Cervical injury following a horse kick to the head in two dogs

Two dogs were presented to North Carolina State University Veterinary Teaching Hospital following blunt trauma to the head delivered by a horse kick. On presentation, both dogs had resolving clinical signs directly related to the head trauma, but both also had compromise to their upper airway as a result of indirect injury to the soft tissues of the neck, visible on plain radiographs. One dog made a full recovery following a period of assisted ventilation. The other dog was euthanized at the request of the owner. These injuries illustrate the importance of evaluating the cervical spine and soft tissues of the neck following blunt trauma to the head.     

Magnetic resonance features of closed head trauma in two foals

Two foals were admitted for neurological signs after trauma. Clinical and diagnostic investigations were performed that were suggestive of closed head trauma characterised by right parietal bone deviation (ping‐pong fracture), cerebral contusion, haematoma and cerebellar contusion. The histopathological findings were consistent with areas of abnormal signal found on magnetic resonance investigations.     

Aggression to a foal after 4 months of nursing

A 4-month-old male Arabian foal was examined because of a kicking trauma to the right frontal region. The foal had been kicked by its dam when it was seeking the udder the previous day. Radiographic inspection of head and neck showed no defect or bone fracture. Treatment consisting of intravenous administration of hypertonic solution, dexamethasone, and furosemide improved the clinical signs temporarily; however, second head trauma due to falling of the standing foal resulted in deterioration of clinical condition and finally death. At necropsy, epidural, subdural, and subarachnoid hemorrhages, a hematoma at cerebrocerebellar fissure and cerebellar herniation were observed. Continuous assessment of foal rejection-related signs in susceptible mares should be considered until foal weaning.     

Diagnosis and treatment of a chronic atlanto-occipital subluxation in a dog

A 6-year-old Labrador retriever-cross was evaluated for an abnormal gait and head carriage 6 weeks after suffering trauma. The dog was presented with an ambulatory tetraparesis and was reluctant to move his head. Myelography and computed tomography demonstrated a subluxation of the atlanto-occipital joint with compression of the spinomedullary junction and the brain stem by the occipital bone. Removal of the compressive part of the occipital bone resulted in improvement of the clinical signs within 6 weeks, and resolution of clinical signs occurred 8 months after surgery.     

Head trauma in the cat: 1. assessment and management of craniofacial injury

PRACTICAL RELEVANCE: Feline trauma is commonly seen in general practice and frequently involves damage to the head. CLINICAL CHALLENGES: While craniofacial injuries following trauma vary widely in severity, affected cats can often be severely compromised in terms of their neurological, respiratory and cardiovascular status, and their management can be challenging in both the short and long term. They need prompt stabilisation and careful monitoring in the initial period to maximise prospects of a successful outcome. Many cats with severe facial trauma will require surgery to stabilise skull fractures or address injuries to the eyes, with its inherent issues surrounding pain management, ensuring adequate nutrition and the necessity for ongoing hospitalisation. DIAGNOSTICS: Cats with head trauma benefit from imaging of the injured areas as well as thoracic radiography. Imaging the skull can be challenging and is best performed under general anaesthesia. In unstable patients this can be delayed to prevent any associated morbidity. EVIDENCE BASE: The clinical evidence base relating to injury to the feline head is limited, despite its relative frequency in general practice. This review focuses on the initial approach to craniofacial (in particular, ocular and jaw) trauma, and outlines simple techniques for management of soft tissue and bone injuries. Much of the information is based on the authors' clinical experience, as there is a paucity of well-described clinical case material.     

