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Breeds such as Labrador retrievers, golden retrievers, border collies, and Australian shepherds are more prone to the condition; however, any dog can develop epilepsy.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Secondary seizures","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" result from an identifiable underlying condition or factor, including:","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Metabolic disorders ","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":"â Conditions such as hypoglycemia (i.e., low blood sugar), liver disease, and kidney failure can lead to seizures because of imbalances in the bodyâs chemistry.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Infections ","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":"â Brain infections, such as meningitis and encephalitis, or severe systemic infections can provoke seizures.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Toxicity ","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":"â Exposure to toxins, such as certain plants, chemicals, or human medications, can trigger seizures.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Neurologic disorders","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" â Structural brain abnormalities, such as tumors and congenital defects, can lead to seizures.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Head trauma","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" â Any head trauma can disrupt normal brain function and result in seizures.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Electrolyte imbalances ","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":"â Abnormal electrolyte levels can affect neuronal function, leading to seizures.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"heading-3","data":{},"content":[{"nodeType":"text","value":"How do I know if my pet is having a seizure?","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Seizures in pets can manifest in several ways, and recognizing the signs early can help you respond appropriately. Here are some common seizure signs:","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Loss of consciousness","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" â Your pet may appear unresponsive or unaware of their surroundings and may collapse or fall during a seizure.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Uncontrolled movements ","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":"â Seizures often involve jerking or twitching movements, including rapidly shaking the head, limbs, or entire body.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Stiffness","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" â Some pets may exhibit limb or body stiffness with an arched back or rigid posture.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Paddling or running movements ","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":"â Your pet may make paddling motions with their limbs, as if trying to run, while lying on their side.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Vocalizations","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" â Some pets will vocalize during a seizure, and bark, howl, or whine.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Loss of bladder or bowel control","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" â Some pets may urinate or defecate involuntarily during a seizure.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Confusion or disorientation","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" â After the seizure, your pet may seem confused or disoriented as their brain recovers. This phase can last from a few minutes to several hours, but most pets return to their normal behavior in an hour. ","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"heading-3","data":{},"content":[{"nodeType":"text","value":"What do I do if my pet has a seizure?","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\nIf your pet has a seizure, knowing how to react is critical. Take the following steps:","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\n","marks":[],"data":{}},{"nodeType":"text","value":"Remain calm","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" â Your pet can sense your emotions, so try to remain calm and reassuring when they regain consciousness. Keeping a cool head also helps you care for your pet appropriately.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\n","marks":[],"data":{}},{"nodeType":"text","value":"Ensure safety","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" â Create a safe space for your pet. Clear the area to prevent injury, move any nearby objects or obstacles, and move your pet away from stairs and potentially harmful immovable objects.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\n","marks":[],"data":{}},{"nodeType":"text","value":"Time the seizure","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" â Note the seizureâs duration. If the episode lasts longer than five minutes or your pet has multiple seizures in a row, seek emergency veterinary care.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\n","marks":[],"data":{}},{"nodeType":"text","value":"Video the seizure","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" â If possible, have someone video your petâs seizure, so your veterinarian can witness the episode.\nAvoid potentially harmful contact during the seizure â Donât hold your pet down during a seizure, which can lead to injury, and donât place your hands in or near their mouth. Your pet will not swallow their tongue, and they may inadvertently b
1007ite you during the seizure.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\n","marks":[],"data":{}},{"nodeType":"text","value":"Track symptoms","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" â After the seizure, take note of your petâs unusual behaviors or symptoms. This information can be helpful for your veterinarian.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\n","marks":[],"data":{}},{"nodeType":"text","value":"Contact your veterinarian","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" â Contact your veterinarian to discuss the seizure and for advice on next steps. They may recommend diagnostic tests or a referral to determine the underlying cause.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Recognizing that your pet is experiencing a seizure can be alarming but being informed and prepared can help you respond effectively. By understanding seizure signs and knowing how to act, you can ensure your petâs safety during the distressing event. With the right care and attention, many pets live happy, healthy lives with a seizure disorder. Contact our Bush Veterinary Neurology Service for pet seizure management and treatment advice. ","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"5khlWxYcwnNgcnTQVD7hOM"},"name":"IMAGE CONTAINER - Master - Clinic - Dog - Staff - Stethoscope","title":null,"altText":"Dog being looked at by vet","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"NVA - Clinic - Dog - Staff - Stethoscope","url":"https://images.ctfassets.net/rt5zmd3ipxai/7IFfzIzt9RKTEImXcyDV7Z/d6b4bf75d3d5edb8a907a818ad8d1273/Service-Cards-Dog-Staff.png","size":1673783,"width":1254,"height":1254,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"When Does My Pet Need a Veterinary Neurologist?","name":"BLOG ARTICLE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - When Does My Pet Need a Veterinary Neurologist?","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Veterinary neurologists are specially trained to treat nervous system disorders affecting a petâs brain, spinal cord, and nerves.","marks":[],"data":{}}]}]}},"blogCategory":{"__typename":"BlogCategory","categoryName":"General"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"When Does My Pet Need a Veterinary Neurologist?","nodeType":"text"}],"nodeType":"heading-2"},{"data":{},"content":[{"data":{},"marks":[],"value":"Veterinary neurologists are specially trained to treat nervous system disorders affecting a petâs brain, spinal cord, and nerves. Your pet may need to see a veterinary neurologist if they experience conditions such as seizures, spinal cord injury, brain tumor, or vestibular disease. Highly educated, board-certified veterinary neurologists lead BVNSâs Veterinary Neurology Service team, and they understand veterinary neurologyâs complicated science, as well as how to provide compassionate care.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"What is a veterinary neurologist?","nodeType":"text"}],"nodeType":"heading-3"},{"data":{},"content":[{"data":{},"marks":[],"value":"To become a veterinary neurologist, a veterinarian must commit to many years of intensive training and education. In addition to completing undergraduate courses, finishing veterinary school at an American Veter
1007inary Medical Association (AVMA)-accredited veterinary university, and passing the North American Veterinary Licensing Examination (NAVLE), other requirements include:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Internship ","nodeType":"text"},{"data":{},"marks":[],"value":"â After graduating from veterinary school and passing the NAVLE, someone interested in becoming a veterinary neurologist must complete a one-year internship at an approved veterinary university hospital or at a veterinary practice to gain hands-on experience.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Residency ","nodeType":"text"},{"data":{},"marks":[],"value":"â The next step for an aspiring veterinary neurologist is a three-year residency in which they receive mentorship from one or more board-certified veterinary neurologists. A residency advances a potential specialistâs education and training in the neurology field.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Board certification ","nodeType":"text"},{"data":{},"marks":[],"value":"â After completing these rigorous requirements, the veterinarian has to take a series of examinations to demonstrate their knowledge in general internal medicine as well as in advanced neurology. Once the veterinarian successfully passes these examinations and completes their credentialing requirements, they are recognized as a Diplomate of the American College of Veterinary Internal Medicine (DACVIM) in Neurology.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"blockquote"},{"data":{},"content":[{"data":{},"marks":[],"value":"What conditions do veterinary neurologists treat?","nodeType":"text"}],"nodeType":"heading-3"},{"data":{},"content":[{"data":{},"marks":[],"value":"Neurologists treat conditions that affect your petâs brain, spinal cord, and nerves. Examples include:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Neurologic examination ","nodeType":"text"},{"data":{},"marks":[],"value":"â A neurologic examination involves a thorough physical exam as well as an evaluation of your petâs mental status, gait and body posture, cranial nerve examination, and reflex testing.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Cerebrospinal fluid (CSF) analysis","nodeType":"text"},{"data":{},"marks":[],"value":" â Evaluating your petâs CSF can help detect infection, inflammation, and certain diseases.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Computed tomography (CT) scan ","nodeType":"text"},{"data":{},"marks":[],"value":"â A CT scan uses a rotating X-ray tube to image your pet in multiple planes. In some cases, we use contrast material during a CT scan to detect spinal cord abnormalities.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Magnetic resonance imaging (MRI) ","nodeType":"text"},{"data":{},"marks":[],"value":"â MRI is an excellent diagnostic tool for imaging the brain and spinal cord because the technology allows our team to image your pet in all three dimensions in extremely thin slices. MRI enables us to get a detailed representation of your petâs anatomy and identify any abnormalities.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Electroencephalography (EEG) ","nodeType":"text"},{"data":{},"marks":[],"value":"â An EEG involves attaching electrodes to your petâs scalp to measure their brainâs electrical activity.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Electromyography (EMG) ","nodeType":"text"},{"data":{},"marks":[],"value":"â An EMG measures musclesâ electrical activity.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Brainstem auditory evoked response testing (BAER) ","nodeType":"text"},{"data":{},"marks":[],"value":"â BAER testing detects hearing loss by measuring brain wave activity in response to clicks and tones.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Nerve conduction velocity (NCV) ","nodeType":"text"},{"data":{},"marks":[],"value":"â An NCV test evaluates nerve function by measuring an electrical impulseâs conduction speed through the nerve.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"blockquote"},{"data":{},"content":[{"data":{},"marks":[],"value":"When does my pet need a veterinary neurologist?","nodeType":"text"}],"nodeType":"heading-3"},{"data":{},"content":[{"data":{},"marks":[],"value":"Primary veterinarians are not trained to treat severe neurologic conditions, nor do they have the sophisticated neurologic testing equipment necessary in their clinics. If your primary care veterinarian believes your pet has a severe neurologic condition, they will refer your pet to a veterinary neurologist. Reasons your pet may need to be seen by a veterinary neurologist include: ","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Your pet has a neurologic condition that is not improving or getting worse despite your primary veterinarianâs treatment.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"\nYour primary veterinarian is not comfortable treating your petâs neurologic condition.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"\nYour primary veterinarian canât determine the cause of your petâs neurologic signs.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"\nYour petâs seizures arenât controlled with medication.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"\nYour pet has brain trauma.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"\nYour pet is paralyzed in one or more limbs.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"\nYour pet needs advanced imaging to diagnose their neurologic condition.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"\nYour petâs breed has a high risk for a specific neurologic disease, and you want them screened as a potential preventive measure.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"blockquote"},{"data":{},"content":[{"data":{},"marks":[],"value":"If your pet has a neurologic condition, our ","nodeType":"text"},{"data":{},"marks":[{"type":"bold"}],"value":"Bush Veterinary Neurology Service","nodeType":"text"},{"data":{},"marks":[],"value":" team will work closely with your primary veterinarian to determine the correct diagnosis, implement treatment, and ensure they receive the care and ongoing check-ups they need. ","nodeType":"text"},{"data":{"uri":"/contact-us"},"content":[{"data":{},"marks":[],"value":"Contact us","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":" if you would like to schedule an appointment or if you have questions about your petâs condition. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}}
1007,"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"6IqPjVpRPO7EqM1kSsE1oG"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Dog Eye Examination","title":null,"altText":"A dog is being examined in the eye. ","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Dog Eye Examination","url":"https://images.ctfassets.net/rt5zmd3ipxai/788IWQo9eb2DjhVamE6TRT/36c9903e810703283efe87f0731df554/BVNS_homepage.png","size":575007,"width":1281,"height":354,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"What is a veterinary neurologist?","name":"BLOG ARTICLE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - What is a veterinary neurologist?","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Veterinary neurology is the branch of medicine that treats pet diseases of the brain, spinal cord, and peripheral nervous system. ","marks":[],"data":{}}]}]}},"blogCategory":{"__typename":"BlogCategory","categoryName":"News"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Veterinary neurology is the branch of medicine that treats pet diseases of the brain, spinal cord, and peripheral nervous system. Our ","nodeType":"text"},{"data":{},"marks":[{"type":"bold"}],"value":"Bush Veterinary Neurology Service","nodeType":"text"},{"data":{},"marks":[],"value":" ","nodeType":"text"},{"data":{"uri":"/"},"content":[{"data":{},"marks":[],"value":"(BVNS)","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":" teams, located in Rockville, Springfield, Leesburg, and Richmond, are led by highly trained board-certified veterinary neurologists who are experienced in providing compassionate care for pets affected by neurologic conditions. In addition to improving petsâ lives, BVNS neurology specialists advance veterinary science by conducting valuable research, publishing scientific articles, and lecturing nationally to educate other veterinary professionals about neurologic diseases in pets. ","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"What is a veterinary neurologist?","nodeType":"text"}],"nodeType":"heading-3"},{"data":{},"content":[{"data":{},"marks":[],"value":"To become a veterinary neurologistâa Diplomate of the American College of Veterinary Internal Medicine (Neurology)âtakes extreme dedication and hard work. 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Common neurologic conditions in pets include: ","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Seizures ","nodeType":"text"},{"data":{},"marks":[],"value":"â A seizure is a sudden, uncontrolled electrical brain disturbance that causes behavioral changes, bodily movements, and unconsciousness. To treat a petâs condition appropriately, a veterinary neurologist must first determine the seizureâs underlying cause, which may include primary epilepsy, metabolic disease, brain tumor, or brain infection or inflammation.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Intervertebral disc disease (IVDD) ","nodeType":"text"},{"data":{},"marks":[],"value":"â Intervertebral discs sit between spinal vertebrae, and IVDD causes the intervertebral discs to degenerate, resulting in disc rupture or herniation, which puts pressure on a petâs spinal cord, causing them pain and decreased mobility. Veterinary neurologists grade a petâs condition based on their clinical signs, and the neurologist may perform surgery to prevent a pet from developing permanent spinal cord damage.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Caudal occipital malformation syndrome (COMS) ","nodeType":"text"},{"data":{},"marks":[],"value":"â COMS has been diagnosed in small-breed dogs such as Cavalier King Charles spaniels, Pomeranians, Yorkshire terriers, Maltese terriers, Japanese chins, and Brussels griffons. This condition causes a skull malformation, compressing the brain and causing pinching at the beginning of the spinal cord, which results in sensory information disruption from the body to the brain. COMS signs include vocalizing when handled or picked up, head and neck scratching, holding the head low, and head pressing.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Degenerative myelopathy (DM) ","nodeType":"text"},{"data":{},"marks":[],"value":"â DM is most common in older medium- to large-breed dogs. The disease affects the spinal cord, and causes slowly progressive pelvic limb weakness and paralysis. Initial DM signs include hind paw knuckling, swaying hindquarters when standing still, and difficulty rising from a prone position. The disease is similar to humansâ amy
1007otrophic lateral sclerosis (i.e., Lou Gehrigâs disease).","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"}],"nodeType":"unordered-list"},{"data":{},"content":[{"data":{},"marks":[],"value":"What signs indicate neurologic disease in pets?","nodeType":"text"}],"nodeType":"heading-3"},{"data":{},"content":[{"data":{},"marks":[],"value":"Many varied signs can indicate a neurologic condition. If your pet has a neurologic disease, they may exhibit signs such as:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Behavioral changes","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Altered consciousness","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Seizures","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Complete or partial paralysis","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Neck pain","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Back pain","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Weakness","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Incoordination","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Confusion","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Head tilt","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Incontinence","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"}],"nodeType":"unordered-list"},{"data":{},"content":[{"data":{},"marks":[],"value":"What does a veterinary neurology examination involve?","nodeType":"text"}],"nodeType":"heading-3"},{"data":{},"content":[{"data":{},"marks":[],"value":"During a typical neurologic examinationâwhich proceeds from head to tailâour veterinary neurologists systematically evaluate every body part to detect abnormalities. Evaluations include:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Mental status ","nodeType":"text"},{"data":{},"marks":[],"value":"â We observe your pet to determine if they interact normally with you, other people, and their environment.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Gait and body posture ","nodeType":"text"},{"data":{},"marks":[],"value":"â We assess your petâs body postureâsitting and standingâand we watch them walk on a level surface (i.e., around a room), and up and down stairs.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Cranial nerve examination ","nodeType":"text"},{"data":{},"marks":[],"value":"â We assess your petâs sight, smell, hearing, their chewing and swallowing ability, and whether they can move their eyes and facial structures normally. In addition, we check their pain response.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Physical examination ","nodeType":"text"},{"data":{},"marks":[],"value":"â We palpate your petâs body, checking for pain or muscle atrophy.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Reflex testing ","nodeType":"text"},{"data":{},"marks":[],"value":"â We check your petâs limb reflexes and posture. We may al
