Computed tomographic and magnetic resonance imaging of a coup contrecoup traumatic brain injury in a horse

A 3-year-old Thoroughbred mare found recumbent in the field was referred for further assessment with suspicion of a skull fracture. Neurological examination identified compulsive tight circling to the left, and hypermetria in all four limbs. The mare was obtunded, with a mild head tilt to the right, absent menace response of the right eye and decreased facial sensation on the right. Standing computed tomographic examination revealed a subtle depression fracture of the dorsal calvarium and moderate intra-axial midline shift consistent with a traumatic brain injury (TBI). Despite supportive treatment, the mare deteriorated and was subjected to euthanasia. Post-mortem high field magnetic resonance imaging revealed findings consistent with a small cerebral contusion adjacent to the fracture site, and moderate to severe ipsilateral cerebral oedema within the caudal cerebrum and rostral brainstem, consistent with a coup contrecoup TBI. Brainstem lesions indicate a poor prognosis and support the decision for euthanasia. This is the first report of the imaging findings of a coup contrecoup TBI in a horse.     

Standing removal of the proximal aspect of an olecranon fracture in a mature horse

A 12‐year‐old 450 kg Argentine polo mare presented with a dropped elbow and an unwillingness to bear weight after being kicked by another horse on the lateral aspect of the upper left forelimb. The mare was subsequently diagnosed with a displaced olecranon fracture that did not readily conform to the standard classification systems. Referral for surgical treatment involving open reduction and internal fixation was declined due to financial constraints. Due to the mare being unsuitable for breeding, and conservative treatment of displaced olecranon fractures being deemed to have an overall poor prognosis for return to full athletic performance, another treatment option was sought. Given the fracture configuration, standing surgical removal of the large proximal fragment was performed. The mare returned to full athletic performance 12 months post operatively without lameness. This case report describes an alternative treatment option for selected olecranon fractures.     

Keratoconjunctivitis sicca associated with fracture of the stylohyoid bone in a horse

Keratoconjunctivitis sicca developed in a mare with fracture of the stylohyoid bone. Treatment was directed at preserving the health of the globe while local inflammation at the fracture site was resolved.     

Use of a dynamic compression plate and a cable cerclage system for repair of a fracture of the radius in a horse

A pregnant 9-year-old Peruvian Paso mare was evaluated because of a fracture involving the left radius. On examination, grade IV/V lameness of the left forelimb was observed; radiography of the limb revealed a longitudinal oblique displaced fracture that extended from the caudal cortex of the radial mid-diaphysis into the humeroradial joint. To minimize the development of degenerative joint disease in the humeroradial joint, repair with internal fixation was recommended. A dynamic compression plate was applied to the cranial aspect of the radius; three 2-mm stainless steel cable cerclages were positioned around the mid- and proximal diaphysis. The horse was maintained in a sling for 8 to 12 hours daily for 3 weeks after surgery. Five months after surgery, the mare had foaled without complications, and grade I/V lameness during trotting only was observed. The combination of 1 dynamic compression plate and cable cerclage may provide satisfactory stabilization of this type of fracture in small to medium-sized horses.     

Successful closed reduction of an atlantoaxial luxation in a mature Warmblood horse

A 5‐year‐old Warmblood mare was presented to the clinic 8 h after being found by the owners with luxation of the second cervical vertebra. Clinically, the horse showed an extended posture and reduced movement of the head and neck. A defined lateral swelling of the neck at the level of the first cervical vertebrae was evident. Successful reduction was achieved with the horse under general anaesthesia in lateral recumbency using an electrically powered hand pallet truck. The mare showed no neurological disorders before or after reduction. Seven months after the incident the mare could be ridden and exhibited no functional abnormalities relating to the neck.     

Bad behavior or a physical problem? Rearing in a Dutch Warmblood mare

Behavior problems in horses are often thought to be due to the horse’s bad attitude, which commonly results in them being punished. However, when these cases are carefully worked up, there may be an underlying physical problem, and pain may play an important role. A 5-year-old Dutch Warmblood mare was presented for rearing and flipping over backward. The mare had been repeatedly examined by an equine veterinarian and a nonveterinarian equine dentist who found no abnormalities. Several different bits were tried, and side reins were used to keep her head down. The mare was whipped every time she reared. None of these measures helped. On presentation to our equine teaching hospital, no abnormalities were detected on routine physical examination. The behavior was observed when the mare was lunged; as soon as a small amount of tension was put on the lunge rein, the mare shook her head horizontally for approximately 1-2 seconds, reared, and flipped over onto her back. Neurological examination revealed that the mare was slow to resume a normal stance when her hind legs were placed in an abnormal position. Dental examination and endoscopy of the upper airways proved unremarkable. Radiography of the atlanto-occipital joint area revealed fractures of the first and second cervical vertebrae and fracture fragments, which are both suggestive for the presence of cervical instability and the possible presence of spinal cord compression. These suggestions were further supported by identification of delayed postural reflexes during neurological examination. The mare was deemed unfit for dressage and was successfully kept for breeding. Horses are frequently punished for “bad behavior.” These behaviors are frequently due to underlying physical problems and not a “nasty” horse. This case highlights the importance of careful history taking and a thorough veterinary examination with the use of further diagnostics (if necessary) when dealing with equine behavior problems.     