Traumatic brain injury in horses: 34 cases (1994-2004)

OBJECTIVE: To investigate the clinical, clinicopathologic, and diagnostic characteristics; treatment; and outcome associated with acute traumatic brain injury (TBI) in horses and assess risk factors for nonsurvival in TBI-affected horses. DESIGN: Retrospective case series. ANIMALS: 34 horses with TBI. Procedures-Medical records of horses that had sustained trauma to the head and developed neurologic signs were reviewed. Data that included signalment, clinicopathologic findings, diagnosis, treatment, and outcome were analyzed. Clinicopathologic variables among horses in survivor and nonsurvivor groups were compared, and risk factors for nonsurvival were determined. RESULTS: Median age of affected horses was 12 months. Findings of conventional survey radiography of the head alone failed to identify all horses with fractures of the calvarium. Horses with basilar bone fractures were 7.5 times as likely not to survive as horses without this type of fracture. Depending on clinical signs, horses received supportive care, osmotic or diuretic treatments, antimicrobials, anti-inflammatory drugs, analgesics, or anticonvulsants. Twenty-one (62%) horses survived to discharge from the hospital. In the nonsurvivor group, mean PCV was significantly higher, compared with the value in the survivor group (40% vs 33%). Risk factors associated with nonsurvival included recumbency of more than 4 hours' duration after initial evaluation (odds ratio, 18) and fracture of the basilar bone (odds ratio, 7.5). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that prognosis for survival in horses with acute TBI may be more favorable than previously reported. Among horses with TBI, persistent recumbency and fractures involving the basilar bones were associated with a poor prognosis.     

Hyperglycemia in dogs and cats with head trauma: 122 cases (1997-1999)

OBJECTIVE: To determine whether hyperglycemia is associated with head trauma in dogs and cats and whether the degree of hyperglycemia corresponds to severity of neurologic injury or outcome. DESIGN: Retrospective study. ANIMALS: 52 dogs and 70 cats with head trauma and 122 age- and species-matched control dogs and cats. PROCEDURE: Severity of head trauma was classified as mild, moderate, or severe. Blood glucose concentrations recorded within 1 hour after admission were compared between case and control animals and among groups when case animals were grouped on the basis of severity of head trauma or outcome. RESULTS: Blood glucose concentration was significantly associated with severity of head trauma in dogs and cats and was significantly higher in dogs and cats with head trauma than in the control animals. However, blood glucose concentration was not associated with outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that dogs and cats with head trauma may have hyperglycemia and that degree of hyperglycemia was associated with severity of head trauma. However, degree of hyperglycemia was not associated with outcome for dogs and cats with head trauma. Because hyperglycemia can potentiate neurologic injury, iatrogenic hyperglycemia should be avoided in patients with head trauma.     

Clinical findings and diagnostic value of post-traumatic thoracic radiographs in dogs and cats with blunt trauma

Objective: To characterize the clinical findings in dogs and cats that sustained blunt trauma and to compare clinical respiratory examination results with post‐traumatic thoracic radiography findings. Design: Retrospective clinical study. Setting: University small animal teaching hospital. Animals, interventions and measurements: Case records of 63 dogs and 96 cats presenting with a history of blunt trauma and thoracic radiographs between September 2001 and May 2003 were examined. Clinical signs of respiratory distress (respiratory rate (RR), pulmonary auscultation) and outcome were compared with radiographic signs of blunt trauma. Results: Forty‐nine percent of dogs and 63.5% of cats had radiographic signs attributed to thoracic trauma. Twenty‐two percent of dogs and 28% of cats had normal radiographs. Abnormal auscultation results were significantly associated with radiographic signs of thoracic trauma, radiography score and presence and degree of contusions. Seventy‐two percent of animals with no other injuries showed signs of thoracic trauma on chest radiographs. No correlation was found between the radiographic findings and outcome, whereas the trauma score at presentation was significantly associated with outcome and with signs of chest trauma but not with the radiography score. Conclusion: Thoracic trauma is encountered in many blunt trauma patients. The RR of animals with blunt trauma is not useful in predicting thoracic injury, whereas abnormal chest auscultation results are indicative of chest abnormalities. Thorough chest auscultation is, therefore, mandatory in all trauma animals and might help in the assessment of necessity of chest radiographs.     