1007so pick up your pet and lower them to the floor to see how they position their limbs when they contact the surface.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"}],"nodeType":"unordered-list"},{"data":{},"content":[{"data":{},"marks":[],"value":"What veterinary neurologic diagnostics are performed?","nodeType":"text"}],"nodeType":"heading-3"},{"data":{},"content":[{"data":{},"marks":[],"value":"Our veterinary neurologists recommend specific diagnostics based on the findings of your petâs physical examination. Your petâs physical condition determines which neurologic diagnostics they should undergo, such as:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Spinal radiography ","nodeType":"text"},{"data":{},"marks":[],"value":"â Spinal X-rays can detect fractures, bony tumors, arthritis, and disc infections.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Myelogram ","nodeType":"text"},{"data":{},"marks":[],"value":"â A myelogram is a radiographic examination that uses contrast medium to detect spinal cord pathology, including the location of a spinal cord injury, cyst, or tumor.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Cerebral spinal fluid (CSF) tap ","nodeType":"text"},{"data":{},"marks":[],"value":"â CSF is removed from the spinal canal and analyzed for infection, inflammation, and certain diseases.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Electroencephalography (EEG) ","nodeType":"text"},{"data":{},"marks":[],"value":"â An EEG measures the brainâ electrical activity through small, metal electrodes attached to the scalp.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Electromyography ","nodeType":"text"},{"data":{},"marks":[],"value":"â Electromyography evaluates and records electrical activity the skeletal muscle produces.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Nerve conduction velocity (NCV) ","nodeType":"text"},{"data":{},"marks":[],"value":"â NCV measures an electrical impulseâs conduction speed through a nerve.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Brainstem auditory evoked response testing (BAER) ","nodeType":"text"},{"data":{},"marks":[],"value":"â To detect whether your pet has hearing loss, BAER measures brain wave activity in response to clicks or certain tones.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Magnetic resonance imaging (MRI) ","nodeType":"text"},{"data":{},"marks":[],"value":"â MRI uses a magnetic field and computer-generated radio waves to create detailed brain and spinal cord images. BVNS offers on-site MRI at our full-service locations.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Computed tomography (CT) ","nodeType":"text"},{"data":{},"marks":[],"value":"â A CT scan uses specialized X-ray equipment to produce cross-sectional body images.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"}],"nodeType":"unordered-list"},{"data":{},"content":[{"data":{},"marks":[],"value":"Neurologic conditions in pets are concerning, and you should consult with a trained veterinary neurologist if your pet has neurologic disease signs. If you have concerns about your petâs neurologic health, ","nodeType":"text"},{"data":{"uri":"/contact-us"},"content":[{"data":{},"marks":[],"value":"contact","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":" the ","nodeType":"text"},{"data":{},"marks":[{"type":"bold"}],"value":"BVNS","nodeType":"text"},{"data":{},"marks":[],"value":" team nearest you, so we can ensure they receive the expert care they need.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}}
1007,"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"6QYaFyRbqtjutMsTIsp0xX"},"name":"IMAGE CONTAINER - NVA - MASTER - BLOG - CLINIC - Veterinarian Holding a Gray Cat","title":null,"altText":"Veterinarian Holding a Gray Cat","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - NVA - MASTER - BLOG - CLINIC - Veterinarian Holding a Gray Cat","url":"https://images.ctfassets.net/rt5zmd3ipxai/5gJJASKAaqFKaaDy68YyLq/157d469e06e6c29561b4f3b0d8b07836/blog.jpg","size":161570,"width":1255,"height":685,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null}]}},{"__typename":"PromoBanner","sys":{"__typename":"Sys","id":"6Ds6uZfCuLlLtAaxttwEBF"},"name":"PROMO BANNER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Neurotransmitters Case Studies","fontColor":"Light","anchorLink":null,"categoryTitle":null,"linkedFrom":{"__typename":"PromoBannerLinkingCollections","templateDynamicLayoutPageCollection":{"__typename":"TemplateDynamicLayoutPageCollection","items":[{"__typename":"TemplateDynamicLayoutPage","sys":{"__typename":"Sys","id":"vifQlLdaeq3NrS69bZytq"}},{"__typename":"TemplateDynamicLayoutPage","sys":{"__typename":"Sys","id":"5vga3JvIufZgqBIl2pKbYs"}}]}},"backgroundImage":null,"overrideBackground":{"__typename":"OverrideBackground","backgroundId":"#0E4C8C","colorBackground":"#0E4C8C","colorVariable":null,"imageBackground":null,"imageBackgroundEntry":null},"headline":"Neurotransmitters Case Studies","subheadline":null,"textBlock":null,"cta":null,"multipleCtaCollection":{"__typename":"PromoBannerMultipleCtaCollection","items":[]},"customCode":null},{"__typename":"BlogBlade","name":"BLOG BLADE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Neurotransmitters Case Studies","anchorLink":null,"itemsCollection":{"__typename":"BlogBladeItemsCollection","items":[{"__typename":"Blog","featured":false,"title":"Boudreaux","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Boudreaux","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Boudreaux is a 4 year old male neutered Papillion that the owners brought to BVNS for recurrent back pain. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Boudreaux is a 4 year old male neutered Papillion that the owners brought to BVNS for recurrent back pain. He had several past episodes of having a hunched back, walking slowly and exhibiting signs of pain. Each episode responded to rest and pain medications. The family veterinarian had performed general lab work and radiographs of the thoracolumbar spine with no apparent abnormalities. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting complaint","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Recurrent back pain","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Examination Abnormalities and Localization","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Boudreauxâs general physical examination was within normal limits. On neurologic exam his gait, cranial nerve exam, reflexes and mentation were all normal. He did, however, experience moderate pain on direct palpation of the cervical spine and mild pain in the lumbar spine.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Possible differential diagnoses for a dog of this breed and age included: 1) Intervertebral disc extrusion, 2) Inflammatory disease (i.e. meningitis â infectious or auto immune), 3) Malformations (i.e. Caudal Occipital Malformation Syndrome, Atlanto-Axial subluxation), 4) Neoplasia (less likely).","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Because of the recurrent back and neck pain, an MR
1007I of the thoracolumbar and cervical spine was recommended. Pending those results a spinal fluid analysis was also recommended.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The MRI of the thoracolumbar spine was performed first and did not reveal any significant abnormities other than degenerative intervertebral discs without evidence of herniation. No obvious cause of the back pain was found.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The MRI of the cervical spine revealed a markedly widened C1-C2 joint space. The cranial aspect of C2 was tipping dorsally causing compression of the spinal cord. The dens on C2 appeared to be hypoplastic. Additionally, there was mild hyperintensity noted within the spinal cord near the area of compression that most likely represented edema or scarring from chronic compression. These MRI findings were consistent with an Atlanto-Axial (A-A) subluxation with subsequent spinal cord compression.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Given the severity of the MRI findings and Boudreauxâs neurologic status, surgical stabilization of the A-A joint was recommended. Several factors are considered in determining the prognosis with surgical stabilization:","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Age","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" - younger patients tend to do better than older patients","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Length of time symptoms have existed -","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" chronic symptoms is a negative prognostic indicator","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Severity of neurologic status ","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":"- dogs that are currently ambulatory tend to do better","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Size of dog ","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":"- very small dogs can be difficult to stabilize","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Because of the sensitive region of the nervous system involved with this type of problem, surgical mortality rates can be as high as 25-40%. Nevertheless, given Boudreauxâs current status, we felt that surgical stabilization was the preferred method of treatment and that his prognosis would be good. The owner agreed and surgery was scheduled. The alternative would have been to place Boudreaux in a neck brace for 8-10 weeks. While this is a viable option, neck braces are inherently difficult to place and frustrating to maintain. They are often placed incorrectly, slip, become soiled and need to be frequently changed. The bulk of bandage needed to truly stabilize the A-A joint can often interfere with eating and drinking.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"There are several ways to surgically stabilize the A-A joint. In this case, we reduced the luxation by using bone forceps to pull C2 ventrally. We then placed 2 threaded pins dorsal-laterally through the A-A joint from a ventral approach. Several small cortical screws were also placed in various locations in the ventral aspect of C1 and C2. These screws
1007were then incorporated into bone cement to help hold the fixation. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Itâs been about 9 months since his surgery and he has remained pain free and is off all medications. Repeat radiographs were performed about 3 months after surgery and all implants were in their proper location. Even though Boudreaux didnât know how to express his thanks, his owners were very happy with his outcome.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take Home Points","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Donât exclude A-A luxation as a differential in adult dogs.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Dogs with cranial cervical malformations (AA luxations, Chiari malformations) often will have spinal pain in areas other than their neck (i.e. back). Changes in spinal fluid dynamics and pressure can account for this pain.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"An A-A luxation is occasionally just one part of a combination of concurrent cranial cervical malformations. Sometimes, multiple advance imaging studies such as MRI, flexed and extended CT scans, and 3D reconstructions are needed to gather the full clinical picture.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Several factors determine the prognosis with surgical management. Every patient is evaluated separately.5 â Surgical management is typically the best way to manage this problem. Neck braces can be used but are inherently cumbersome, frustrating and cause numerous potential complications.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"This case was referred by Dr. Bethany Birch of Banfield of Alexandria. For more information or to discuss this case please contact","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":" Dr. Brewer","marks":[],"data":{}}]},{"nodeType":"text","value":" or ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":"Dr. Jarboe","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"4bRmNpCKXGK2iOsv4tHR62"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Boudreaux","title":null,"altText":"Boudreaux smiling in a cone","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Boudreaux","url":"https://images.ctfassets.net/rt5zmd3ipxai/WIzjd3s5cbOXR8AjHk
1007hYr/6308f1dc16cb8e549295273610efec25/Picture11-293x300.png","size":157936,"width":293,"height":300,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Hobbes","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Hobbes","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Hobbes is a 2-year-old Weimaraner who presented to our Springfield location in August 2010. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hobbes is a 2-year-old Weimaraner who presented to our Springfield location in August 2010. Cerebrospinal fluid analysis (CSF) revealed severe neutrophilic pleocytosis and treatment with antibiotics and immunosuppressive doses of steroids were initiated.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"History","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Episodes of fever (104-105), not eating, unwilling to move, intermittent lameness that would last for 10-14 days and resolve while on Rimadyl. A neurologist from a different institution had examined him already and not found any specific deficits.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Examination Abnormalities and Localization","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Neck pain appreciated by reduced range of motion in all directions as well as discomfort demonstrated during lumbosacral palpation. Due to the presence of fever, inflammatory or infectious disease of the meninges or the bone/muscle/nerve of the spinal column was considered most likely. More specifically, we considered steroid-responsive meningitis arteritis, bacterial or fungal diskospondylitis, GME, or infectious meningomyelitis to be highly likely.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Radiographs of Hobbesâs cervical and lumbosacral spine were normal and showed no signs of diskospondylitis. Hobbes was placed under general anesthesia and a spinal tap was performed.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hobbesâs CSF showed a severe neutrophilic pleocytosis (elevated neutrophils in the CSF) and an elevated protein. These findings as well as Hobbesâs signalment were consistent with sterile meningitis, also known as steroid-responsive meningitis arteritis. However, infection could not be ruled-out so Hobbes was started on doxycycline, clindamycin and immunosuppressive doses of corticosteroids.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnosis","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cerebrospinal fluid bacterial culture, toxoplasma/neospora and a PCR tick panel were found to be normal, as a result antibiotics were later discontinued. The C-reactive protein (CRP) was markedly elevated at 60 mg/dL. These findings, coupled with his signalment, history and response to medications (see below), provided for a diagnosis of steroid-responsive meningitis arteritis (SRMA).","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"On recheck examination one month later, Hobbes was pain free, afebrile and back to his normal self at home. A follow-up C-reactive protein was submitted and was normal at 0.1 mg/dL. Hobbes was continued on his tapering course of steroids and received a total of 8 weeks of therapy. He later relapsed based on examination and an elevated CRP and is now well controlled on cyclosporine.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take Home Points","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In a large breed and young dog (typically 8 months of age or older) exhibiting a waxing and waning fever, examine for neck pain and be highly suspicious of SRMA. The Boxer, Bernese Mountain Dog, Great Pyrenese and Newfoundland are at a particularly high risk.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Elevated neutrophils in the CSF (neutrophilic pleocytosis) are common in autoimmune and infectious conditions of the spinal cord. Infectious disease testing and a trial with antibiotics are recommended under these conditions.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"C-reactive protein (CRP) is a marker of inflammation and is typically elevated in dogs with SRMA. This is a very useful test for assisting in the diagnosis of SRMA and documenting relapse of this condition.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In addition to prednisone, immune-modulating drugs like cyclosporine, azathioprine, leflunomide or mycophen
1007olate can also be effective in the treatment of SRMA.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"To discuss this case or to ask a question related to this case please email","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":" Dr. Neary","marks":[],"data":{}}]},{"nodeType":"text","value":". This case was referred by Dr. Tracy Appelbaum of ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://www.rockygorgevet.com/"},"content":[{"nodeType":"text","value":"Rocky Gorge Animal Hospital Resort \u0026 Spa","marks":[],"data":{}}]},{"nodeType":"text","value":". Hobbes was seen by Dr. Tiches and Dr. Neary.","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"4ns6QKxDF09uZk3stsfawY"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Hobbes","title":null,"altText":"Woman in a blue shirt smiling next to Hobbes, a Weimaraner","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Hobbes","url":"https://images.ctfassets.net/rt5zmd3ipxai/2lligfLbDCXTqGhK5kGsgx/b384ae19923a5bcff9b975fe2b781eef/Hobbes-Owner-Picture-Edit-1024x772.jpg","size":131044,"width":1024,"height":772,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Max","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Max","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Max is a 19 year-old, male castrated mixed breed that presented to BVNS for circling and a head tilt. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Max is a 19 year-old, male castrated mixed breed that presented to BVNS for circling and a head tilt. He was diagnosed with two meningiomas and ten months later he is thriving at home.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting Complaint","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"One month lethargy, 4 days of stiffness after walks, not jumping into the car and suddenly circling to the right, head tilt right.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Examination Abnormalities and Localization","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Max had a right head tilt, fast phase nystagmus to the left, and would lean and fall to the right but also make large circles to the right. His right eye was droopy, the third eyelid was prolapsed and he did not menace well on the right. A central vestibular problem was likely due to the poor menace with a normal palpebral response. However, a poor menace response and large radius circling can indicate forebrain dysfunction. Therefore disease in more than one area was also considered.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MRI of the brain showed a large, right-sided mass at the level of the pons and a second mass in the left olfactory lobe.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The characteristics were the most compatible with TWO meningiomas. However, lymphoma or a fungal infection called Cryptococcus were also considered. A CSF analysis was inconsistent with lymphoma and Cryptococcus antigen testing was negative, therefore Max was diagnosed with TWO meningiomas.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Palliative or symptomatic treatment with prednisone allowed Max to do so well that definitive treatment was considered. BVNS worked with Dr. Rick Joseph and Dr. Sarah Charney at the Animal Specialty Center in Yonkers, New York to obtain ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://www.vcaspecialtyvets.com/animal-specialty-center/departments-doctors/departments/radiation-oncology"},"content":[{"nodeType":"text","value":"cyber knife radiation treatment","marks":[],"data":{}}]},{"nodeType":"text","value":" for Max. This technologically advanced form of radiation therapy can direct the radiation such that larger doses of radiation can be given per treatment, reducing the number of anesthetic episodes from 15 to 3.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Max is currently about six months out from his radiation and is doing well. We received this update from his family recently: âMax is still doing fantastic! â¦chasing bikers, joggers, deer and puppy wrestling. His hearing is good, sight seems very good too. He sleeps very well and is alert and active when heâs awake. Heâs walking 1-2 miles/day, and back to playing with stuffed animals and throwing them around, and playing with squeaky toys (He can hear them again!).â While Max was in Yonkers he met another dog who was twenty-four years old and was going in his for second round of radiation therapy four years after his first treatment of a meningioma, and was otherwise happy and healthy.We are thrilled with Maxâs progress and look forward to hearing more positive updates from his family in the future.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take Home Points","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Patients with head tilt + poor menace and a normal blink reflex have disease within the brain and therefore do not have Old Dog Peripheral Vestibular Disease. Furthermore, when the signs just do not seem to fit, often more than one lesion
