Severe haemoptysis associated with seizures in a dog

CASE HISTORY: A 7-year-old, sterilised male German Shepherd dog was presented with a history of three episodes of severe haemoptysis and associated dyspnoea within a 3-week period. A generalised tonic-clonic seizure was witnessed preceding the third episode. CLINICAL FINDINGS: Thoracic radiographs revealed a severe bilateral alveolar lung pattern of the caudodorsal lung fields; extension into the left cranial lung lobe was present but pulmonary vessels were within normal size limits. Frank blood was the only abnormality present at bronchoscopy. A coagulation profile, parasitological screening, thoracic and brain computed tomography (CT), and cerebrospinal fluid (CSF) cytological analysis did not identify any abnormalities. DIAGNOSIS: Haemoptysis due to either severe neurogenic pulmonary oedema or rupture of the pulmonary capillaries secondary to seizures was considered a possible diagnosis. The primary generalised seizures were attributed to late-onset idiopathic epilepsy diagnosed by exclusion of other causes. CLINICAL RELEVANCE: This is the first known case report describing severe haemoptysis associated with seizures in a dog.     

Successful management of saltwater submersion injury in a dog using mechanical ventilation

Objective– To describe successful management of saltwater near-drowning in a dog using mechanical ventilation. Case Summary– A 7-year-old spayed female Golden Retriever weighing 37 kg was referred for mechanical ventilation after saltwater submersion injury. The dog had a history of rare seizures characterized by pre-ictal agitation. On the morning of the event, the dog became agitated and ran toward Puget Sound. The owners discovered the dog unconscious in approximately 25.4 cm (10 in) of water, with her head submerged. The owners estimated that the dog was submerged for approximately 30 seconds. The dog was presented immediately to the nearest emergency facility where initial diagnostic testing and treatment included venous blood gases, nasal oxygen, and IV fluids. The dog was dyspneic despite nasal oxygen administration and was referred for mechanical ventilation. Upon arrival the patient was cyanotic with an arterial partial pressure of oxygen of 38 mm Hg (reference interval 85–100 mm Hg) and oxygenation saturation of 62% (reference interval >95%). Thoracic radiographs were taken and revealed severe, bilateral pulmonary infiltrates. The patient was ventilated for 70 hours and was discharged 4 days later. Complications included pneumonia and phlebitis at the site of a cephalic IV catheter. Follow up thoracic radiographs 10 days after discharge were within normal limits and the owners report a full recovery at 1 year. New or Unique Information Provided– Submersion injury can result in acute respiratory distress syndrome in dogs. Mechanical ventilation provided critical support during pulmonary recovery in this dog.     

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.     

Re: Severe haemoptysis associated with seizures in a dog

Extract

In the paper by FE James, VS Johnson, ZM Lenard and CS Mansfield published in the New Zealand Veterinary Journal 56, 85–88, 2008, entitled, “Severe haemoptysis associated with seizures in a dog”, the authors reported a case of repeated haemoptysis and radiographically visible severe bilateral alveolar lung pattern in a 7-year-old German Shepherd dog suffering from generalised tonic-clonic seizures. On the basis of several other examination methods, they concluded that “The cause of the haemoptysis could not be defined in this dog, but was considered likely to be due to either severe neurogenic pulmonary oedema or rupture of the pulmonary capillaries secondary to seizures.” Further in the text they stated that “Haemoptysis associated with severe neurogenic pulmonary oedema, rather than traumatic rupture of the pulmon ary capillaries may have occurred in this dog.” I agree with these statements.     

Treatment of a dog with severe baclofen intoxication using hemodialysis and mechanical ventilation

Objective: This case report describes the successful management of a dog with coma and respiratory depression due to severe baclofen intoxication. Case summary: A Doberman Pinscher mixed breed dog ingested 500 mg (20 mg/kg) of baclofen. Signs of severe intoxication included coma and profound respiratory muscle weakness. The dog was supported with positive pressure ventilation and treated with one session of hemodialysis. Weaning from the ventilator was achieved within 4 hours of hemodialysis, and recovery from coma occurred over the following 12–36 hours. The dog regained full neurologic function and was normal at discharge following 3 days of hospitalization. New or unique information provide: Severe central nervous system depression and respiratory depression due to baclofen intoxication can be life threatening. In addition to other supportive care, hemodialysis may hasten recovery and ventilatory support may be essential to achieve a positive outcome. With successful treatment, toxicity can be decreased and the associated life‐threatening central nervous system and ventilatory depression can resolve. Prognosis for return of normal function is excellent.     

Diagnosis of severe traumatic brain injury using multimodal imaging in a donkey

A 6‐month‐old donkey presented with recumbency after rearing and falling over. A presumptive diagnosis of traumatic brain injury secondary to a skull fracture was made following the clinical examination, although a fracture could not be identified on radiography. To provide a definitive diagnosis, for planning any surgical intervention and to obtain prognostic information, computed tomography and magnetic resonance imaging were performed. An occipital depression skull fracture with secondary haemorrhage and oedema of the cerebellum and brainstem were identified. The imaging findings were confirmed at pathological examination. This report describes the imaging features of a traumatic brain injury in a donkey.     