Head trauma in the cat: 2. assessment and management of traumatic brain injury

PRACTICAL RELEVANCE: Feline trauma patients are commonly seen in general practice and frequently have sustained some degree of brain injury. CLINICAL CHALLENGES: Cats with traumatic brain injuries may have a variety of clinical signs, ranging from minor neurological deficits to life-threatening neurological impairment. Appropriate management depends on prompt and accurate patient assessment, and an understanding of the pathophysiology of brain injury. The most important consideration in managing these patients is maintenance of cerebral perfusion and oxygenation. For cats with severe head injury requiring decompressive surgery, early intervention is critical. EVIDENCE BASE: There is a limited clinical evidence base to support the treatment of traumatic brain injury in cats, despite its relative frequency in general practice. Appropriate therapy is, therefore, controversial in veterinary medicine and mostly based on experimental studies or human head trauma studies. This review, which sets out to describe the specific approach to diagnosis and management of traumatic brain injury in cats, draws on the current evidence, as far as it exists, as well as the authors' clinical experience.     

Emergency Presentations of the Exotic Small Mammalian Herbivore Trauma Patient

Trauma is a common complaint by owners of small exotic mammalian herbivores (e.g., rabbits, rodents) presented to veterinary hospitals. The term “trauma” is a broad disease category applied to patients with physical debilitation associated with injury often classified as “blunt,” “penetrating,” or “burn” in origin. Because many small exotic mammalian herbivores are prey animals, clinical signs of trauma may be masked until the effects of the injury outweigh the innate nature to survive. Small exotic mammalian herbivores are disproportionately sensitive to stress; thus, pain management and supportive care are extremely important during the initial stages of trauma management. Small exotic mammals differ slightly from other companion animals (e.g., dogs, cats) in regard to common trauma presentations. However, with a few therapeutic modifications (e.g., antibiotic selection, avoidance of corticosteroids, preventing self-trauma), treatment of small exotic mammalian herbivore trauma cases follows the same conventional guidelines used for other companion animals.     

Horner's syndrome in dogs and cats: 49 cases (1980-1986)

Medical records of 49 dogs and cats with Horner's syndrome were reviewed. Causes included head, neck, and chest trauma, chronic otitis, cranial thoracic mass, and injury attributable to cleaning of the external ear canal. Cause could not be delineated in 54.5% of the dogs. Numerous diagnostic tests and pharmacologic challenge exposure with epinephrine were used to localize the site of injury. Resolution of all clinical signs was observed in 36 animals and required a mean of 7.7 weeks.     

Disorders of the vestibular system

Disorders of the vestibular system are common in veterinary practice and result in a clinical syndrome characterized by head tilt, asymmetric ataxia, and nystagmus. These signs may occur with lesions involving the peripheral or central vestibular structures. Careful neurologic evaluation of the animal and knowledge of surrounding neuroanatomic structures and their functions enable the clinician to differentiate between peripheral and central disorders. Conditions resulting in peripheral vestibular symptoms include idiopathic syndromes, otitis interna, trauma, neoplasia, drug-induced ototoxicity, and congenital disorders. Radiographs of the petrous temporal bone and tympanic bulla and examination of the tympanic membrane are useful in determining the specific etiology. Central vestibular dysfunction may result from inflammatory CNS diseases, neoplasia, trauma, thiamine deficiency, and storage diseases. Cerebrospinal fluid analysis, skull radiographs, and computed tomography are diagnostic tests useful in animals with central vestibular symptoms. Once the etiology is identified, specific therapy may be provided and a more accurate prognosis can be determined.     

Traumatic brain injury: a review of pathophysiology and management

Objective – To review current information regarding the pathophysiology associated with traumatic brain injury (TBI), and to outline appropriate patient assessment, diagnostic, and therapeutic options. Etiology – TBI in veterinary patients can occur subsequent to trauma induced by motor vehicle accidents, falls, and crush injuries. Primary brain injury occurs at the time of initial impact as a result of direct mechanical damage. Secondary brain injury occurs in the minutes to days following the trauma as a result of systemic extracranial events and intracranial changes. Diagnosis – The initial diagnosis is often made based on history and physical examination. Assessment should focus on the cardiovascular and respiratory systems followed by a complete neurologic examination. Advanced imaging may be indicated in a patient that fails to respond to appropriate medical therapy. Therapy – Primary brain injury is beyond the control of the veterinarian. Therefore, treatment should focus on minimizing the incidence or impact of secondary brain injury. Because of a lack of prospective or retrospective clinical data, treatment recommendations for veterinary TBI patients are primarily based on human and experimental studies and personal experience. Therapeutic guidelines have been developed that center on maintaining adequate cerebral perfusion. Prognosis – Severe head trauma is associated with high mortality in humans and animals. However, dogs and cats have a remarkable ability to compensate for loss of cerebral tissue. It is therefore important not to reach hasty prognostic conclusions based on initial appearance. Many pets go on to have a functional outcome and recover from injury.     