1007is present or at a minimum the disease is within the brain rather than Old Dog Peripheral Vestibular Disease.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Meningiomas are the most common type of primary brain tumor in cats, dogs, and humans. Surgery and/or full course radiation have been the mainstay of treatment. Technological advances and research are providing excellent long term outcomes with a high quality of life in many patients.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"BVNS strives to offer as many treatment options as possible and partners with many different experts nationwide. Current treatment options and average survival times are as follows.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Steroid alone - 3 months","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Steroid + Hydroxyurea - 6 months","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Conventional surgery - 10 months","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Full course radiation or cyberknife - 12-14 months, may be longer with cyber knife","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Surgery + Autologous Vaccine - pilot date shows 75% of dogs alive 600 days post-treatment","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"BVNS is working with Dr. John Ohlfest at the University of Minnesota","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://www.braintumorlab.com/"},"content":[{"nodeType":"text","value":" Brain Tumor Lab","marks":[],"data":{}}]},{"nodeType":"text","value":" where the patientâs meningioma is developed into an intradermal vaccine that is then administered along with a topical immunostimulant every 2 weeks for 12 weeks. The patients we have treated had complete excisions of their tumors prior to vaccine and are doing exceedingly well.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"To discuss this case or to ask a question related to this case please email Dr. Young. Case referred to BVNS by Dr. Renee Welch at the ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://www.acah.com/"},"content":[{"nodeType":"text","value":"Andersonâs Corner Animal Hospital","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"51Jg7ssTKaJvdEjGXoVpxT"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Max","title":null,"altText":"Max, mixed breed dog, outside standing on leaves","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Max","url":"https://images.ctfassets.net/rt5zmd3ipxai/71q9xx9hrkOvPFuUNMpxl3/f7ac63f0ca3b4ae39ae0b22d2d353fde/max1.jpg","size":126289,"width":524,"height":504,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Prinz","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Prinz","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Prinz is a 9-year-old German Shepherd mix referred to BVNS for an inability to walk in the hind legs and severe back pain of less than 24 hours duration. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Prinz is a 9-year-old German Shepherd mix referred to BVNS for an inability to walk in the hind legs and severe back pain of less than 24 hours duration. The prior afternoon, Prinz had been playing ball. He jumped to catch the ball, and upon landing, cried out, and was immediately paralyzed in the back legs. Over the next 15 minutes, he regained movement in the back legs but was unable to walk. He continued to be extremely painful, even biting his owner when they tried to help him, very atypical behavior for him as heâs normally a lover and very playful. He was rushed to an animal emergency hospital and treated supportively with anti-pain medications, NSAIDs, and fluids.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting Complaint:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Peracute paraplegia (loss of conscious movement in the pelvic limbs) and severe back pain after a jump while playing ball.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Slightly improved neurologic grade, non-ambulatory paraparesis (conscious movement present in the pelvic limbs but unable to walk) and continued intense pain de
1007spite analgesics (anti pain medications).","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Assessment (Neurolocalization):","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Severe non-ambulatory paraparesis, absent postural and placing responses in the pelvic limbs, brisk spinal reflexes with intact superficial pain perception, cutaneous trunci reflex present cranial to T12 on the left and present cranial to L1 on the right, left sided muscle spasms and discomfort extending from T12 to L4/L5.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Prinzâs deficits localized to a left lateralizing T3-L3 myelopathy with the primary differentials being a Type I or Type III disc extrusion.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Spinal radiographs taken by the emergency hospital revealed predominant finding of a subtle narrowing of the T12-T13 intervertebral disc space.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"An MRI of the thoracic to sacral spine was performed. E
1007xtra-dural hemorrhagic material was dispersed along the left canal extending from T11 to T13 causing mild cord deviation towards the right of the canal. Nearly 75% of the spinal cord parenchyma, slightly left lateralizing but predominantly central in distribution, demonstrated increased T2W signal consistent with edema, dorsal to the T12-T13 disc space. The left paraspinal muscles extending from T9 to L2 were diffusely swollen and edematous.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"These findings were most consistent with a high velocity, low volume disc extrusion at T12-T13 and likely concurrent neurogenic myositis or vasospasm with infarction to the left paraspinal musculature.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"A left hemilaminectomy was performed from T11 to T13. Upon fascial incision, the left paraspinal muscles everted out the incision margins and were grossly swollen, edematous, and pale. Biopsies were obtained of the abnormal musculature. Upon entry into the canal, the epidural adipose tissue was discolored and intermixed with hemorrhagic material. Tannish fluid like material was removed from the ventral canal dorsal to the T12-T13 disc space. Samples of each were also submitted for histopathological evaluation. Cultures were also collected and submitted. The venous sinus structures lining the floor of the canal were dilated and pulsating. Histopathology results demonstrated myofiber necrosis with neutrophilic inflammation and mineralized cartilage removed from the spinal canal samples. Cultures were negative for bacterial growth.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnosis:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hansen Type III disc extrusion (high velocity, low volume) at T12-T13 causing internal cord injury and secondary inflammatory muscle necrosis.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Prinz recovered to his normal, active, happy self over the following days and was discharged several days later so he could travel with his family to California where they had recently been stationed. We continue to receive updates from the ownerâs regarding Prinz and his life as a âbeach dogâ! We remain humbled by Prinzâs endearing zest for life and for his military family serving our country.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take Home Points:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Review of the three primary classifications of Intervertebral Disc Disease:","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hansen Type I: an acute extrusion, under varying velocities, of the nucleus pulposus (inner portion of the disc, normally gelatinous but can become rock like when degeneration occurs) causing moderate to severe cord compression. Often requires surgical intervention to remove compressive elements and continued cord injury. If the disc material ruptures under high velocity forces,internal cord injury occurs. Less than 1% of patients will develop life ending myelomalacia up to 5-7 days following the injury, despite emergent surgical decompression. MRI often helps identify significant intraparenchymal cord injury and can better help predict prognosis following surgical decompression.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hansen Type II: a slow, chronic protrusion or prola
1007pse of the dorsal annulus (ligamentous structure surrounding the nucleus pulposus) into the spinal canal causing slow compression of the spinal cord. One caveat is an âacute on chronic discâ presentation where acute decompensation can occur. If the spinal cord impacts/strikes a mound of protruding dorsal annulus, severe internal cord injury can occur resulting in rapid decompensation.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hansen Type III: a high velocity or âexplosiveâ, low volume disc extrusion causing severe internal cord injury. Also referred to as acute non-compressive nucleus pulposus extrusion or ANNPE. If severe enough, myelomalacia, a potentially fatal break down process of the spinal cord, can occur up to 5-7 days from the injury.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"To ask a question related to this case or discuss any aspect of it please email ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":"Dr. Jarboe","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Case referred to BVNS by Dr. Roque Pereira at the ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://www.aecfred.com/"},"content":[{"nodeType":"text","value":"Animal Emergency Clinic of Fredericksburg","marks":[],"data":{}}]},{"nodeType":"text","value":", Prinzâs primary care veterinarian is Dr. Gary Dunn at ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://www.woahvets.com/"},"content":[{"nodeType":"text","value":"White Oak Animal Hospital","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"375UkvHsdtEUjuLrOX8Dlj"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Prinz","title":null,"altText":"Two people smiling next to Prinz, a German Shepherd mix","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Prinz","url":"https://images.ctfassets.net/rt5zmd3ipxai/426qXuXmFlwEsaBYZT68Ch/d4b24babf0c274b19f1493a93d64e493/Prinz-300x224.png","size":128960,"width":300,"height":224,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Tiki","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Tiki","blogAuthor":null,"blogDate":null,"url":"tiki","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Tiki is a 4 year-old spayed female Maltese referred to Bush Veterinary Neurology Service after one week of 30-60 second episodes of lethargy, shaking and keeping her head down. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Tiki is a 4 year-old spayed female Maltese referred to Bush Veterinary Neurology Service after one week of 30-60 second episodes of lethargy, shaking and keeping her head down. She became progressively worse, started crying out during the episodes and would intermittently circle to the left.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The owner brought a video of the episode, which showed a two-minute episode of vestibular ataxia, mild left head tilt and holding her head down. Tiki would also hold her right pelvic limb up during the episode and appeared alert and aware (would wag her tail when the owner called her name). Immediately after the episode, Tiki moved normally. Neurologic examination showed evidence of an abnormality in the caudal fossa (caudal cerebrum and cranial brainstem), lateralized to the left. Her intermittent episodes were most likely due to an increase in intracranial pressure, rather than seizure activity.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"An MRI of the brain was consistent with diffuse encephalomyelitis and cerebellar herniation. A cerebrospinal fluid anal
1007ysis was recommended to confirm the diagnosis for inflammatory disease, but considered of increased risk due to the foramen magnum herniation. Despite concerns for her long-term prognosis (due to how severe the changes seen on her MRI and her progressive clinical signs) she has continued to do well on medications.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting Complaint:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Increasing frequency of episodes of keeping her head down and mental dullness, lethargy, decreased appetite, and circling to the left.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Assessment (Neurolocalization):","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Left lateralized caudal fossa","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"1. Dull mentation\n2. Tendency to hold head and neck down\n3. Circling to the left\n4. Vestibular ataxia, with intermittent crossing in all four limbs\n5. Decreased placing reactions in the left limbs\n6. Pain on palpation over the head","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"An MRI of the brain shows moderate enlargement of all ventricles and a non-contrast enhancing hyperintensity within the cervical spinal cord parenchyma. On the post contrast T1W post sagittal image, the caudal aspect of the cerebellum was herniated through the foramen magnum.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Tiki was administered mannitol (1g/kg) intravenously after her MRI to decrease intracranial pressure. Due to her signalment, examination and MR findings, we were most suspicious of an immune-mediated meningioencephalitis, specifically granulomatous meningioencephalitis (GME). Tiki was admitted to the hospital for empirical therapy for her inflammatory disease. She was started on steroid medication (prednisone 0.5mg/kg PO q12h) and immunomodulatory medication with a CRI of intravenous cytarabine (Cytosar) over 48 hours and cyclosporine (5mg/kg PO q12h). She was also placed on famotidine (0.5mg/kg) for gastroprotection while on the steroid. Tiki was discharged from the hospital two days later with an improved neurologic examination (less compulsive circling, mild ataxia and improved postural reactions).","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In the few months after her hospitalization, Tiki has shown progressive improvement and is now neurologically normal. She has not required any additional cytarabine therapy and is currently being maintained on daily cyclosporine and a low dose of steroids, which we have been tapering slowly over the past several months. We suspect that due that her prognosis is good, though relapse in patients with immune-mediated inflammatory central nervous system disease is always possible.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take Home Points:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Having clients videotape episodic neurologic abnormalities can be helpful when considered along with the history and neurologic examination in determining a patientâs neurolocalization. This is especially true in cases like Tikiâs, where the neurologic examination is normal between episodes.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cerebellar herniation is a dynamic process and is observed in patients with an increase in intracranial pressure.\n","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The prognosis for immune-mediated brain disease like GME was once poor but with the advent of new medications and protocols, the prognosis is much better. A recent retrospective showed that 60% of dogs were normal and the other 40% much improved on azathioprine, the dogs in this study had an average survival of almost 6 years. At BVNS we use prednisone to manage the acute symptoms but try to replace this medication with immune modulators like azathioprine, cyclosporine, leflunomide and/or chemotherapies like cytosar, procarbazine, and lomustine.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"To ask a question related to this case or discuss any aspect of it please email ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":"Dr. Hague","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"A special thank you to Dr. Jennifer Lauer at the ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://www.pendervet.com/"},"content":[{"nodeType":"text","value":"Pender Veterinary Center","marks":[],"data":{}}]},{"nodeType":"text","value":" who referred this case. Dr. Lauer is an Ohio State University classmate of Dr. Hagueâs and is now practicing at ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://vverc.com/"},"content":[{"nodeType":"text","value":"Valley Veterinary Emergency and Referral Center","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}}
1007,"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"3RpMfglC8PRJoRJoZ3L4O4"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Tiki ","title":null,"altText":"White maltese dog named Tiki ","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Tiki ","url":"https://images.ctfassets.net/rt5zmd3ipxai/6Ns37zsdCezjHUawA3m55C/09bfd8d5a550cf29c15889102435b56b/Tiki.jpg","size":69426,"width":524,"height":393,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Squirrel ","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Squirrel ","blogAuthor":null,"blogDate":null,"url":"squirrel","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Squirrel is a 10 year old, male, castrated cat that presented to BVNS for persistent, intermittent 15 second seizures (non-responsive, left side facial twitching progressing to generalized twitching, salivation) despite treatment with multiple doses of valium and 10 mg/kg of phenobarbital.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Squirrel is a 10 year old, male, castrated cat that presented to BVNS for persistent, intermittent 15 second seizures (non-responsive, left side facial twitching progressing to generalized twitching, salivation) despite treatment with multiple doses of valium and 10 mg/kg of phenobarbital. Squirrelâs examination suggested multifocal brain disease because there was a tendency to turn head to right, poor postural ability on right side, circling left, and a poor menace and poor palpebral response on the left. Infection, inflammation, or a neoplastic process were considered most likely. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Chemistry, CBC, and later, MRI, spinal tap, and infectious disease titers were all negative and treatment was initiated for infection (likely viral) and seizure. Squirrel was treated with zonisamide, levetiracetam, and phenobarbital as well as low doses of prednisolone and clindamycin. Thirty hours later he had the following story: ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting Complaint: ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Fever, confusion, dull, non-ambulatory, intermittent eyelid twitching, squinting, and right head turn. To view a video of Squirrel shortly after his admission at BVNS, visit our site: www.bvns.net/neurotransmitter. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Assessment: ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Mutlifocal brain disease was noted. Brainstem disease was suggested by weakness, dullness and poor palpebral response; right forebrain disease was suggested based on confusion and head turn. The patient was thought to be having a constant seizure (Status Epilepticus or SE) based on eyelid twitching and fever, however, there are many other causes for fever and eyelid twitching. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics: ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Dr. Mark Stecker, who is a physician, neurologist and world expert on EEG that has been helping Dr. Bush perform EEG for over 10 years, was asked to assist with Squirrelâs care. An electroencephalogram (EEG) was recorded (video at: www.bvns.net/neurotransmitter) in a double banana montage and read real time by Dr. Cuff, Dr. Bush and Dr. Stecker. Dr. Stecker remotely viewed the EEG in order to provide ongoing feedback and consultation. This allowed us to titrate treatment to the dissipation of epileptiform activity with 100 mg/kg of phenobarbital. Phenobarbital was selected because barbiturates are the most useful drugs in this situation in people as opposed to diazepam, propofol or levetiracetam. The patient was intensely monitored (end tidal CO2, blood gas, blood pressure, ECG) but did not require cardiorespiratory support during the 12 hour loading with phenobarbital. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome:","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Squirrel developed serious heart disease and azotemia while being treated for SE. A heart murmur had been noted 2 years ago and current thinking is that this disease may have become clinical due to administration of low doses of fluids and prednisone or possibly related to the cardiovascular effects of the diluent in phenobarbital (a phenomenon reported in the 1940âs in people). After 2 weeks of intensive care from the Critical Care Service at TLC, CVCA, and BVNS, Squirrel was healthy enough to go home. Here he is pictured with the owners and Dr. Cuff. Squirrel is about 2 months out from his presumed severe viral brain problem and doing very well. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take Home Points","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": ","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Status Epilepticus leads to death of inhibitory neurons, release of excitatory neurotransmitters and generates other pockets of abnormal electrical activity (kindling) leading to more seizure and occasionally death. ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Patients can have active severe EEG seizure without any autonomic signs (salivation, urination, defecation, pupil dilation or constriction) and without obvious muscle movement. ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment of SE, ideally guided by the EEG, can require very high doses of phenobarbital. ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}}
1007,"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"2Qzta2JZHIT0sXhGY8mEUV"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Squirrel ","title":null,"altText":"Squirrel the cat surrounded by doctors ","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Squirrel ","url":"https://images.ctfassets.net/rt5zmd3ipxai/2IzuPqdsbt7WCTfMlJOvlk/7f6e89d618cc7a31cb766b7497812c85/Squirrel-lg11.jpg","size":186831,"width":524,"height":359,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Dallas","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Dallas","blogAuthor":null,"blogDate":null,"url":"dallas","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Dallas is a 3-year-old Beagle that presented to our Springfield location for back pain and the inability to walk in the rear limbs. ","marks":[],"data":{}}]}]}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Dallas is a 3-year-old Beagle that presented to our Springfield location for back pain and the inability to walk in the rear limbs. On examination, Dallas had no motor ability in the left rear limb and minimal ability to move the right rear and cranial lumbar back pain. Dallas was treated for several days prior to referral with a combination of NSAIDs, muscle relaxants and analgesics, but his signs worsened. Eight months prior to this presentation, Dallas had a left hemilaminectomy performed by Dr. Bush for a herniated L5-6 disc and made a full recovery. MRI showed a right-lateralized herniated disc and extra-dural hemorrhage extending from L2 to the middle of L4. There was a concern that the area of compression overlapped the previous surgery site and instability of the spine would result in a poor long term prognosis.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Presenting Complaint:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"⢠Unable to walk, painful\n⢠Paralysis of the left pelvic limb, weak on the right pelvic limb","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Neurolocalization:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"⢠Left side T3-L3 spinal cord disease evident from paralysis and back pain.\n⢠Absent left patella reflex with increased cranial tibial and gastrocnemius reflexes indicates involvement of the L4-5 segments.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Diagnostics:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"⢠High-field MRI shows herniated disc material and blood clots severely compressing the spinal cord from L2 to mid-L4 on the right side.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Outcome:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"A hemilaminectomy was performed from L1-L5 on the right, dorsal laminectomy at L5 to accommodate for compression as a consequence of past hemilaminectomy on the left. In effect, 3 sides of the box that contains the spinal cord were removed leaving only the base of the box to support the spine. Dallas showed rapid improvement and began to move his left hind limb two days post-operatively. At his 2 week recheck, he was pain-free and ambulatory without assistance.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Take Home Points:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"blockquote"},{"data":{},"content":[{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Neurological grade and MRI findings are the best indicators of success with surgery.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"A decreased patella reflex can help to localize the spinal cord lesion in patients with rear limb paralysis.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"The odds of recovery and recurrence are no different in a patient that has already recovered from a previous spinal surgery compared to patients undergoing spinal surgery for the first time.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Bilateral hemilaminectomy and removal of dorsal spinous processes can result in a positive clinical outcome without clinically relevant spinal column instability.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"}],"nodeType":"ordered-list"},{"data":{},"content":[{"data":{},"marks":[],"value":"This case was referred by ","nodeType":"text"},{"data":{"uri":"http://www.friendshiphospital.com/"},"content":[{"data":{},"marks":[],"value":"Friendship Hospital for Animals","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":".","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}}