Imaging characteristics and treatment of a penetrating brain injury caused by an oropharyngeal foreign body in a dog

A 4‐year‐old Border collie was presented with one episode of collapse, altered mentation, and a suspected pharyngeal stick injury. Magnetic resonance imaging (MRI) and computed tomography showed a linear foreign body penetrating the right oropharynx, through the foramen ovale and the brain parenchyma. The foreign body was surgically removed and medical treatment initiated. Complete resolution of clinical signs was noted at recheck 8 weeks later. Repeat MRI showed chronic secondary changes in the brain parenchyma. To the authors' knowledge, this is the first report of the advanced imaging findings and successful treatment of a penetrating oropharyngeal intracranial foreign body in a dog.     

Hypothalamic-pituitary axis deficiency following traumatic brain injury in a dog

Objective – To describe endocrine dysfunction associated with traumatic brain injury in a dog.
Summary – A 12-week-old dog presented with traumatic brain injury and did not respond to traditional supportive care. Continued hypothermia, electrolyte derangements, hypotension, and hyposthenuria prompted screening for and detection of several hypothalamic-pituitary disorders including: hypoadrenocorticism, central diabetes insipidus, hypothyroidism, and growth hormone deficiency. Electrolyte abnormalities, urine osmolarity, and blood pressure improved with treatment for the associated disorders.
New or Unique Information Provided – This is the first report of generalized hypothalamic-pituitary dysfunction or panhypopituitarism following traumatic brain injury in a dog.     

Pathologic sideroblasts and siderocytes associated with chloramphenicol therapy in a dog

Siderotic granules were recognized in blood erythrocytes from a male Boxer dog with suppurative prostatitis, cystitis and pyelonephritis that was being given high dosage chloramphenicol therapy. Siderotic inclusions were recognized in the cytoplasm of 96% of the rubricytes and metarubricytes in a bone marrow aspirate. Siderotic inclusions were numerous and in some cases formed a ring around the nucleus. This perinuclear location suggested that pathologic mitochondrial iron accumulation had occurred, resulting in the formation of "ringed" sideroblasts. The occurrence of pathologic sideroblasts was confirmed by electron microscopy. Blood siderocytes and bone marrow sideroblasts disappeared after cessation of chloramphenicol therapy.     

Hypercalcemia associated with gastric pythiosis in a dog

A 20-month-old castrated male Labrador Retriever with a 3-month history of anorexia, weight loss, and vomiting was evaluated. Plasma biochemical abnormalities included marked hyperglobulinemia and hypercalcemia. Serum levels of parathyroid hormone, parathyroid hormone-related protein, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D were either low or within reference intervals. Gastric wall thickening and abdominal lymphadenomegaly were observed with abdominal ultrasonography. Cytologic evaluation of a sample obtained via fine-needle aspiration of the gastric wall revealed pyogranulomatous inflammation and numerous poorly stained hyphae. Partial gastrectomy was performed, and a diagnosis of gastric pythiosis was made by immunohistochemical staining of infected gastric tissue, as well as by immunoblot serology. This case demonstrates that diagnostic samples for cytologic evaluation can be obtained by fine-needle aspiration of Pythium insidiosum-infected tissues and that a presumptive diagnosis can be made by examination of a Romanowsky-stained smear. Furthermore, pythiosis should be considered as a differential diagnosis for hypercalcemia, especially in young dogs with inflammatory lesions that have a granulomatous component. The mechanism for the hypercalcemia in this dog was not determined; however, calcium concentrations normalized after surgical resection of the gastric lesion.     

Refractory shock,hypercoagulability, and multiorgan thrombosis associated with hypertrophic osteodystrophy in a dog

Objective

To describe the clinical findings and case progression in a dog presenting with severe systemic inflammatory response, refractory shock, progressive metabolic acidosis, and respiratory failure that was ultimately diagnosed with hypertrophic osteodystrophy (HOD).

Case Summary

A 4-month-old male intact Mastiff presented with a 24-hour history of lethargy and generalized ostealgia. On examination, the dog was recumbent, febrile, and tachycardic with pain on palpation of the abdomen, right femur, and mandible. Appendicular joint radiographs showed changes consistent with osteochondrosis and ulnar-retained cartilaginous cores, with no overt evidence of HOD. Initial treatment included IV fluid therapy, multimodal analgesia, and broad-spectrum antimicrobials. Vasopressor therapy was initiated following hemodynamic decompensation. Synovial fluid cytological analysis and culture revealed nonseptic suppurative inflammation and no bacterial growth, respectively. Blood and urine cultures also yielded no growth. Viscoelastic testing was consistent with hypercoagulability. The dog initially had a metabolic acidosis with appropriate respiratory compensation that progressed to a mixed metabolic and respiratory acidosis despite aggressive therapies that included antimicrobials, vasopressors, positive inotropes, and corticosteroids. Humane euthanasia was elected approximately 32 hours after admission. Necropsy yielded a diagnosis of HOD.

New or Unique Information Provided

This is the first report detailing the occurrence of refractory shock and hypercoagulability associated with HOD in a dog without evidence of another identified comorbidity. HOD should be considered in any young, large-breed dog with generalized ostealgia and signs of systemic illness, even in the absence of classic radiographic abnormalities. Further investigation of coagulation status in dogs with HOD and a secondary systemic inflammatory response is warranted.     

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.