The prognostic value of the modified Glasgow Coma Scale in head trauma in dogs

A clinical coma scale modified from the Glasgow Coma Scale used for humans has been suggested as a useful predictor of outcome in the head trauma patient. The objective of this study was to correlate the modified Glasgow Coma Scale (MGCS) score of dogs with head trauma with their probability of survival. Thirty-eight dogs with head trauma were selected and retrospectively evaluated. The information retrieved from the medical record of each dog included signalment, body weight, cause of head trauma, MGCS, presence of concurrent neck pain, and outcome (dead or alive) after 48 hours. Logistic regression was used to model survival in the 1st 48 hours as a function of MGCS, gender, weight, and calvarial fractures. The MGCS ranged from 5 to 18. Seven dogs died within 48 hours of the head trauma. The MGCS could predict the probability of survival in the 1st 48 hrs after head trauma with 50% probability in a patient with a score of 8. Gender, weight, and presence of skull fractures did not predict survival. In conclusion, the MGCS is a useful index for prediction of outcome in dogs with head trauma.     

MRI FEATURES OF GASTROCNEMIUS MUSCULOTENDINOPATHY IN HERDING DOGS

Pelvic limb lameness that was localized clinically to the lateral gastrocnemius head was observed in dogs without history of trauma. The aim of this retrospective study was to describe magnetic resonance imaging (MRI) findings of this condition. Nine dogs were identified, eight Border Collies and one Australian Shepherd. They all had chronic pelvic limb lameness; no signs of joint effusion or instability were present. In MR images there was high signal intensity in the lateral head of the gastrocnemius muscle around the sesamoid bone in T2‐weighted, T2^*‐weighted, and STIR images and an iso‐ to mildly hyperintense signal in T1‐weighted images with marked contrast enhancement. The abnormal signal intensity most likely represents a myotendinous strain. The breed affiliation to Border Collies is striking, and a relation to biomechanical forces or motion pattern may be possible. Except for the dog with the most extensive lesion all dogs had an excellent outcome.     

Solving return-to-sensibility problems after electrical stunning in commercial pork slaughter plants

OBJECTIVE: To determine causes and solutions for return-to-sensibility problems after electrical stunning in pigs. DESIGN: Case studies. SAMPLE POPULATION: 6 federally inspected pork slaughter plants. PROCEDURE: 100 to 200 pigs were scored in each plant for stunner positioning, squealing when stunner was applied, and signs of insensibility. All pigs were held in a V-shaped restrainer conveyor and stunned with a manually applied head-to-body electrical stunner. RESULTS: Percentage of pigs that had blinking after stunning ranged from 0.5 to 7. None of the pigs had a righting reflex or kicked in response to stimuli. All signs of possible return to sensibility disappeared before bleeding pigs reached the scalding tub. Spontaneous eye blinking was eliminated by improving bleeding practices to increase blood flow, ergonomically redesigning the stunner operator's work station to make correct placement of the stunner easier, redesigning the head electrode to facilitate correct placement, reducing line speed from 1,200 to 1,080 head/h, correcting problems with poor initial contact of the stunner, and increasing amperage of a stunner that was set too low for sows. In 1 plant, a fatigued operator was the cause of stunner placement mistakes that resulted in signs of returning to sensibility. CONCLUSIONS AND CLINICAL RELEVANCE: Problems with electrical stunning can be easily corrected, but effective stunning requires monitoring of correct electrode placement, amperage, and bleeding procedures. Observation of spontaneous natural eye blinking without touching the eye is recommended for use under field conditions, because it is less prone to misinterpretation than are other methods.     

Clinical signs associated with brain tumors in dogs: 97 cases (1992-1997).