1007,"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"4gfj2i9rxCKOhFllHs0lx"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Dallas","title":null,"altText":"Vet holding dog named Dallas ","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Dallas","url":"https://images.ctfassets.net/rt5zmd3ipxai/dIcSX6PKSx7syMqX8eLPt/854e27f3dfb85a72fde6339617b161b2/dallas-hires.jpg","size":169514,"width":524,"height":635,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Cooper ","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Cooper ","blogAuthor":null,"blogDate":null,"url":"cooper","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Cooper is a 9 year old Airedale Terrier referred to BVNS for the inability to walk and severe neck pain. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Cooper is a 9 year old Airedale Terrier referred to BVNS for the inability to walk and severe neck pain. The pain had been intermittent for 3 weeks and acutely worsened two days before presentation. Cooper had also been having difficulty rising and was non-ambulatory at the time of presentation.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Presenting Complaint:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"⢠3 weeks progressive neck pain which became severe\n⢠2 days progressive weakness in all 4 limbs resulting in an inability to rise upon admission\n⢠Depressed and inappetent","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Assessment (Neurolocalization):","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"⢠Non-ambulatory with severe tetraparesis; low head and neck carriage; proprioception slow in the thoracic limbs and absent in the pelvic limbs; hopping absent in all limbs; intense pain response with palpation of the cranial cervical region (between the occiput and C2); distended urinary bladder.\n⢠Cranial cervicalmyelopathy with primary differentials being neoplastic, immune mediated or infectious disease process","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Diagnostics:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"⢠Bloodwork revealed leukocytosis and thrombocytopenia.\n⢠MRI of the cervical spine showed a paraspinal abscess, primarily right-sided in the C1 region with probable extension of the mass into the epidural space. There was also evidence of meningitis from the posterior fossa through C2-C3.\n⢠Fine-needle aspirate and cytology revealed cocci and neutrophils (both present in quantities too numerous to count)","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Outcome:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Initial treatment with intravenous fluids, antibiotics and analgesics provided subtle improvement; however, Cooper remained non-ambulatory and the thrombocytopenia worsened. The decision was made to proceed with an exploratory surgery of the right paraspinal cranial cervical musculature together with a modified laminectomy of C1. Much of the tissue in the region was found to be necrotic and discolored. The abscess within the muscle was opened and flushed and a small tubular structure was removed from within; histopathology later revealed this to be foreign material resembling plant matter. After laminectomy, fibrin adhesions were detached from the dura and the spinal cord was decompressed. A drain was placed and Cooper was hospital
1007ized for several days after surgery for continued supportive care. At the time of release, Cooper was able to walk with minimal support and was able to move his head and neck with improved range of motion and comfort. He went on to show continued improvement and made a full recovery over the following weeks.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Take Home Points:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"blockquote"},{"data":{},"content":[{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":" Weakness and neck pain can be associated with cervical spinal cord disease.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Foreign body migration is an uncommon cause of spinal cord disease, but a favorable outcome can often be achieved with advanced diagnostics and surgical intervention.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"}],"nodeType":"ordered-list"},{"data":{},"content":[{"data":{},"marks":[],"value":"Case referred by Dr. Meryl Lessinger at the ","nodeType":"text"},{"data":{"uri":"https://vcahospitals.com/merrimac"},"content":[{"data":{},"marks":[],"value":"Animal Clinic and Wellness Center","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":" in Williamsburg, VA. For more information or to discuss this case please email ","nodeType":"text"},{"data":{"uri":"mailto:[email protected]"},"content":[{"data":{},"marks":[],"value":"Dr. Jarboe","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":" or ","nodeType":"text"},{"data":{"uri":"mailto:[email protected]"},"content":[{"data":{},"marks":[],"value":"Dr. Cuff","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":". ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"5VrerpRMLtHUdwnFmsHycr"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Cooper ","title":null,"altText":"Cooper the dog in front of a brick wall ","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Cooper ","url":"https://images.ctfassets.net/rt5zmd3ipxai/5ctjsvRlbdcLuvWRb98fP/8ef20bf65a674ec4ce68b69230d45b8b/Cooper-727x1024.jpg","size":192371,"width":727,"height":1024,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"King ","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - King ","blogAuthor":null,"blogDate":null,"url":"king","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"King is a 12 year old mixed breed referred to BVNS for the inability to get up. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"King is a 12 year old mixed breed referred to BVNS for the inability to get up. Kingâs story started 9 years ago when he was rescued by the current owners after surviving being dragged behind a truck on a highway.When referred King was unable to get up when laying on his side and once assisted to rise he would cross over his back legs, knuckle them and was drunk and weak on the back legs. He was also stiff in his low neck and taking little short steps on the thoracic limbs. King had been examined 1 year ago for back pain and the current problem started 2 months ago. He had not been able to get up for the last 5 days and his symptoms were unresponsive to medication. Examination supported a neck problem and MRI showed a tumor was severely pressing on the spinal cord. There was a concern that surgery may not remove all of the tumor, the tumor would come back, or that King would never regain the ability to walk, even with surgery. Below is a summary of the case:","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting Complaint:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"⢠Unable to rise when laying on his
1007side, progressive weakness and ataxia of pelvic limbs (PL), short strided and crossing of the thoracic Limbs (TL)","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Assessment (Neurolocalization):","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Low cervical spinal cord disease evident:","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"1. Pelvic limbs were weak, long strided, high stepping, circumducting and had poor proprioception,\n2. Thoracic limbs are short strided,\n3. Neck held in a persistently flexed position.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"High field MRI pre- and post-surgery performed showing a tumor invading the spinal canal and severely compressing spinal cord segments C6 and C7.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Owners opted for surgery knowing that prognosis was good for a return to function but potentially poor for maintenance of long term function. Post-operative MRI shows reduction of tumor to microscopic disease and biopsy showed synovial myxoma. Five days after surgery King was stronger, playful and much improved from pre-surgery status. Biopsy revealed the tumor to be a synovial myxoma which is a slow growing benign tumor and the prognosis is thought to be good.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take Home Points:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Patients with low cervical spinal cord are short strided on the TL, hold their head flexed and are long strided, weak and ataxic on the PL. Neck pain is not always obvious or present.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Surgery can be effective at rapidly improving clinical signs and producing good long term outcomes even when there is severe compression from a tumor.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Performing a MRI after surgery and while still under anesthesia is useful in assessing decompression, tumor resection, and prognosis.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Case referred to BVNS by Dr. Steven Skinner at the ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://hartfieldanimalhospital.com/"},"content":[{"nodeType":"text","value":"Hartfield Animal Hospital","marks":[],"data":{}}]},{"nodeType":"text","value":". For more information or discuss this case please email ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":"Dr. Bush","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"7kAE18prbyaAepDmAG2hC8"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - King","title":null,"altText":"King the dog sitting in grass","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - King","url":"https://images.ctfassets.net/rt5zmd3ipxai/4G4P8VnzaZpItq9WbyYxK3/e2fe409bf8d4d778a8b419b2cf6ba0b6/King_web.jpg","size":15600,"width":250,"height":188,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Lucy","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Lucy","blogAuthor":null,"blogDate":null,"url":"lucy","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{}
1007,"marks":[],"value":"This morning Lucy was discovered in her crate with large amounts of saliva, urine and feces. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Lucy is a 3 year-old, FS, Shih Tzu referred by Animal Emergency \u0026 Critical Care and Dr. Dove of Companion Animal Clinic.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting complaint/History","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"This morning Lucy was discovered in her crate with large amounts of saliva, urine and feces. She was twitching, unsteady when she walked and had a glazed appearance. The emergency clinic noted profuse salivation and twitching and treated for possible organophosphate toxicity with atropine, anti-emetics and methocarbamol. Lucy was transferred later that day for progressive twitching on the right more than left-side and right side postural deficit.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Lucy was thought to be having a seizure-like episode or\npossibly a non-convulsive seizure. The underlying cause was\nthought to be inflammation or infection of the brain.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"EEG showed that Lucy was having constant right-side seizure or non-convulsive status epilepticus (NCSE).In-house MRI showed a left forebrain inflammatory lesion while in-house CSF analysis and infectious disease testing were normal.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In house MRI: Blue arrow shows increase T2 signal (inflammation) in the left parietal lobe. This is the motor area for the right side of the body which explains the right side twitching seen on the video.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnosis","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Meningoencephalitis of Unknown Etiology (MUE) manifested as non-convulsive status epilepticus.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"NCSE was treated with Keppra 60 mg/kg IV in addition to about 20 mg/kg of phenobarbital. MUE was treated with dexamethasone 0.2 mg/kg, BID, Cytosar 200 mg/M2 CRI and cyclosporine 6 mg/kg, BID.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Lucy made a rapid recovery and was sent home 3 days later on prednisone 0.5 mg/kg, BID, cyclosporine 6 mg/kg, BID\nand zonisamide 10 mg/kg, BID. Happily Lucy remains well 9 months after her diagnosis on every other day prednisone, cyclosporine and zonisamide every other day.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take Home Points:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"25% of dogs (and people) in Convulsive Status Epilepticus will die from that disease. Human patients with abnormal mentation and NCSE have an even worse prognosis.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"âTwitchyâ veterinary patients are common in veterinary medicine â many have encephalitis and NCSE. If these disease entities can be recognized and treated, a good outcome is likely. If these diseases are not recognized and treated, death is likely.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"BVNSâ clinical and research program using EEG has established that similar to human medicine, NCSE is an important and not uncommon disease entity. BE AWARE that all twitchy or dull dogs or cats may be having constant, global electrical seizure and require treatment.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Keppra 60 mg/kg IV and/or Phenobarbital 30-60 mg/kg, divided into doses of 6-8 mg/kg are recommended treatments stopping Convulsive or Non-Convulsive Status Epilepticus.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"For more information or to discu
1007ss this case please contact","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":" Dr. Bush","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"3k62nxMXmYvCDFQ0clPKk0"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Lucy","title":null,"altText":"Close up of Lucy the dog","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Lucy","url":"https://images.ctfassets.net/rt5zmd3ipxai/3oZIW3JrvrOe4yGzRdkAN6/2245e438596cae4d9158508b409ae012/Lucy-July-NT.jpg","size":53485,"width":550,"height":381,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Misty","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Misty","blogAuthor":null,"blogDate":null,"url":"misty","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Misty, an indoor / outdoor cat, was discovered non-responsive with dilated pupils. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Misty, a 12-year-old, Siamese, was referred by the","nodeType":"text"},{"data":{"uri":"http://www.vetreferralcenter.com/emergency-critical-care.htm"},"content":[{"data":{},"marks":[],"value":" Emergency Service","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":" of ","nodeType":"text"},{"data":{"uri":"http://www.vetreferralcenter.com/"},"content":[{"data":{},"marks":[],"value":"Regional Veterinary Referral Clinic","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":" in Springfield. Mistyâs primary care veterinarian was Dr. Lynn Gulledge at ","nodeType":"text"},{"data":{"uri":"http://www.kingstownecatclinic.com/"},"content":[{"data":{},"marks":[],"value":"Kingstowne Cat Clinic","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":".","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Presenting Complaint/History:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Misty, an indoor / outdoor cat, was discovered non-responsive with dilated pupils. She was rushed to the emergency service, resuscitated and presented to Dr. Bush 36 hours later for confusion, poor balance and behavior changes.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Exam Findings:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Misty was mildly confused, not feisty (unusual for her despite her angelic picture), side stepped when elevating her head while walking, had subtle right side placing deficits and dilated, non-responsive pupils with a normal retinal exam.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Localization / Assessment:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"A right forebrain lesion was suspected based on behavior changes and postural deficit, however the side-stepping and postural deficits along with pupil changes also supported a midbrain lesion. A brain problem was certain, but its exact location and whether it was one mass lesion or multifocal disease was less clear. The disease was a sudden onset and mildly improving so an infar
1007ct (stroke) was suspected; however, lymphoma, infection and a meningioma were also suspected.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Diagnosis Findings:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"MRI of the brain showed compression of the cerebellum indicating there was high brain pressure and brain herniation. There was increased T2 signal in the left piriform lobe consistent with a stroke, infection, or lymphoma. CSF analysis was performed to narrow the list of possible causes and demonstrated moderate inflammation with eosinophils, most consistent with parasitic infection.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Diagnosis:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"The sudden onset of signs and recovery along with MRI and CSF changes in an indoor/outdoor cat presenting in the northeast during the fall is most consistent with Cuterebra infection.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Pathogenesis:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Botfly eggs stick to the fur of small rodents and the larvae develop under the skin. In the cat, an abberant host, the larvae can take an atypical course and migrate from the nose into the brain. Inflammation, necrosis and vasospasm / stroke are common histopathological findings in this disease. The goals of treatment are to kill the larvae and eliminate an anaphylactic and inflammatory response as well as treat any secondary bacterial infection that may have occurred from the migrating larvae.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Treatment:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"1. Benadryl 4 mg/kg and then 2 hours later ivermectin on Day 1, Day 2 and then Day 4","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"2. Steroid therapy (we gave depo medrol 20 mg)","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"3. Baytril (antibiotic for bacterial infection from migrating parasite).","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Outcome:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Cats that do recover from this disease typically have behavior changes such as poor eating, aggression, seizure and loss of house training. Remarkably, Misty has returned to herself with the exception of no longer biting when getting restrained or her medication.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Take Home Points:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"blockquote"},{"data":{},"content":[{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Migrating Cuterbra larvae cause inflammation and stroke within the brain of indoor /outdoor cats in the fall generating rapid onset of clinical signs that can include seizure, behavior changes, coma, hypothermia and dilated pupils.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Signs can be recurrent and progressive due to continued larval migration. Treatment should be directed at killing the migrating larvae and treating the secondary inflammation and potential infection","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Many cats survive, however most are left with significant behavior changes and a diminished quality of life. Misty was lucky.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"}],"nodeType":"ordered-list"},{"data":{},"content":[{"data":{}