Standing repair of a proximal,incomplete, articular fracture of the third metatarsal bone

A 5-year-old National Hunt Thoroughbred mare presented with sudden onset left hindlimb lameness after race training on the gallops. Clinical examination revealed a marked painful reaction over the proximal metatarsal region but no other obvious abnormalities were detected. Survey radiographs at the yard did not reveal any abnormalities. Nuclear scintigraphic examination 3 days after injury revealed focal marked increased radiopharmaceutical uptake in the proximal metatarsal region. Subsequent radiography revealed an incomplete, articular fracture of the proximal left third metatarsal bone. Repair of the fracture using 3 × 4.5 mm cortical screws placed in lag fashion was performed under standing sedation following perineural analgesia. Follow-up radiographs demonstrated progressive healing of the fracture. The mare returned to race training 8 months after the fracture was repaired and raced successfully 12 months post injury.     

Conservative management of comminuted central tarsal bone fracture and joint instability in a horse

A comminuted fracture of the central tarsal bone, fragmentation of the fourth tarsal bone and associated joint instability was diagnosed in a 14‐year‐old Sport Horse mare who presented for investigation of acute nonweightbearing hindlimb lameness. The mare responded well to conservative management and, unlike previously reported cases of similar injuries, returned to a similar level of athletic activity.     

Neurological signs in a horse due to metastases of an intestinal adenocarcinoma

A 22-year-old Dutch Warmblood mare was referred to Utrecht University with progressive left hind limb paresis and hyporeflexia. The preliminary clinical diagnosis was the neurological form of equine herpes virus (EHV-1) infection. Within 1 day of admission, the mare became recumbent and deteriorated rapidly. Postmortem examination revealed an adenocarcinoma of the caecum, with metastases in all regional lymph nodes and extending from the lumbar nodes into the vertebral canal, causing spinal cord compression and destruction of the left 4th and 5th lumbar nerves.     

Halicephalobus gingivalis encephalomyelitis in a horse

An 8-year-old, Arabian mare presented with acute progressive ataxia and a firm swelling over the right mandible. Radiographs revealed multiple radiolucent areas on the mandibles. The mare's neurological signs progressed, she was consequently euthanized. Postmortem examination revealed mandibular granulomatous reactions and meningoencephalitis due to the nematode Halicephalobus gingivalis.     

Schiff-Sherrington syndrome in a 7-year-old zebra mare (Equus quagga)

A 7-year-old plains zebra (Equus quagga) mare was presented to the Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Germany as an emergency. The owner reported that the mare was unable to stand after a suspected traumatic episode at the home yard. The mare was transported in lateral recumbency in a trailer. Clinical examination revealed tachycardia (up to 102 beats/min), tachypnoea (28 breaths/min), mild fever (38.7°C) and clinical dehydration with elastic skin and dry and red mucous membranes. Neurological examination showed paraplegia with complete loss of nociception of the mid-thoracic region and caudal to it. In contrast, examination of the thoracic limbs revealed marked extensor rigidity and hyperaesthesia resulting in an enhanced acute response to minimal touch of the neck and shoulder region. Lateral radiographs of the thoracic vertebral column led to the diagnosis of a complete fracture of the vertebral body of the 7th thoracic (T) vertebra with suspected traumatic compression of the spinal cord. Post-mortem examination confirmed the diagnosis. Gross pathology revealed a complete comminuted fracture of T7 with marked compression of the spinal cord. This is the first report describing the clinical, radiological and pathological findings of a fracture of a thoracic vertebra leading to a Schiff-Sherrington syndrome in a zebra (Equus quagga).     

Successful treatment of a horse with presumed parasitic encephalitis

Verminous myeloencephalitis is a rare, but predominately fatal, cause of neurological disease in horses. A 6‐year‐old mare was admitted to the Royal Veterinary College Equine Referral Hospital following acute onset of depression, central unilateral blindness and compromised vision in the opposite eye. Based on pronounced eosinophilic inflammation detected in the cerebrospinal fluid (CSF) and diagnostic imaging findings indicating a space‐occupying lesion within the brain, a presumptive diagnosis of aberrant parasitic migration causing parasitic encephalitis was made. Treatment consisted of anti‐inflammatories and high doses of an anthelmintic. The horse's condition improved, the neurological deficits and observed space‐occupying lesion within the brain resolved completely and the mare returned to full work. To the authors’ knowledge, this is the first report describing complete recovery from suspected aberrant parasite migration in the CNS and will hopefully encourage treatment of suspected cases in the future.     