OBJECTIVE: To determine the prevalence of various clinical signs in dogs with brain tumors. DESIGN: Retrospective study. ANIMALS: 97 dogs with brain tumors. PROCEDURE: Medical records were reviewed for signalment, tumor type and location, and clinical signs. RESULTS: 33 breeds were represented; Golden Retrievers were most commonly affected. Most dogs were older (median age, 9 years); 95% of dogs were > or = 5 years old. Seventy-six percent of dogs had tumors in the supratentorial region. Seizures were the most common clinical sign at initial examination, with lower prevalence for circling, ataxia, and head tilt. Meningioma was the most common tumor. CONCLUSIONS AND CLINICAL RELEVANCE: Brain tumors develop most often in dogs > or = 5 years old and are uncommon in dogs < 5 years old. Seizures are a common clinical sign, and a brain tumor should be considered in dogs that have their first seizure after they are 4 years old.     

Electrical stunning of red deer (Cervus elaphus)

Eighteen of 23 red deer (Cervus elaphus) at a deer slaughtering premises were successfully stunned with an apparatus modified from that normally used to stun sheep. The five unsuccessful electrical stuns were associated with poor head restraint and poor head contact by the electrodes. The median stunning current was 0.9 A, and in the majority of cases the duration of stunning was less than 1 second. The signs of the electrically induced epileptiform seizures in the deer were dissimilar to those seen in sheep, cattle and pigs, in that the initial tonic phase was less marked, and of shorter duration. A similar shorter and less obvious tonic phase was noted in four deer shot with a captive bolt pistol. Two animals which were electrically stunned, and bled within 10 seconds, showed no signs of recovery while bleeding. The electroencephalograms of four deer stunned with currents of 1.3 A for a duration of either 0.5 or 1.0 seconds were recorded under more controlled conditions. All four animals developed electroencephalograms typical of an epileptiform seizure. The animals exhibited behavioural reactions similar to the other 18 animals in the trial at the deer slaughtering premises and were rendered unconscious for between 54 and 122 seconds. The electroencephalogram activity amplitude was greater than that recorded immediately before stunning and took between 6 and 9 seconds to build up to maximum value. It is concluded that, providing the heads of deer are adequately restrained, head-only electrical stunning can be incorporated into a humane method of slaughter for deer.     

Progressive axonopathy: an inherited neuropathy of Boxer dogs. 1. Further studies of the clinical and electrophysiological features

The clinical and electrophysiological findings in 14 Boxer dogs with progressive axonopathy (PA) are described. The salient clinical features are hind-limb ataxia which may later involve forelegs, proprioceptive defects, hypotonia, patellar areflexia, absence of muscle atrophy and, in a few instances, ocular tremor and head bobbing. The outward signs are often observed by 2–3 months of age but clinical testing can reveal patellar areflexia at 1 month of age. After an initial progression, the signs may stabilize and dogs are alive at 4 years of age having shown no deterioration over the previous 2 years. The electrophysiology shows reduced motor nerve conduction velocities and evoked potential amplitudes after about 4 months of age. The F-wave latency is considerably increased. Sensory nerves also show a marked reduction in the amplitude of their evoked potentials and eventually cease to conduct. Abnormal spontaneous activity is not a feature on electromyography. The conduction defects probably reflect to some degree the reduced nerve fibre diameters and myelin sheath changes found in PA although other factors may also be operating. The study shows that PA can be diagnosed with reasonable confidence by routine clinical testing at an early age.     

A case of congenital unilateral hip dysplasia in a newborn calf

We describe the case of a Simmental calf with congenital unilateral hip dysplasia. In the initial physical exam, the calf was able to stand unsteady when helped and showed severe swinging lameness in the left hind limb. Unilateral hip laxity and a positive Ortolani sign indicated subluxation of the femur within the hip joint. This finding was further confirmed by radiographic examination which also showed malformation of the left femoral head and acetabulum. After a short period of clinical improvement the calf's health deteriorated and it was euthanized due to signs of severe coxarthrosis. Pathological examination of the affected hip joint revealed a severe acetabular and femoral dysplasia with an incomplete formation of the epiphysis of the femoral head and a chronic granulating coxarthritis without evidence of primary infectious events.