1007,"marks":[],"value":"For more information or to discuss this case please contact ","nodeType":"text"},{"data":{"uri":"mailto:[email protected]"},"content":[{"data":{},"marks":[],"value":"Dr. Bush","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":".","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"60qb1wJZD1r52PedA7inYR"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Misty","title":null,"altText":"Close up of Misty","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Misty","url":"https://images.ctfassets.net/rt5zmd3ipxai/Qw6KNGcZivUx4THojas2R/eadf4d7853e49b1784eeae8691f2c1fd/Misty-Duff-955x1024.jpg","size":139599,"width":955,"height":1024,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Riley","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Riley","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Riley, 2 year-old male Cocker Spaniel, was referred by Apple Valley Animal Hospital for left-side weakness and concern for spinal cord lesion.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Riley, 2 year-old male Cocker Spaniel, was referred by ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"https://www.applevalleypet.com/"},"content":[{"nodeType":"text","value":"Apple Valley Animal Hospital","marks":[],"data":{}}]},{"nodeType":"text","value":" for left-side weakness and concern for spinal cord lesion. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting Complaint/History:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Playing vigorously in yard when yelps out and then very weak on the left side. Referred for left-side weakness and concern for spinal cord lesion.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Exam Findings:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Riley was ambulatory but would drag and scuff his left thoracic and pelvic limbs. Left side postural reactions (hopping, paw flip test) delays along with decreased withdrawal response and tone on the left thoracic limb. Although bright and responsive and non-painful, Rileyâs left pupil was too small and the third eyelid elevated. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Localization / Assessment:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Localization was left side cervical spinal cord based on left-side weakness and postural deficit. The decreased tone and reflex made a lesion within the intumescence or C6-T2 region the most likely. Furthermore, the miosis and prolapsed nictitans were thought to be from disease of the Hornerâs tract as it passes through cervical spinal cord. Lastly, because there was no discomfort on exam, a lesion within the spinal cord was suspected. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MRI showed disease within the spinal cord just above the C4 disk space on the left consistent with a high velocity, low volume hydrated disk extrusion or acute non-compressive nucleus pulposus extrusion from C4-C5 disk.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnosis:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Low volume high velocity nucleus pulposus (disk) extrusion at C3-C4.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Discussion:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Traumatic disc extrusions have several common synonyms in veterinary literature including acute non-compressive nucleus pulposus extrusions, low volume high velocity disc extrusions, and Type 3 disc extrusions. They occur from vigorous activity or trauma where the normal intervertebral disc is placed under stress which exceeds it structural capacity and a small amount of nuclear material is extruded under high pressure and velocity. The extruded disc material strikes the spinal cord causing a contusion and clinical signs. This mimics the clinical course of fibrocartilagenous embolism (FCE) and the two diseases are often indistinguishable unless the MRI is closely scrutinized. Prognosis for each disease is similar and interesting the prognosis is best predicted by MRI. Treatment is predominantly directed at bladder management with phenoxybenzamine or prazosin and valium, pain medication if needed, 2 weeks rest and physical therapy if needed. Although the disease is from disk extrusion there is no compression and therefore no need for surgery. Hornerâs syndrome is from a lack of sympathetic influence to the eye and features miosis, enopthalmos, ptosis, 3rd eyelid elevation and dilation of the scleral blood vessels. The pathway, a circuitous one, starts in brainstem, runs down cervical spinal cord, leaves the vertebral column in the thoracic spine and runs back up the neck entering the skull where it passes adjacent to the middle ear in route to the eye. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"At a recheck several months later, Riley had made a full recovery and was still pain-free. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take home points:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Two common, non-surgical diseases of the inside of the spinal cord are called low volume, high velocity traumatic disk extrusions and FCE","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnosis and prognosis is made with MRI and cross sectional area strongest predictor of outcome","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Bladder management (expression, drug therapy), restricted activity, and physical therapy / rehab are hallmarks of therapy in cat and dogs","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hornerâs syndrome, when noted with spinal cord disease, localizes lesion to the cervical spinal cord and typically involves non-surgical lesions of the inside of the spinal cord.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"For more information or to discu
1007ss this case please contact ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":"Dr. Bush","marks":[],"data":{}}]},{"nodeType":"text","value":". ","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"4hED4DEsjU2UuXVyj8DfUk"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Riley","title":null,"altText":"A brown Cocker Spaniel look up at the camera","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Riley","url":"https://images.ctfassets.net/rt5zmd3ipxai/IA57ZtuPxj5sGQ2t5Tdql/a979907c29206991863f034cd2317180/Riley-300x291.png","size":144055,"width":300,"height":291,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Winston","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Winston","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Winston, a 6-year-old Cavalier King Charles Spaniel, was referred by Seneca Hill Animal Hospital for collapse with a concern for a seizure-like episode. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Winston, a 6-year-old Cavalier King Charles Spaniel, was referred by Seneca Hill Animal Hospital for collapse with a concern for a seizure-like episode. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting Complaint/History:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Winston was out for a walk when he collapsed on his side, went stiff and starting trembling. He remained stiff with an altered gait overnight and in the morning could walk a little but would stagger to the right.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Exam Findings:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Winston was ambulatory with marked ataxia. He would fall and list to the right and âcrab walkedâ to the right. He was hypermetric in the left thoracic and pelvic limbs. His right limbs had normal proprioception, but his left limbs had absent placing and hopping was delayed and exaggerated. He had a normal menace response bilaterally and a normal physiologic nystagmus. He was not painful on palpation of his head or spine.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Localization / Assessment:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Left vestibular system because of his tetra-ataxia, falling and listing to the right. Most concerned for a central lesion due to his left-sided CP deficits and specifically the cerebellum because of his absent menace response.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MRI showed a lesion in the left dorsolateral cerebellum most consistent with a cerebrovascular accident (stroke).","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"CSF centesis and analysis showed a neutrophilic pleocytosis (elevated number of WBC, specifically neutrophils). ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnosis:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Left cerebellar stroke.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Discussion:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cerebrovascular accidents (strokes) occur in dogs and cats from disease in the blood vessels that supply the brain. The most common area of the brain to be affected
1007is the cerebellum, with the rostral cerebellar artery being the most commonly affected blood vessel. However, strokes can occur anywhere in the brain. Signs of stroke vary depending on the area affected. With cerebellar strokes, the most common signs are ipsilateral ataxia, head tilt, nystagmus, opisthotonus, and menace deficits.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In about half of all dogs, an underlying etiology is never found. However, a variety of diseases including neoplasia, hypertension, hypothyroidism, sepsis, vascular malformations, coagulopathies, chronic renal disease, and hyperadrenocorticism have all been associated with strokes and searching for an underlying cause is recommended. The prognosis is generally good for dogs and cats with strokes with no underlying cause and in animals where the underlying cause is found and treated. Supportive care both in hospital and at home may be needed depending on their deficits and level of impairment. Most animals recover within a few weeks.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MRI is the gold standard for diagnosing strokes. We use a variety of sequences including diffusion-weighted imaging (DWI) to diagnose strokes and differentiate them from other possible lesions including neoplasia and inflammatory disease. CSF centesis and analysis is also sometimes performed and the results can range from normal to a mild to moderate monocytic or neutrophilic pleocytosis.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Within two to three days, Winston was walking well and was about 90% normal. A few weeks later, his family reported that he was completely normal.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take Home Points:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cerebrovascular accidents (strokes) can occur in any dog or cat breed.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"About half of dogs affected will have a primary disease process associated with the stroke and treating that primary disease will improve the chances of them not having another stroke.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Half of dogs who have strokes have no underlying disease process that can be identified. We often see them recover and never have another stroke.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Signs will vary with the region of the brain affected. Supportive care, both in hospital and at home, is usually what the dog needs most and most make an excellent recovery within a few weeks.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"32PSPdWHnjsBn4yZLECNwj"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Winston","title":null,"altText":"A Cavalier King Charles Spaniel siting in the grass looking up","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Winston","url":"https://images.ctfassets.net/rt5zmd3ipxai/1wNsYY5lSC5vOwxBqyxAiS/4e045ab975ad13d5025911abe3f9bb4d/winston-sc.png","size":413250,"width":1254,"height":1254,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Herschel","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Herschel","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Herschel is a 10 year old Poodle-Mix that presented to our Woodstock location for a 24 hour history of progressive back pain and the inability to walk in the rear limbs. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Herschel was referred by Dr. Leisa Jennings of ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"https://www.bridgemillvet.com/"},"content":[{"nodeType":"text","value":"Bridgemill Animal Hospital","marks":[],"data":{}}]},{"nodeType":"text","value":". ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Herschel is a 10 year old Poodle-Mix that presented to our Woodstock location for a 24 hour history of progressive back pain and the inability to walk in the rear limbs. On examination, Herschel was non-ambulatory with severe paraparesis (weakness of his rear limbs) and thoracolumbar back pain. MRI showed a right lateralized herniated disc at T12-T13 causing severe spinal cord compression. Surgery was recommended to provide Herschel with the best chance at a successful recovery.\n","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting Complaint:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Unable to walk, painful","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Severe weakness (paraparesis) of the pelvic limbs ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Neurolocalization:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"T3-L3 spinal cord segments as evident from normal cranial nerve exam / normal thoracic limb function, and pelvic limb paraparesis with
1007normal reflex function ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In-house high-field MRI shows herniated disc material compressing the spinal cord at the T12-T13 disc space on the right side with no evidence of internal spinal cord damage. Based on these findings, we predicted that Herschelâs prognosis for recovery with surgery was excellent.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"A hemilaminectomy was performed at T12-T13 on the right side to allow for removal of extruded disc material and subsequent decompression of the spinal cord. Herschel showed rapid improvement and was weakly ambulatory two days post-operatively. At his 2 week recheck, he was pain-free and ambulatory without assistance. \n","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Major Take Home Point:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Neurological grade and MRI findings are the best indicators of success with surgery for intervertebral disc disease. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"For more information or to discuss this case please contact ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":"Dr. Neary","marks":[],"data":{}}]},{"nodeType":"text","value":". ","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"3t7tuCxMrSnWa0cFKiLdbk"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Herschel","title":null,"altText":"A staff member sitting next to a man who is holding a black poodle mix","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Herschel","url":"https://images.ctfassets.net/rt5zmd3ipxai/5bPWumjGSRkvDkb1UWp3Vs/9c32bb7e9b111ca9210f728022313f39/Herschel.jpg","size":75474,"width":1100,"height":825,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Gus","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Gus","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Augustus âGusâ is a 1 year 10 month old Standard Poodle who presented to our Woodstock location for a 24 hour history of difficulty walking in the back legs. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Augustus âGusâ is a 1 year 10-month-old Standard Poodle who presented to our Woodstock location for a 24-hour history of difficulty walking in the back legs. The day before, Gus was on a walk with his owners and suddenly sat down and wouldnât get back up. He had to be carried home. On neurologic examination, Gus was reluctant to move and preferred to sit or stay sternal. He was able to walk albeit weakly and demonstrated extreme fatigue that worsened with exertion. Based on his history and neurologic examination, myasthenia gravis was suspected. A Tensilon test was performed and was positive.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting complaint:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Difficulty using back legs","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Extreme fatigue worsened by any exertion/activity including walking","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Neurolocalization","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":":","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Gusâ neurologic examination revealed abnormalities consistent with diffuse neuromuscular disease.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Two view thoracic radiographs: no clinically significant findings","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Tensilon test: positive response","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Baseline cortisol: 4.8 (normal)","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Acetylcholine receptor antibody test: positive serum antibody titer","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Serology for Toxoplasmosis and Neospora: negative","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Tick-borne disease panel: negative","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnosis","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Acquired myasthenia gravis","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment for myasthenia gravis typically involves daily administration of oral anticholinesterase agents, such as pyridostigmine, which act to enhance neuromuscular transmission by prolonging the action of acetylcholine at the neuromuscular junction. Immunosuppressive drugs are sometimes used to suppress the overactive immune system. Upright feedings are necessary if megaesophagus is present.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Gus was started on maintenance therapy for myasthenia gravis, the oral medication pyridostigmine, while in the hospital. At the time of discharge, Gus had shown a dramatic improvement in his strength and exercise tolerance. He walked for 2-3 minutes without any evidence of fatigue and was eating well with no evidence of regurgitation. An email update from his owners one month later indicated that Gus was doing extremely well and was almost back to 100% of his
1007normal self. ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"https://vimeo.com/178651398"},"content":[{"nodeType":"text","value":"He had resumed his one-mile hikes with his owners","marks":[],"data":{}}]},{"nodeType":"text","value":" and standard poodle housemate, Ari.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take-Home Points","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Prognosis for myasthenia gravis is good in less severe cases","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Prognosis is guarded in cases with concurrent megaesophagus or persistent underlying cause such as neoplasia","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Prognosis is poor with the development of aspiration pneumonia","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MG will spontaneously resolve in some animals after months of therapy","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The acetylcholine receptor antibody titer determined by radioimmunoassay performed by the UCSD Comparative Neuromuscular Laboratory is 98% accurate for generalized acquired myasthenia gravis","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Thank you to ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://ucpetvet.com/about-us/our-doctors/dr.-dwaine-zagrocki.html"},"content":[{"nodeType":"text","value":"Dr. Zagrocki","marks":[],"data":{}}]},{"nodeType":"text","value":" of ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://ucpetvet.com/"},"content":[{"nodeType":"text","value":"Union County Pet Hospital","marks":[],"data":{}}]},{"nodeType":"text","value":" for referring Gus to BVNS. For more information or to discuss this case, please contact ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":"Dr. Erin Akin","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"5jkVgPcEwHtQrBEzr3MUCK"},"name":" IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Gus","title":null,"altText":"Black dog with red leash","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":" IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Gus","url":"https://images.ctfassets.net/rt5zmd3ipxai/10s7v8LsGvRdgXMiJRTVfv/b81552bc842cdcfea0a92b39bc763e88/Gus.jpg","size":201429,"width":752,"height":1022,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Fergie","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Fergie","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"When Fergie came to BVNS in Springfield, she was unable to jump and was having difficulty navigating steps and curbs. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2017"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"When Fergie came to BVNS in Springfield, she was unable to jump and was having difficulty navigating steps and curbs. After an MRI, Fergie was diagnosed with COMS (Caudal Occipital Malformation Syndrome), a common malformation of the breed. Dr. Bush and Dr. Barker performed a FMD (Foramen Magnum Decompression) to alleviate compression.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"This picture was taken the day Fergie was discharged, which just happened to be her birthday! Her mom was so happy to have her home and celebrate, but Fergie was happy to go home and sleep!","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"She truly stole the hearts of everyone at BVNS.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"To learn more about COMS, visit ","nodeType":"text"},{"data":{"uri":"https://bvns.net/coms"},"content":[{"data":{}
1007,"marks":[],"value":"www.bvns.net/coms","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"9frcwANPKgm01dJskZJdN"},"name":" IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Fergie","title":null,"altText":"brown dog, Fergie, lying on couch next to happy birthday balloon","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":" IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Fergie","url":"https://images.ctfassets.net/rt5zmd3ipxai/2PditPYPajN9KxL5uu6jPs/03d9dd86a0784cc781eaaec0e7568b49/Fergie-300x225.png","size":116138,"width":300,"height":225,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Lucy 2","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Lucy 2","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Lucy was discovered like this in her crate and is now being treated for organophosphate toxicity in the emergency room. What do you see in the video? What could be wrong? How would you prove it and treat it?","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2017"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"CHECK OUT THIS VIDEO","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Lucy was discovered like this in her crate and is now being treated for organophosphate toxicity in the emergency room. What do you see in the video? What could be wrong? How would you prove it and treat it?","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Video:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"There is right sided facial twitching more than left sided accompanied by confusion / stupor.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"What could be wrong? This could be continuous partial seizure which is often called non-convulsive epilepticus. An EEG could be used to prove it. An MRI coupled with a CSF analysis could identify the cause of the non-stop seizure.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnosis:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The persistent trains of left sided spikes allowed for diagnosis of non-convulsive status epilepticus. The MRI coupled with CSF showed a left sided inflammatory lesion (which makes sense because a left side lesion would be expected to cause twitching on the right).","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Lucy was treated for seizure with Keppra 60 mg/kg and 3 boluses of 10 mg/kg phenobarbital. This stopped the twitching and also converted the EEG to normal. She was also treated for non-infectious encephalitis (meningoencephalitis of unknown etiology) with cytosar, cyclosporine and prednisone. Lucy has very good seizure control at 1, 3 and 12 month follow-up.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"If you have questions about this case, please contact Bill Bush at ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":"[email protected]","marks":[],"data":{}}]},{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}}