Standing low‐field magnetic resonance imaging of a comminuted central tarsal bone fracture in a horse

This report describes the use of low‐field standing magnetic resonance imaging (MRI) in the diagnosis and clinical decision making process in a 14‐year‐old Dutch Warmblood mare with a comminuted central tarsal bone fracture. Magnetic resonance imaging in the standing horse was preferred over computed tomography examination under general anaesthesia because the animal had sustained the injury during a poor recovery from a previous general anaesthetic episode. Magnetic resonance imaging examination identified a comminuted central tarsal bone fracture with a configuration that was not identifiable with radiography. Due to extensive comminution of this fracture, conservative management was pursued. Standing low‐field MRI examination enabled safe examination of this animal and provided useful diagnostic information whilst facilitating the clinical decision making process.     

Pathological fracture through a subchondral bone cyst in the proximal phalanx of a horse

A 12‐year‐old Morgan broodmare presented for a nonweightbearing right forelimb lameness. Radiography and computed tomography confirmed the presence of a pathological fracture of the proximal first phalanx through a large subchondral bone cyst (SBC) in the right forelimb and a large SBC in the proximal first phalanx of the left forelimb. Surgical repair of the large palmar medial eminence fracture of the proximal first phalanx fracture was performed using bone screws placed in lag fashion placed through stab incisions after debridement and bone grafting of the SBCs. Approximately 6 months after surgery the mare was ambulating comfortably at pasture. This case report describes a fracture through a large subchondral bone cyst in a horse despite chronicity and ongoing bone remodelling. Careful consideration regarding exercise or use should be considered in horses with large SBCs.     

Birth of live triplets in a mare

An 11‐year‐old American Buckskin mare gave birth to live triplets unattended at approximately 300 days gestation. All foals were small and dysmature, requiring intensive care. The smallest foal died 4 days after admission, the second was subjected to euthanasia 24 days after admission due to poor healing of a third metatarsal fracture. The remaining foal survived to discharge and was considered small but otherwise normal at age one year.     

Uterine rupture as a postpartum complication in two mares

Uterine rupture was diagnosed in 2 postpartum mares with hemorrhagic vaginal discharge. Both mares had abdominal pain, as evidenced by pawing, kicking at the abdomen, or attempting to roll. Peritoneal fluid analysis was useful in establishing a diagnosis. One mare had many RBC in the peritoneal fluid and was anemic; this mare was managed medically with oxytocin, antibiotics, and blood transfusion. The mare was able to raise her foal to weaning age. The second mare had many RBC, degenerate neutrophils, and intracellular and extracellular bacteria in peritoneal fluid. Surgical repair of the uterus was performed, and the mare was treated for peritonitis. The mare later became pregnant.     

Disseminated cryptococcosis including osteomyelitis in a horse

A 4-year-old Arab mare was diagnosed with disseminated cryptococcosis, including osteomyelitis of the proximal phalanx of the left hind limb, osteomyelitis with associated soft tissue granuloma of a rib and disseminated, large cryptococcal nodules in the lungs. The lesion in the dorsoproximal aspect of the proximal phalanx had a large area of cortical lysis with spiculated periosteal new bone and extensive soft tissue swelling. The affected rib had a pathological fracture. Cryptococcal osteomyelitis has not been previously reported in horses but should be considered as a differential diagnosis, particularly in endemic regions.     

Leucocytoclastic vasculitis associated with Staphylococcus intermedius in the pastern of a horse

A pregnant quarterhorse mare became acutely lame as a result of severe swelling of its right hind leg, thought to have been caused by a fracture or a muscle tear. Diagnostic procedures ruled out a traumatic musculoskeletal cause and a physical examination revealed chronic pastern dermatitis ('scratches'/'grease heel'). Histopathological evaluation of biopsy samples from the right hind leg was consistent with a leucocytoclastic vasculitis, and culture yielded Staphylococcus intermedius. The treatment and infectious causes of pastern dermatitis are discussed.     

Surgical resection of a dysgerminoma in a mare

A mare was referred for further evaluation of a mass found in the left caudal abdomen during a routine postpartum reproductive palpation. The mare was clinically normal with no history of health problems. Ultrasonographic examination of the mass confirmed its presence, but the origin of the mass could not be accurately determined. Routine haematology and serum biochemistry results were within normal limits. The mare was initially treated conservatively with antibiotics, but the mass continued to increase in size, so it was surgically excised. The mass involved the left ovary. The mare showed transient abdominal pain after surgery, but developed no other complications and was in foal 7 months later. On histology, the mass was diagnosed as a dysgerminoma, a rare ovarian tumour of germ cell origin.