cats infected with feline immunodeficiency virus: 42 cases (1983-1988).

A retrospective study of stored feline serum samples was done to determine the infection rate of feline immunodeficiency virus in cats in central Missouri. Infected cats were compared with uninfected cats subjected to the same selection criteria on the basis of signalment, clinical signs, and CBC abnormalities. A significant incidence of virus infection was found in male cats. Neither age nor breed predilection could be identified. Infected cats were more likely to be anemic and leukopenic because of neutropenia. Cellulitis and neoplasia were more common in infected cats. A spectrum of disease severity was seen in infected cats ranging from no clinical signs to signs of severe chronic inflammatory disease. Infected cats were more likely to have clinical disease. Mean survival of infected cats was 24.4 months from the time of diagnosis.     

Feline dysautonomia in the Midwestern United States: a retrospective study of nine cases

Dysautonomia of domestic animals is pathologically characterized by chromatolytic degeneration of the neurons in the autonomic nervous ganglia that results in clinical signs related to dysfunction or failure of the sympathetic and parasympathetic nervous systems. The exact cause is unknown. It has a poor prognosis among all species reported and no definitive treatment is available currently. To date, most reported feline cases have occurred in the United Kingdom and Scandinavia. The cases reported here highlight the clinical signs, physical examination findings, and results of autonomic nervous system function testing in nine cats with dysautonomia in the US. Feline dysautonomia is uncommon in the US, but may have a regional prevalence, as is seen in dogs with most cases reported in Missouri and Kansas.     

Feline heart disease: An update

Heart disease is relatively common in cats and our understanding of feline cardiomyopathy has improved considerably over the last two decades, in part as a result of the improved sophistication of non-invasive diagnostic techniques. The incidence of feline dilated cardiomyopathy has declined markedly since the discovery of taurine deficiency as an aetiological factor and subsequent modification of commercial diets. Hypertrophic cardiomyopathy now seems to be the commonest primary form and is characterised by unexplained left ventricular hypertrophy and diastolic dysfunction. Intermediate forms of cardiomyopathy are also recognised. Secondary cardiomyopathies are common; examples of causes include hyperthyroidism, systemic hypertension and acromegaly. Congenital cardiac disease is also well recognised and may lead to clinical signs even late in life.     

Feline adrenal disorders

Although only recently discovered, feline adrenal disorders are becoming increasingly more recognized. Feline adrenal disorders include diseases such as hyperadrenocorticism (Cushing's syndrome) and hyperaldosteronism (Conn's syndrome). The clinical signs of feline hyperadrenocorticism, which include unregulated diabetes mellitus and severe skin atrophy, are unique to the cat. Other signs of feline hyperadrenocorticism, such as potbellied appearance, polydipsia, polyuria, and susceptibility to infections are also seen in dogs with hyperadrenocorticism. Conn's syndrome has only recently been described in the cat and is in fact more common in cats than in dogs. Characterized by severe hypokalemia, hypertension, and muscle weakness, Conn's syndrome may be misdiagnosed as renal failure. The clinician should become familiar with the clinical signs of adrenal disorders in cats and the common diagnostic tests used to diagnose these syndromes in cats as they differ from those in the dog. Treatment of feline adrenal disorders may be challenging; the clinician should become familiar with common drugs used to treat adrenal disorders in cats.     

Retrospective study of 60 cases of feline lymphosarcoma

Objective To characterise epidemiological and clinical findings, and diagnostic procedures undertaken, in cats with lymphosarcoma at a veterinary teaching hospital.
Design Retrospective case study.
Procedure Hospital records were reviewed for 7159 cats, sick or healthy, examined during a 10-year period (1984 to 1994). Sixty cats with lymphosarcoma were identified and classified by anatomical location of the tumour. Data on breed, age, sex, clinical signs and diagnostic procedures were collated.
Results The prevalence of feline lymphosarcoma in the hospital population was 0.84%. Siamese cats appeared predisposed to lymphosarcoma but other purebreds were not. Males were somewhat overrepresented amongst affected cats. Similar numbers of cases (12 to 18) were seen in each of the four anatomic categories (multicentric, mediastinal, alimentary and extranodal). Cats with mediastinal lymphosarcoma were mostly young and Siamese. Clinical signs in affected cats were varied, usually multiple and often nonspecific. Two of 22 cases tested positive for feline leukaemia virus antigen in blood and 6 of 13 were positive for feline immunodeficiency virus antibody.
Conclusions Extranodal lymphosarcoma seemed more prevalent in this study than reported elsewhere. Siamese cats in the study population may have had a genetic predisposition to lymphosarcoma. Limited evidence suggested feline leukaemia virus may be less important, and feline immunodeficiency virus more important, in the local population than indicated in overseas reports. Additional studies are needed to investigate breed predisposition and feline leukaemia virus and feline immunodeficiency virus status in Australian cats with lymphosarcoma.     