1007,"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"6VF4XXEZbjhyqSJyQ6wMM2"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Lucy 2","title":null,"altText":"A white dog laying down on a tabletop","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Lucy 2","url":"https://images.ctfassets.net/rt5zmd3ipxai/2YRS8aSttYXQxek9UMS4x/27495420be3d28835bfb4553e085e8a2/Lucy_2.jpg","size":70176,"width":718,"height":406,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Duke","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Duke","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Duke is a 7 year old, MC, Pitbull presenting for right head tilt that was a gradual onset and progressive over the last 6 weeks. Hypermetria on the left thoracic limb was noted about 6 months ago. He is bright and responsive at home and does not seem painful.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2017"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Introduction:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Duke is a 7 year old, MC, Pitbull presenting for right head tilt that was a gradual onset and progressive over the last 6 weeks. Hypermetria on the left thoracic limb was noted about 6 months ago. He is bright and responsive at home and does not seem painful.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Video:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Based on this videotape where would you localize the lesion and why?","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Duke from ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"/"},"content":[{"nodeType":"text","value":"Bush Veterinary Neurology","marks":[],"data":{}}]},{"nodeType":"text","value":" on Vimeo.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Answer:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Central vestibular because he is non-ambulatory, extreme head tilt to the right, leaning right but no nystagmus.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Discussion:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Peripheral vestibular cases are familiar to us all. They have a sudden onset of a head tilt, veer and side-step to the side of the head tilt and have rapid (greater that 60 beats per minute) rotary and/or horizontal nystagmus whose fast phase is opposite the head tilt. Whenever a presentation deviates from this presentation then likely to be within the brainstem. In Duke's case he is non-ambulatory, has extreme head tilt but no nystagmus - definitely not what you would expect for a peripheral lesion.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Duke's MRI shows a brain tumor.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Thank you to Dr. Skinner of Hartfield Animal Hospital for referring Duke to BVNS. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"If you have any questions about this case, please contact Bill Bush at ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":"[email protected]","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}}
1007,"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"BVTaIH0EGqdX8HxX6si5e"},"name":"IMAGE CONTAINER Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Duke","title":null,"altText":"A brown and white Pitbull being held on the table","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Duke","url":"https://images.ctfassets.net/rt5zmd3ipxai/4DQMDLgtta3A65JqrK9agW/0662a7bb9fc5ce4f2a3113c01b217150/Duke.jpg","size":87013,"width":955,"height":540,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Cervical Spondylomyelopathy (CSM)","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - CSM","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"CSM is a disease that affects the cervical spine in large and giant breed dogs. The etiology is multifactorial and thought to represent a combination of genetic, nutritional, and degenerative causes. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2018"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cervical spondylomyelopathy (CSM) is often referred to as 'Wobbler Syndrome.' Why you may ask? Because affected dogs have a wobbly gait!","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"CSM is a disease that affects the cervical spine in large and giant breed dogs. The etiology is multifactorial and thought to represent a combination of genetic, nutritional, and degenerative causes. Important factors include congenital vertebral canal narrowing, vertebral body instability, disc degeneration and protrusion, joint capsule proliferation and osteophyte formation, and hypertrophy of the ligaments that surround the spinal cord. The most common clinical sign is a chronic, progressive gait disturbance which can range from mild to severe tetraparesis and proprioceptive ataxia affecting all 4 limbs. Cervical pain and low head carriage may also be seen. There are 2 types of CSM recognized in dogs: Disc-associated and Joint-associated.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Disc-associated CSM","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" is seen in middle aged to older large breed dogs; Doberman Pinschers are most often affected followed by Rottweilers and Bernese Mountain Dogs. Spinal cord compression most commonly occurs at C5-6 and C6-7 due to Type II disc degeneration and protrusion (leading to ventral compression); thickening of the vertebral ligaments and vertebral body instability may also contribute to cord compression.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Joint ","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":"or ","marks":[],"data":{}},{"nodeType":"text","value":"osseus-associated CSM","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" is a disease of young adult giant breed dogs such as Great Danes and Mastiffs. Spinal cord compression usually occurs at C2-3 and C3-4 due to proliferation of the articular facet joints (leading to dorsolateral compression).","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DIAGNOSIS:","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Imaging of the cervical spinal cord with an MRI examination or a CT/myelogram study demonstrates the location and extent of cervical spinal cord compression. Lesions can also be classified as dynamic (compressions that worsen or improve with different neck positions) or static.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"TREATMENT AND PROGNOSIS:","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"There are two treatment options for CSM: Conservative medical therapy and surgical treatment:","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MEDICAL THERAPY:","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Medical therapy involves anti-inflammatory medication with prednisone or non-steroidal anti-inflammatory agents, physical therapy, periods of exercise restriction, and pain medication (often with gabapentin). Reports of success are variable; two large retrospective studies have found that between 45-54% of dogs treated medically improve in the short term; however, neurological deficits and pain progressed in the majority of affected dogs from both
1007studies over the long term. Progression of disease may result in humane euthanasia due to poor patient quality of life and the difficulty for pet owners in trying to manage a large breed dog with limited mobility.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"SURGICAL TREATMENT:","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Surgical treatment may be recommended based on several factors including the degree of neck pain. severity of neurologic dysfunction, the degree of spinal cord compression seen on MRI examination, and lack of to medical management. There are many different types of surgical techniques described and in some instances there may be a disparity in agreement as to which procedure carries the best outcome. The treatment for disc-associated CSM is typically ventral slot surgery at the site of disc protrusion (stabilization may be necessary in cases with dynamic compressions). For joint-associated CSM, decompression of the spinal cord via dorsal laminectomy is most often performed. The majority of authors claim a 70-80% success rate with surgical therapy; therefore, the majority of surgically managed patients improve in the short term.3 However, over the long term, CSM can continue to progress in up to 50% of affected dogs in spite of surgical therapy again eventually resulting in poor patient and owner quality of life. This is due to several factors, most the development of spinal compression at other sites along the cervical spine (termed \"adjacent segment disease\").","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In summary, both medical and surgical treatment can benefit dogs with CSM in the short term. However, long term this disease has the potential to progress with either methodology. The choice of which treatment suits each individual patient must take into account many factors; most importantly, the short and long term expectations of each individual owner must taken into consideration so that an informed decision can be made on their dog's behalf.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"REFERENCES:","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"De Decker S et al. Clinical evaluation of 51 dogs treated conservatively for disc-associated wobbler syndrome. Journal Small Animal Practice. 2009; 50, 136-142.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Da Costa R, et al. Outcome of medical and surgical treatment in dogs with cervical spondylomyelopathy: 104 cases (1988-2004). 2008; 233(8),1284-1290.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Da Costa. Cervical Spondylomyelopathy (Wobbler Syndrome). Vet Clin North Am Small Anim Practice.2010 Sep;40(5):881-913.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"xYLOJd9sumOfdoJ3gdq9q"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - CSM","title":null,"altText":"Cervical Spondylomyelopathy","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - CSM","url":"https://images.ctfassets.net/rt5zmd3ipxai/1fiyGukrU7
1007MqXoFXTXlymc/d60559d49d9e0554934a494e52027b02/CSM.png","size":71676,"width":367,"height":200,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Motley","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Motley","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Motley presented to BVNS to see Dr. Young in February 2018 due to lethargy and decreased motion of his tail. His owners had noticed that in previous weeks, Motley's outgoing energy and happy tail wag was diminishing.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2018"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Presenting Complaint: ","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Motley presented to BVNS to see Dr. Young in February 2018 due to lethargy and decreased motion of his tail. His owners had noticed that in previous weeks, Motley's outgoing energy and happy tail wag was diminishing.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Neurolocalization:\nDuring Dr. Young's exam, he noticed a dropped tail with blunted to absent superficial sensation, blunted deep pain perception, and little tone. An MRI was recommended.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Diagnostics:\nMRI of the tail and pelvis were performed, and findings were consistent with a mass lesion of L5 vertebral body.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Diagnosis:\nThis lesion was suspected to be a plasma cell tumor based on radiologist review. With decompressive surgery and radiation therapy survival beyond two years would be expected. With palliative care, we would anticipate survival to be limited to several months to 6 months.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Treatment:\nMotley's family decided to proceed with surgery. Dr. Young performed a left hemilaminectomy at L5-L6 and surgical biopsy of the body of L5. Stabilization was achieved with SOP plating. The biopsy was sent to Virginia Tech, which confirmed the tumor type as a plasma cell tumor. Motley then received radiation therapy and oncology care through The Oncology Service for the best prognosis.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Outcome:\nLess than 10 days following surgery, Motley's owners reported that Motley was comfortable and wagging his tail again!","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Take Home Points:\nMotley is now a happy, active dog and is enjoying his additional time with his family!","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"4PS8uY4KNKEEmbSlkeQ9YE"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Motley","title":null,"altText":"Motley the golden retriever.","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Motley","url":"https://images.ctfassets.net/rt5zmd3ipxai/4kyn2D61LBoTwY09w9w6aP/3c98932485d5848eac2f587b0c519dba/motley-1024x898.jpg","size":151994,"width":1024,"height":898,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Head Trauma in Veter
1007inary Medicine","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Head Trauma in Veterinary Medicine","blogAuthor":null,"blogDate":null,"url":"head-trauma","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Traumatic brain injury in dogs and cats can occur due to a variety of causes including motor vehicle accidents, falls from a height, crush injuries, or attacks by other animals. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2018"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Traumatic brain injury in dogs and cats can occur due to a variety of causes including motor vehicle accidents, falls from a height, crush injuries, or attacks by other animals. This event secondary to a serious accident can be terrifying for owners and is a veterinary emergency for the injured patient. Initial patient assessment and rapid initiation of appropriate treatment measures are critical to maximize the chance for a successful outcome. Appropriate guidelines for veterinary patients are somewhat limited and, therefore, often based on results of human trauma studies, experimental investigations, and clinical experience.\n","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"PATIENT ASSESSMENT","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\nMODIFIED GLASGOW COMA SCALE (MGCS)\nOne quantitative measure shown to be associated with survival in dogs with traumatic brain injury is the Modified Glasgow Coma Scale. This scale has been shown to predict the probability of survival in the first 48 hours in patients with traumatic brain injury.1 It is therefore most useful for initial patient assessment; however, it can also be used as an objective way to monitor progression of neurological signs on a serial monitoring basis. The MGCS provides a score that addresses the three domains listed below. A score of 1-6 is assigned to each category; the final score ranges from 3â18, with lower scores indicating more severe neurologic deficits. ","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Level of Consciousness\n⢠Alert and responsive: normal responses to sensory stimuli\n⢠Obtunded: slow/inappropriate responses to sensory stimuli\n⢠Stuporous: unresponsive except to noxious stimuli","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Pupil response to light and other brainstem reflexes\n(palpebral, corneal, gag)","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Posture and motor activity (1-6)\n⢠Ambulatory vs. non-ambulatory status\n⢠Abnormal postures\n » Decerebrate rigidity = stupor/coma, rigid extension of all 4 limbs, opisthotonus (brainstem lesion)\n » Decerebellate rigidity = conscious/mentally alert, rigid extension of thoracic limbs, flexion of pelvic limbs, opisthotonus (cerebellar lesion) ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In 38 dogs with head trauma, the MGCS predicted the probability of survival in the first 48 hours. The graph below illustrates there is a 50% probability of survival in a patient with a score of 8; patients with scores higher than 8 have a higher probability of survival compared to patients with lower scores. (2)","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DIAGNOSTICS:(1)(2)","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Complete bloodwork (an initial PCV/TS, blood glucose, and electrolytes followed by a complete cbc/chemistry panel) as well as assessment of the abdomen and chest for signs of trauma (if indicated) should be obtained. Radiogra
1007phs of the head can be taken to screen for the presence of skull fractures. Imaging of the brain in head trauma patients is via CT or MRI examination; these advanced imaging tests provide assessment of both skull and brain damage. In a recent study of 18 dogs with acute head trauma, dogs with parenchymal brain injuries affecting the caudal fossa (brainstem/cerebellum) alone or affecting both the rostral (forebrain) and cauda fossa typically had poorer outcomes.(3) If a patientâs neurological status continues to decline despite aggressive medical treatment, then evaluation of the extent of brain damage via CT or MRI exam and consultation with a veterinary neurologist is indicated.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"THERAPY:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The goals of treatment in traumatic brain injury include reducing intracranial pressure, maintaining blood pressure, and ensuring proper ventilation. Hyperosmolar therapy reduces brain edema. Mannitol is a hyperosmolar osmotic diuretic which is considered the first line treatment for reducing intracranial pressure; administration of mannitol (0.5-2 grams/kg as an IV bolus over 20minutes q6-8 hours) has been shown to have a beneficial effect on neurological outcome in human and veterinary patients with brain injury. Hypertonic saline (3-5ml/kg) is another hyperosmolar solution with effects similar to mannitol which can be used to reduce intracranial pressure and rapidly provide intravascular volume expansion. Other important steps in managing trauma patients include intravenous fluid therapy to prevent hypotension, placing patients in an oxygen-rich environment to prevent hypoxia, and close monitoring of ventilation to prevent hypercarbia. Analgesic care should be given as needed with opioids or other reversible medications. If there is a risk for infection, antibiotic therapy should be provided to reduce the risk of an abscess from developing. Importantly, glucocorticoids are contra-indicated and should not be given to patients with brain injury; administration of steroids is associated with worse outcomes in human adults with head trauma. A helpful clinical practice review article from the Journal of Veterinary Emergency and Critical detailing medical management recommendations for patients with traumatic brain in is provided below in the article references. (4)","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In the event that medical therapy is unsuccessful, surgical treatment (decompressive craniectomy) may be necessary for patient stabilization. This is the case with depressed skull fractures, large space occupying hematomas, or intracranial abscessation.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"PROGNOSIS:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"There is scarce available information that is predictive of prognosis in veterinary medicine for patients with traumatic brain injury. However, many patients can recover if systemic and neurological abnormalities are identified and treated early. Dogs and cats have an extraordinary ability to compensate and improve after sustaining brain damage. Long-term effects such as post-traumatic epilepsy are reported to occur in a small percentage of patients with head trauma; in one retrospective study of dogs with epilepsy, 15% of dogs had a history of prior head injury. (5) Ultimately, patient response and degree of improvement to treatment over time ultimately determines the prognostic outcome.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"REFERENCES: ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DeLahunta and Glass. Veterinary Neuroanatomy and Clinical Neurology, 3rd ed. St. Louis, MO: Elsevier Inc:2009. ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Platt SR, Radaelli ST, McDonnell JJ. The Prognostic Value of the Modified Glasgow Coma Scale in Head Trauma in Dogs. J Vet Intern Med 2001; 15:581-584. ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Yanai H, et al. Results of magnetic resonance imaging performed within 48 hours after head trauma in dogs and association with outcome: 18
1007cases (2007-2012). J Vet Am Med Assoc 2015;11(1):1222-1229. ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Sande A and West C. Traumatic brain injury: A review of pathophysiology and management. Journal of Vet Emerg and Crit Care 2010;20(2):177-190. ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Steinmetz S, et al. Epilepsy after head injury in dogs: a natural model of posttraumatic epilepsy. Epilepsia 2013; 54(4):580-8. ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"5QM5hAnR6JlSTDerOMGTdQ"},"name":"IMAGE CONTAINER - MASTER - Nature- Dog in Car Driving -Head out Window","title":null,"altText":"Head out the window dog in car","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"NVA - MASTER - Nature- Dog in Car Driving -Head out Window","url":"https://images.ctfassets.net/rt5zmd3ipxai/WjJECOyul39PYzi9Q7WnP/e3d675cb328f0919efa40beae165420a/ServiceCards-Dog.png","size":2523439,"width":1254,"height":1254,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Lufa","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Lufa","blogAuthor":null,"blogDate":null,"url":"lufa","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Lufa, an 8 year old Pomapoo (Pomeranian/Miniature Poodle mix) was referred by Veterinary Referral Center NoVA for seizures and impaired mentation.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2019"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Lufa, an 8 year old Pomapoo (Pomeranian/Miniature Poodle mix) was referred by Veterinary Referral Center NoVA for seizures and impaired mentation. Lufa had a history of seizures, was treated with levetiracetam (25 mg/kg) and he had not had a seizure for approximately two years. Two days before presentation, he had missed a dose of levetiracetam, and had two seizures. Since the seizures, Lufaâs behavior was abnormal. He wandered around the house, was more willing to be petted, and he walked into the ownerâs mirror. On exam at the referring veterinarianâs office, Lufa had a very stiff gait. He had no menace response, but a normal pupillary light reflex. Shortly after his exam, Lufa had a generalized clonic-tonic seizure and was given a dose of 30 mg/kg levetiracetam intravenously. While hospitalized, Lufa was seen to chew at the air in the corner of his cage. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"PRESENTING COMPLAINT ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Seizures, mental dullness, pacing. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"EXAM FINDINGS ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Lufa was obtunded. He was ambulatory with normal postural and reflexes. He had no menace response bilaterally, and had anisocoria (right pupil smaller than left). He was comfortable with palpation of his spine and skull.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Q/A","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Based on Lufaâs history and clinical signs, where would you localize? ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Localization: Lufaâs clinical signs localize to the forebrain. His anisocoria may indicate pathology within the left cerebral hemisphere. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"What is the cause of Lufaâs ongoing seizures and dullness? ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Differential Diagnoses: ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"(i) Lufa was previously diagnosed with idiopathic epilepsy. His current mental dullness and pacing could be post-ictal behavior, or ongoing seizure activity, such as non-convulsive status epilepticus. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"(ii) Lufaâs current clinical picture is also consistent with neoplasia, encephalitis (autoimmune vs infectious), or a cerebrovascular accident. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"What diagnostic plan should be considered? Based on the results, what treatments should be initiated? ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostic Plan: ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"(i) General wellness screening: ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"This was performed to rule out systemic disease as a cause for Lufaâs clinical signs. Blood work, blood pressure and ECG were normal. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"(ii) Electroencephalogram (EEG): ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"This was performed since our main concern was ongoing seizure activity. EEG was reviewed by Dr. Bush and Dr. Colette Williams, an expert in EEG. Lufaâs EEG indicated that he did not have seizures, but the had spike activity that may indicate some form of intracranial disease. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"(iii) MRI of the brain:","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Lufaâs MRI revealed changes consistent with inflammation within the left cerebral hemisphere ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Based on the results, what treatments should be initiated? ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment plan: ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MUE requires prompt treatment to reduce intracranial pressure and inflammation, and to halt ongoing seizures. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"OUTCOME ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{}
1007,"content":[{"nodeType":"text","value":"Lufa was hospitalized for seizure management and immunosuppressant therapy. He was treated with mannitol (0.5g/ kg) to relieve elevated intracranial pressure, and his MUE was managed with immunosuppressant drugs (steroids and cytarabine). Lufa recovered well and was discharged after 48 hours. He continues to receive immunosuppressant medications and anti-epileptic drugs to reduce his seizure frequency and severity. His neurological status has improved and his seizure frequency has decreased. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DISCUSSION ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MUE (meningoencephalitis of unknown origin) signs can range from discrete focal deficits to widespread dysfunction including changes in mentation and cranial nerve deficits. MUE can be life-ending, and requires prompt treatment. Inflammation within the brain causes increased intracranial pressure that compromises blood supply and causes swelling of brain tissue that results in herniation and death. Seizures place a high metabolic demand on the already compromised brain, and can cause further elevations in intracranial pressure. Immediate treatment includes reducing intracranial pressure, controlling seizures, and halting the ongoing immune attack on brain tissues. Long term prognosis for patients with MUE is mixed: while some animals recover fully, relapses are common, and in some patients, progression of the disease cannot be controlled. Sadly, a percentage of patients do not survive to discharge despite therapy. What makes Lufaâs case interesting is his prior history of seizures that pointed us to idiopathic epilepsy as our top differential, although our diagnostic tests indicated otherwise. Lufa is older than the typical patient that presents with a first episode of MUE, and we suspect that Lufaâs condition is in fact long-standing, with a relapsing and remitting course. TAKE HOME POINTS Clinical signs of MUE can vary, and can be easily overlooked, particularly when the disease has a waxing/waning course. However, awareness of the condition and early referral is critical to treatment for these patients and improves survival. Thanks to the prompt action of Veterinary Referral Center of NoVA, Lufaâs encephalitis was diagnosed quickly and treated appropriately. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"References: ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Coates JR, Jeffery ND (2014) Perspectives on meningoencephalomyelitis of unknown origin. Vet Clin North Am Small Anim Pract. 44:1157-85 ","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"5nw0t4nx7bFaxwfabSY3Mf"},"name":"IMAGE CONTAINER - MASTER - EE - Nature Outdoor Seasonal - VAR A - Contact Us (/contact-us) - Pomeranian standing in leaves ","title":null,"altText":"Pomeranian standing in a field of leaves ","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - MASTER - EE - Nature Outdoor Seasonal - VAR A - Contact Us (/contact-us) - Pomeranian standing in leaves ","url":"https://images.ctfassets.net/rt5zmd3ipxai/7hMmkiQNywdxaJTtqaUaTt/3b668e7e9a99f122504828f80734548b/HERO-CARD-MASTER-EE-NatureOutdoorSeasonal-VarA-Pomeranian-leaves-1-.jpg","size":258823,"width":1600,"height":580,"contentType":"image/jpeg"},"mobileImage":{"__typename":"Asset","title":"IMAGE - MASTER - EE - Nature Outdoor Seasonal - VAR A - Contact Us (/contact-us) - MOBILE - Pomeranian standing in leaves ","url":"https://images.ctfassets.net/rt5zmd3ipxai/ql73a3sdgGIxk5a5IbpzF/e9fb532509f60d9a43e8d305d36d5e33/HERO-CARD-Mobile-MASTER-EE-NatureOutdoorSeasonal-VarA-Pomeranian-leaves-1-.jpg","size":137483,"width":1006,"height":528,"contentType":"image/jpeg"}},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Travis","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Travis","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Travis, a 3-year old MN Dalmatian, presented to BVNS Richmond in April of 2017. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2019"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Travis, a 3-year old MN Dalmatian, presented to BVNS Richmond in April of 2017. A month before coming to us, he was seen at his primary care veterinarian as well as an internist for vomiting, letharg
1007y, and inappetence. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting Complaint","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Ataxia and falling over when walking. Suspected spinal disease. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics Prior to Presenting to BVNS:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"GI biopsies: lymphoplasmacytic gastroenteritis\nNH3+: 18 (normal) ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"EXAM FINDINGS","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Mentation","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Subdued to dull","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Posture of Head and Body","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Limbs occasionally found in abnormal positions (ie. abducted, splayed, crossed)","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Gait","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": tetraparesis with general proprioceptive ataxia noted in all 4 limbs. Occasionally, the patient displayed subtle signs of vestibular ataxia","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Postural Reactions","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Normal to slightly delayed paw replacement in the forelimbs and very delayed in both rear limbs","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Thoracic Limb Reflexes","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Normal withdrawal reflexes bilaterally","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Pelvic Limb Reflexes","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Normal patellar and withdrawal reflexes bilaterally ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cutaneous Trunci","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Present bilaterally at L5 (normal)","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Perineal Reflex","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Normal","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Muscle Tone","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Normal tone","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cranial Nerve Function","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Normal cranial nerve function","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Retinal Exam","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Normal fundic exam OU","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hyperesthesia","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": No pain elicited on spinal palpation or cervical manipulation","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Other Findings","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Patient resisted lateral recumbency and dorsal recumbency. After examination, patient altered between dull and stupor in the exam room. Stumbling and not appropriately responsive to auditory or visual stimuli","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Q \u0026 A ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Based on Travis' history and clinical signs, where would you localize?","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Localization","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":":","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Multi-focal localization. There were aspects of the exam that suggested intracranial disease (i.e. alternating mental status, reduced response to auditory and visual stimuli), and other aspects that suggested spinal cord disease (tetraparesis).","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"What diagnostic plan should be considered?","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostic Plan","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":":","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"(i) ","marks":[],"data":{}},{"nodeType":"text","value":"Brain MRI","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": bilaterally symmetrical lesions within the brain most suggestive of metabolic, toxic, or degenerative disease. Given the hospital hepatopathy, the lesions are consistent with Wilson disease","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"(ii) ","marks":[],"data":{}},{"nodeType":"text","value":"Abbreviated Cervical MRI","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": normal","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"(iii)","marks":[],"data":{}},{"nodeType":"text","value":" Cerebrospinal Fluid Analysis","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": normal","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"What is was the tentative diagnosis for Travis' case?","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Tentative Diagnosis","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":":","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Brain disease consistent with neurotoxicity (endogenous \u003e exogenous) or inborn error of cellular metabolism ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DEFINITIVE DIAGNOSIS AND TREATMENT ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"What were the follow-up diagnostics?","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Bile acid profile:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"pre:","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" 149.5 umol/L, (normal:0 â 6.9 umol/L)","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"post: ","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":"280.6 umol/L, (normal: 0 â 14.9 umol/L)","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Liver biopsy:","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" descriptive for copper storage disease ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Based on the results, what was the definitive diagnosis? What treatments should be initiated?","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Definitive Diagnosis:","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" Copper-storage disease with secondary brain pathology consistent with Wilson disease in humans","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment:","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" Penicillamine, Prednisone, Denosyl, and Phosphatidylcholine ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"FOLLOW-UP DIAGNOSTICS (ABOUT 7 MONTHS LATER): ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Brain MRI:","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" mild, bilaterally symmetrical lesions noted in the body of the thalamic hemispheres, the rostral thalamic nuclei, and the body of the caudate nuclei. The previously noted midbrain and lentiform lesions were no longer present.\n","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DISCUSSION ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"We are often presented with patients with signs consistent with âroutineâ spinal disease. Travisâ medical history prior to coming to BVNS was extremely important in explaining his clinical signs. His exam changed and took on different qualities during his initial consultation at BVNS. While he was sent to us for problems walking, it became clear that he had intracranial abnormalities as well. The brain MRI showed symmetrical abnormalities that are typical of toxic or metabolic derangements. Given his age, breed, lab work abnormalities, and some additional ancillary tests, an accurate diagnosis was reached. Copper-associated liver disease is common in Dalmatians and can also result in brain pathology. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"TAKE HOME POINTS FROM DR. HIGGINBOTHAM ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"A patient's past medical history is extremely important.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"A patient's condition can change abruptly during an exam.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Bilaterally symmetrical brain disease is often associated with toxic or metabolic disease.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diseases such as Travis' are treatable and potentially reversible. 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1007,"content":[{"nodeType":"text","value":"Thank you Cooke Veterinary Medical Center of Chesapeake, VA for referring this case. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"What you should expect from BVNS when you refer a case:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Faxed Referral Letter (with call to confirm receipt).","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Desire to discuss any case, whether it is a referred case or a consultation.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Dedication to provide superior service to you and your clients. ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\nFor more information on services offered, please visit us at www.bvns.net ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Selected References ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Brewer G. Wilson disease and canine copper toxicosis. Am J Clin Nutr 1998; 67(suppl):1087S-1090S","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Webb CB, Twedt DC, Meyer DJ. Copper-associated liver disease in Dalmatians: a review of 10 dogs(1998-2001). J Vet Intern Med 2002; 16:665-668 ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"159FcpTwvfP9liQYLjMeoM"},"name":"IMAGE CONTAINER - MASTER - STUDIO - DALMATIAN - BLUE","title":null,"altText":"dalmatian with food on blue background","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"NVA-Studio-Dog-Dalmation-Blue","url":"https://images.ctfassets.net/rt5zmd3ipxai/RLy1KcpoWd5uQIRVywlwn/d976b17e9c5d19ccf5e9294e398657a2/NVA-Studio-Dog-Dalmation-Blue.jpg","size":81070,"width":728,"height":545,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Suki Hall","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Suki Hall","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Suki is a one-year-old, female spayed Yorkie who was referred to BVNS by Dr. Mazur at Clocktower Animal Hospital in Herndon, VA.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2020"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"EXAM FINDINGS","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Suki became non-ambulatory over just a few hours, with severe pain that slowly subsided. By the time we saw her at BVNS Springfield, she was non-ambulatory paraparetic with
1007just a little bit of motor in her pelvic limbs. Her reflexes were normal in all four limbs and she had normal proprioception in the thoracic limbs but absent placement and hopping of the pelvic limbs. We could not elicit a cutaneous trunci reflex anywhere along her back. Her problem was localized to the T3-L3 region of the spinal cord and differentials discussed included IVDD, FCE and spinal GME. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MRI SCANS","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Based on Suki's history and clinical signs, where would you localize?\nHer problem was localized to the T3-L3 region of the spinal cord and differentials discussed included IVDD, FCE, and spinal GME.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DEFINITVE DIAGNOSIS","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Pre-anesthetic blood work was run, which was normal. MRI of the spine revealed a reduced volume of nucleus pulposus at L1-2 with focal T2w hyperintensity spanning from caudal-vertebral body T13 to mid L1 vertebral body. There was minimal compression of the spinal cord. Suki was diagnosed with an acute non-compressive nucleus pulposus extrusion (ANNPE) of the L1-2 intervertebral disc. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"WHAT IS ANNPE? ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"ANNPE is defined as a sudden extrusion of non-degenerate disc material from the nucleus of intervertebral disc. With ANNPE, there is minimal compression of the spinal cord but because it comes out of the disc space with a significant amount of force, concussive damage is done to the spinal cord. Prognosis varies depen
1007ding on which study you read, from 66-100% recovery, and correlates to the amount of concussive damage done to the spinal cord. ANNPE signs can be lateralized and can cause both urinary and fecal incontinence. A recent paper showed that treating with an appropriate NSAID significantly decreased the risk of long term urinary incontinence.\n ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"TREATMENT","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Suki was sent home on meloxicam, gabapentin and diazepam with instructions for strict rest. Strict rest should be instituted, as with any disc herniation, to prevent further disc extrusion that could cause further neurologic decline. This can be compared to treatment for an FCE (another type of non-surgical spinal cord injury), where pain management is less necessary and strict rest is not critical because we arenât worried about triggering recurrences. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Over the next 4-8 weeks, Suki grew stronger and stronger and is now doing amazing. Her family is keeping a close eye on her and decreasing the amount of dynamic leaping she is doing, but she has an awesome quality of life and is her happy, adorable self again. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"https://www.youtube.com/watch?v=8AZyMeUbfGY"},"content":[{"nodeType":"text","value":"Suki, 4 weeks into Recovery","marks":[],"data":{}}]},{"nodeType":"text","value":"","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"https://www.youtube.com/watch?v=uLnGgbRfVnA"},"content":[{"nodeType":"text","value":"Suki, 8 weeks into Recovery","marks":[],"data":{}}]},{"nodeType":"text","value":"","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"TAKE HOME POINTS FROM DR. BARKER","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\n1. Quickly becoming a âdown dogâ doesnât have to be life threatening and recovery doesnât always require surgery ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"2. An MRI can help determine if surgery should be considered and what medical management is most appropriate.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"3. Strict rest and NSAIDs are important treatment components for ANNPE.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Selected References","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\n1. De Decker et al. Acute Herniation of Nondegenerate Nucleus Pulposus Acute Noncompressive Nucleus Pulposus Extrusion and Compressive Hydrated Nucleus Pulposus Extrusion. Vet Clin Small Anim 48, 95â109. 2018","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"2. Mari et al. Outcome comparison in dogs with a presumptive diagnosis of thoracolumbar fibrocartilaginous embolic myelopathy and acute non-compressive nucleus pulposus extrusion. Veterinary Record, 10.1136/vr.104090. 2017","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"3. Mari et al. Predictors of urinary or fecal incontinence in dogs with thoracolumbar acute non-compressive nucleus pulposus extrusion. JVIM, 33:2693-3000. 2019 ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{}
1007,"content":[{"nodeType":"text","value":"Thank you Dr. Mazur and Clocktower Animal Hospital of Herndon, VA for referring this case! ","marks":[{"type":"italic"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"What you should expect from BVNS when you refer a case:","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Faxed Referral Letter (with call to confirm receipt).","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Desire to discuss any case, whether it is a referred case or a consultation.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Dedication to provide superior service to you and your clients. ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"2uCqgOpMnGo0FbWIFbKlZD"},"name":"IMAGE CONTAINER - MASTER - INCLINIC - DOG - TRIMMING ","title":null,"altText":"White Yorkshire Terrior getting a hair cut from two female groomers. ","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"NVA-Clinic-Dog-Trimming","url":"https://images.ctfassets.net/rt5zmd3ipxai/6JS4NqMMvpmMy3pgNwmzoK/a4f5dcd401fae32cf5d7b2850083d17f/NVA-Clinic-Dog-Trimming.jpeg","size":2117357,"width":3000,"height":2208,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Barney","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Barney","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"For this edition of the BVNS Neurotransmitter, Dr. Bush would like you to answer questions about a 10.5-year-old Labrador named Barney (pictured below) with sudden onset of weakness and poor balance.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2020"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Please play the video below and answer the questions provided.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"But wait... there's more:","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"If you participate, you will be entered into a drawing to win a $100 Amazon gift card!","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Barney from ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"/"},"content":[{"nodeType":"text","value":"Bush Veterinary Neurology","marks":[],"data":{}}]},{"nodeType":"text","value":" on Vimeo.","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"6Fc7jGBcHanIQY9PV2ZiG6"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Barney","title":null,"altText":"Barney","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405","url":"https://images.ctfassets.net/rt5zmd3ipxai/5btNe388EeCW89HaDFcfd6/5bddcd2ea81b40d5408c4a0e71800f5a/Barney.jpg","size":73163,"width":750,"height":562,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Sassy Chupacabra","