Surgical cytoreduction for the treatment of non-lymphoid vertebral and spinal cord neoplasms in cats: retrospective evaluation of 26 cases (1990–2005)

Medical records of 26 cats with non‐lymphoid vertebral and spinal cord neoplasms treated surgically were reviewed to determine outcome and prognostic factors for survival. Of the factors examined, only tumour phenotype was significantly associated with survival. Osteosarcoma (3/26 cats) and meningioma (16/26 cats) were the most common malignant and benign tumours, respectively. The median survival time for cats with malignant neoplasms was 110.5 days, compared with 518 days for cats with benign tumours. Cytoreductive surgery resulted in clinical improvement in 25/26 cats, but local treatment failure occurred in 10/26 cats. Overall, 19/26 cats died of confirmed (12/19) or suspected (7/19) tumour‐related causes, including all eight cats with malignant neoplasms. Results suggest that contemporary neurosurgical techniques commonly result in incomplete excision of feline non‐lymphoid vertebral and spinal cord tumours but are efficacious at palliation of clinical signs of spinal cord dysfunction.     

Feline glaucoma--a comprehensive review

Cats with glaucoma typically present late in the course of disease. It is likely that glaucoma in cats is under-diagnosed due to its insidious onset and gradual progression, as well as limitations of some commonly used tonometers in this species. Treatment of glaucoma in feline patients presents a clinical challenge, particularly as glaucoma is often secondary to other disease processes in cats. In this review, we consider the clinical features, pathophysiology, and classification of the feline glaucomas and provide current evidence to direct selection of appropriate treatment strategies for feline glaucoma patients.     

Clinical Feline Toxoplasmosis

Clinical toxoplasmosis was diagnosed in 15 cats by correlating serologic evidence of infection and clinical signs to either response to therapy or histopathologic demonstration of the organism. Ophthalmic manifestations, primarily involving the anterior segment, were common. Other common physical examination abnormalities included muscle hyperesthesia, fever, and weight loss. Response to therapy was variable, but administration of clindamycin hydrochloride resulted in resolution of all clinical signs not involving the eyes in surviving animals. This drug, alone or in combination with corticosteroids, led to total resolution of clinical signs in four of four cats with active retinochoroiditis and in six of nine cats with anterior uveitis. Four of the 15 cats had concurrent infection with feline immunodeficiency virus (FIV). Feline leukemia virus antigen or antibodies to feline infectious peritonitis virus were not detected.     

Therapeutic effects of recombinant feline interferon-omega on feline leukemia virus (FeLV)-infected and FeLV/feline immunodeficiency virus (FIV)-coinfected symptomatic cats

The clinical efficacy of a recombinant feline interferon, rFeIFN-omega, was evaluated for the treatment of cats presented with clinical signs associated with feline leukemia virus (FeLV) infection and FeLV/feline immunodeficiency virus (FIV) coinfection in the field. In this multicentric, double-blind, placebo-controlled trial, 81 cats meeting the inclusion criteria were randomly placed into 2 groups and treated subcutaneously with rFelFN-omega (1 million [M]U/kg per day) or placebo once daily for 5 consecutive days in 3 series (day 0, 14, 60). The cats were monitored for up to 1 year for clinical signs and mortality. During the initial 4-month period, interferon (IFN)-treated cats (n = 39) had significantly reduced clinical scores compared with placebo (n = 42), with all cats having received concomitant supportive therapies. Compared with the control, the IFN-treated group showed significantly lower rates of mortality: 39% versus 59% (1.7-fold higher risk of death for controls) at the 9-month time point and 47% versus 59% (1.4-fold higher risk of death for controls) at the 12-month time point. The IFN treatment was associated with minor but consistent improvement in abnormal hematologic parameters (red blood cell count, packed cell volume, and white blood cell count), apparently underlying the positive effects of IFN on clinical parameters. These data demonstrate that rFeIFN-omega initially has statistically significant therapeutic effects on clinical signs and later on survival of cats with clinical signs associated with FeLV infection and FeLV/FIV coinfection.     

Facial neuropathy in dogs and cats: 95 cases (1975-1985)

The medical records of 79 dogs and 16 cats admitted to the New York State College of Veterinary Medicine between January 1975 and October 1985 with facial nerve dysfunction were reviewed. In 31 dogs and 8 cats, facial neuropathy was the only abnormal finding. In 48 dogs and 8 cats, the clinical findings most often noted in the records in addition to facial neuropathy were vestibular signs. Facial neuropathy appeared unassociated with gender or right vs left sides in both dogs and cats, or with hypothyroidism in dogs. Facial neuropathy was associated with increased age, with certain breeds in both dogs and cats, and with otitis media/interna and keratoconjunctivitis sicca in dogs. Causes of facial nerve dysfunction in dogs and cats included surgical and nonsurgical trauma, neoplasia, and otitis media/interna. Facial neuropathy was judged to be idiopathic in 74.7% of dogs and 25% of cats.