1007name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Sassy Chupacabra","blogAuthor":"Ashley Bensfield, DVM, DACVIM (Neurology)","blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Sassy is an 11-year-old female domestic short-hair cat.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2020"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Sassy has had intermittent âfightsâ with her own back legs for years. Owner describes that Sassy scratches her own ear with her back leg, and then, she seems surprised that her leg touched her. She then attacks the offending paw, which hurts, and then she proceeds to roll around and bite and scratch herself. She once got a hind claw stuck through her âeyebrowâ narrowly missing her eyelid. Episodes were only once a month or so. Owner says talking to Sassy during the episode makes her growl more, so they have not tried to interfere.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Recently, a second cat has been added to the household. The other cat is minimally aggressive toward Sassy. He will guard the litterboxes, but otherwise, he shows little interest in her. Since addition of second cat, the rolling and self attacking episodes have gotten more frequent and more violent. No skin wounds have been seen, but owners are concerned that Sassy will hurt herself. She is also now having episodes where her pupils dilate, she licks her lumbar region aggressively, she swings her tail around vigorously, and then she runs away as if something has bitten her.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\nSassy has had mild, very intermittent left forelimb lameness for approximately 5 years. Since adoption 7 years ago, she also has episodes when she is falling asleep where her ears and facial muscles with exhibit brief myoclonic jerking movements. She is very agile despite the forelimb issue hand has no difficulty jumping on and off tall furniture or playing vigorously with toys. She is sleeping well and eating well. She vomits about once every 2 weeks when she eats too quickly; the vomitus is always undigested food. No diarrhea, coughing, or sneezing have been noted. Her\nweight is stable. Her CBC, chemistry profile, urinalysis, and T4 are all WNL.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"EXAM FINDINGS","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":"\n","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Physical and neurological exam are completely normal. Sassy is outgoing, vocal, and mildly fractious during the appointment.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\n","marks":[],"data":{}},{"nodeType":"text","value":"DIFFERENTIAL DIAGNOSIS","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":"\n","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Feline Hyperesthesia Syndrome, atypical seizures, and less likely pain episodes.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"TREATMENT","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Sassy was started on 2.5mg fluoxetine once daily. Within 2 weeks, the episodes had decreased by 90% in frequency and were much shorter and less violent than before. The occasional limping and also the face twitching episodes were unchanged.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"FINAL DIAGNOSIS:","marks":[{"type":"bold"},{"type":"underline"}],"data":{}},{"nodeType":"text","value":" FELINE HYPERETHESIA SYNDROME","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Feline Hyperesthesia Syndrome, also known as \"rolling skin disease,\" has been described as a form of Obsessive Compulsive Disorder in cats. It c
1007an be related to a primary behavioral issue, like inter-cat stress in Sassyâs case, or it can be a response to chronic pain. Some cats with Feline Hyperesthesia Syndrome go on to develop more readily identifiable true epileptic seizures.\n","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Testing is aimed at ruling out systemic causes of discomfort and ruling out seizures. Neurological tests that may be performed include a brain MRI with cerebrospinal fluid analysis, and electroencephalogram to check for seizure-like brain electrical activity, and/or a treatment trial with an anti-epileptic drug. If no neurological or pain cause is identified, then a treatment trial with a serotonin enhancing medication like fluoxetine or clomipramine can be helpful. Referral to a board certified veterinary behaviorist should also be considered.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"What you should expect from BVNS when you refer a case:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Faxed Referral Letter (with call to confirm receipt).","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Desire to discuss any case, whether it is a referred case or a consultation.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Dedication to provide superior service to you and your clients. ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"4bw8MEAiHsVncks5SfV7Il"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Sassy","title":null,"altText":"Sassy Chupacabra ","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405","url":"https://images.ctfassets.net/rt5zmd3ipxai/6hLTTxh153oZq3p8F9Jgej/44bd9ff9ad41b29e18d721a66bd4b3ea/Sassy_ChupacabraEDITED.jpg","size":199075,"width":1536,"height":2048,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Buttercup","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Buttercup","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Buttercup is a 1-year-old female, spayed domestic shorthair cat.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2021"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"heading-3","data":{},"content":[{"nodeType":"text","value":"MEET BUTTERCUP ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"She was adopted as a kitten along with her âsister,â Sarahbellum, in Spring 2020. They were both adopted from a wonderful local cat rescue called Good Mews with a tentative diagnosis of cerebellar hypoplasia. On neurologic examination, Buttercup is very spastic in all four legs with exaggerated stepping movements - this is called hypermetria. Buttercup is also ataxic,\nmeaning wobbly in all four legs and she frequently loses her balance. Buttercup also has a pronounced intention tremor which is an involuntary, rhythm
1007ic, oscillatory movement of the head; in her case, the tremors are exaggerated by goal-oriented actions (when she intends to do something such as eating, drinking, or playing with a toy). ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"PRESENTING COMPLAINTS ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hypermetria","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Ataxia in all four limbs","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Intermittent intention tremor ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DIAGNOSTICS ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"CBC and chemistry: within normal limits","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Brain MRI to be scheduled","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"To view videos of Buttercup's gait and intention tremors, visit ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"bit.ly/3c2yoX5"},"content":[{"nodeType":"text","value":"bit.ly/3c2yoX5","marks":[],"data":{}}]},{"nodeType":"text","value":" ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"NEUROLOCALIZATION ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Buttercup's neurologic examination shows abnormalities consistent with diffuse cerebellar disease.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"TENTATIVE DIAGNOSIS ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cerebellar Hypoplasia.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"TREATMENT ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"There is no treatment for this condition.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"OUTCOME ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Buttercup has continued to thrive in our home alongside Sarahbellum and their three Dachshund housemates, Malcolm, Lucy Goo, and New Rock. You can see Malcolm get in on the laser pointer action in one of Buttercupâs videos. Buttercup has grown into a healthy, happy adult cat and we expect to enjoy many more years with her.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"WHAT IS CEREBELLAR HYPOPLASIA?","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cerebellar hypoplasia is a disorder in which the cerebellum fails to develop properly. The\ncerebellum is the part of the brain that controls purposeful movement, coordination, balance (has direct input to the vestibular system), and refines our motor skills. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"HOW DID BUTTERCUP GET CEREBELLAR HYPOPLASIA?","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Most commonly, kittens become affected with feline panleukopenia virus during the perinatal peri
1007od (in the last weeks of pregnancy and the first weeks after birth). During this period, the cerebellum is undergoing rapid growth making it susceptible to attack as the panleukopenia virus tends to damage highly active, rapidly dividing cells. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Clinical Signs ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cerebellar ataxia (including hypermetria) often noticed when the kitten starts walking ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Intention tremor","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Other neurologic signs can occasionally be seen if the virus has affected other areas of the brain ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"HOW DO YOU DIAGNOSE AND WHAT IS THE PROGNOSIS?","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cerebellar hypoplasia is not detected with routine laboratory tests. It is often diagnosed based on history, signalment, and examination findings. In some kittens, MRI (magnetic resonance imaging) may show a smaller than normal cerebellum. The prognosis: kittens with cerebellar hypoplasia typically have a normal life expectancy. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"TAKE HOME POINTS","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cerebellar hypoplasia is not painful or contagious.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The most common cause is infection with feline panleukopenia virus. Other much less common causes include trauma, infections such as Toxoplasmosis, or other causes.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The vaccination of female cats against panleukopenia virus prior to pregnancy can help prevent this disease.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Many kittens will adapt to their cerebellar dysfunction and clinical signs may improve with time.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"5tttPiWYgPym5lVvkDInDi"},"name":"IMAGE CONTAINER - BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Buttercup","title":null,"altText":"Buttercup the tuxedo cat.","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Buttercup","url":"https://images.ctfassets.net/rt5zmd3ipxai/7ewAaqUO9c6TmTgmGk8NnL/1132ca0a8f20a6d0597e24e918cac0da/buttercup.png","size":653111,"width":1008,"height":646,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Milo","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Milo","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Milo is an 8-month-old neutered male Boxer.\n ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2021"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"MEET MILO","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Milo is an 8-month-old neutered male Boxer.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Milo presented to BVNS Woodstock in July of 2019 for a 3-day history of neck pain and lethargy. 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Diagnosis is made by excluding other causes of symptoms and documenting resolution of signs once drug is withdrawn +/- reappearance of signs if drug is restarted (1-4).\n","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Idiosyncratic reactions tend to be uncommon, but can be responsible for the onset of systemic disease in patients receiving drug therapy. Pseudolymphoma should be a differential for any patient with a recent history of starting a new anti-epileptic drug presenting for lymphadenopathy.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"REFERENCES","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"blockquote"},{"data":{},"content":[{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Djani, DM \u0026 Draper, WE. Suspected phenobarbital-induced fever in a cat. Journal of Feline Medicine \u0026\nSurgery 2019:1-3.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Lampe R, Manens J and Sharp N. Suspected phenobarbital-induced pseudo lymphoma in a dog. JVIM\n2017;311:858-9.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Lieser, J \u0026 Schwedes, CS. Pseudolymphoma in a cat on phenobarbital treatment. JSAP 2017;1-4.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Sohn, SJ et al. Phenobarbital-induced anticonvulsant hypersensitivity syndrome in a cat. Journal of\nVeterinary Medical Science 2019.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Collinet A and Sammut V. Suspected zonisamide-related anticonvulsant hypersensitivity syndrome in a cat.\nJ Am Vet Med Assoc 2017;251:1457-61.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Podell M et al. 2015 ACVIM small animal consensus statement on seizure management in dogs. J Vet Intern\nMed 2016;30:477-90.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Ackermann AL et al. Erythema multiforme associated with zonisamide in a dog. Vet Dermatol 2015;26:391-\ne89.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Bersan A et al. Phenobarbitone-induced haematological abnormalities in idiopathic epileptic dogs:\nprevalence, risk factors, clinical presentation and outcome. Vet Record 2014;10:247-51.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Koch T et al. Cutaneous adverse drug reactions in dogs treated with antiepileptic drugs. Frontiers in\nVeterinary Scie
1007nce 2016;3:1-10.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Schwartz M, Munana KR \u0026 Olby, NJ. Possible drug-induced hepatopathy in a dog receiving zonisamide\nmonotherapy for treatment of cryptogenic epilepsy. Journal of Veterinary Medical Science 2011;73:1505-8.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"}],"nodeType":"ordered-list"},{"data":{},"content":[{"data":{},"marks":[],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"4UGVgfF6lYizfsv3jaaXsA"},"name":"IMAGE CONTAINER - NVA - MASTER - BLOG - Dog laying down in dog bed","title":null,"altText":"Dog laying down in bed","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - NVA - MASTER - BLOG - Dog laying down in dog bed","url":"https://images.ctfassets.net/rt5zmd3ipxai/f3X9DrLQD8OnbCLptYNWa/9ff5cb8004a0f80fb7cb7cd1b04a3d62/MicrosoftTeams-image__287_.png","size":220720,"width":1255,"height":685,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Rabies","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Rabies","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Luckily, rabies is a disease that most people have no experience with, other than the vaccination of their pets. It is important to realize that rabies is fatal over 99% of the time and that more than 59,000 people worldwide still die of rabies every single year. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2022"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"BACKGROUND","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Luckily, rabies is a disease that most people have no experience with, other than the vaccination of their pets. It is important to realize that rabies is fatal over 99% of the time and that more than 59,000 people worldwide still die of rabies every single year. This makes it one of the deadliest and most important diseases on the planet. The following is an overview of the disease as well as a reminder that current vaccination is is strongly recommended and may be required by some veterinarians.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"EPIDEMIOLOGY","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Rabies is present worldwide and reported in over 150 countries. The only place that it has not been reported is Antarctica. All mammals can potentially carry and/or become infected with rabies. Wildlife such as bats, skunks, raccoons, and foxes are the most common hosts. Rabies is exceptionally rare in opossums due to their lower-than-normal body temperature (~94-97 degrees Fahrenheit). Birds have only been experimentally infected and are not considered a natural threat. Rabies virus is specifically adapted to its reservoir host species with several different variants existing in the United States. These include raccoon variant, bat variant, fox variant, and skunk variant. The canine variant was eliminated in the US in 2004 thanks to leash laws and a rigorous (and effective) vaccination program. Although cross-species transmission of rabies variants does occur (for example, dogs becoming infected with bat or raccoon variant), rabies virus variants are primarily transmitted within the species to which they are adapted. In other words, the raccoon variant is primarily transmitted between raccoons. With that said, it is still entirely possible for dogs to become infected and then transmit the disease to a human.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"STRUCTURE","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The rabies virus is within the family Rhabdoviridae. Each viral particle is surrounded by a thick lipid (fatty) envelope which helps protect it from attack while within an animal. This is part of what makes rabies infection so difficult to treat or cure once an animal is infected. Once outside of the animal, the envelope makes them very sensitive to drying out in the environment, and relatively easy to kill with various chemicals (ie. formalin, alcohol, phenols), soaps, and detergents. So, rabies actually has limited survival when not inside of its host animal. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"RABIES VIRUS IS A ROD- OR BULLET-SHAPED, SINGLE-STRANDED, NEGATIVE-SENSE, UNSEGMENTED, ENVELOPED RNA VIRUS. ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"INFECTION","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Rabies virus is transmitted through direct contact (ie. through broken skin or mucous membranes in the eyes, nose, or mouth) with saliva or nervous system tissue from an infected animal. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"While this occurs most readily through a bite wound from a clinically rabid animal, infected saliva can get into the body through any of the above-mentioned methods. Inhalation has been reported but is extremely rare. Blood, urine, and feces are not considered with risk of infection.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Once an animal becomes infected with the rabies virus, there is an incubation period before the virus actually ascends through the nerves to the central nervous system. This is influenced by many things including the age of the animal, the proximity of the bite to the spinal cord, and the degree of innervation of the inoculation site. The virus particles enter the peripheral nerves near the inoculation site and travel in a retrograde fashion toward the spinal cord. This travel can be as slow as 1 cm/day or as fast as 40 cm/day. Once in the spinal cord, the virus ascends towards the brain\nrapidly and bilaterally resulting in damage to the spinal cord's lower motor neurons. This can result in flaccid weakness or paralysis. Once in the brain, necrotizing encephalitis ensues resulting in marked injury and death of neurons. After this damage occurs, the virus then travels through cranial nerves and peripheral spinal cord nerves to other tissues. This includes the acinar cells of the salivary glands. Presence of virus in saliva indicates brain involvement has already occurred.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"CLINICAL SIGNS","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The clinical course associated with rabies infection is invariably progressive and has classically been divi
1007ded into a furious (or \"psychotic\") form and a paralytic (or \"dumb\") form. It should be noted that clinical signs in rabid animals can be highly variable and that not all cases adhere to these specific signs.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The furious type of disease can last from 1-7 days and is marked by increasing levels of anxiety, restlessness, hyperesthesia, and photophobia. As they progress through this form of the disease, they become increasingly aggressive to people, objects, or their enclosure (cage). Ataxia and seizures can also occur. Cats typically show wild and\nerratic behavior, muscle tremors, and continuous running.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The paralytic form of the disease is characterized by ascending paralysis until the entire central nervous system is affected. This form is most commonly seen in dogs; however, when seen in cats, it typically follows the furious form. Dogs will often show the characteristic change in bark, dropped jaw, difficulty swallowing, and hypersalivation (\"foaming at the mouth\") due to the brainstem and cranial nerves being affected. Since it was often mistaken\nfor choking, people may be exposed when exploring or trying to clear the mouth.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DIAGNOSIS \u0026 PATHOLOGIC FINDINGS","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Rabies is most often strongly suspected based on clinical signs and history; however, due to the large variation in presentation, it should be suspected in any animal displaying a profou
1007nd change in attitude or behavior. Definitive diagnosis is only made postmortem by finding rabies virus antigen in suitable brain tissue samples. Similar testing on skin samples, saliva, and blood have been described, but lack the sensitivity and specificity required for such an important disease.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"POST-EXPOSURE MANAGEMENT","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Whenever there is concern that an animal may have been exposed to the rabies virus, care needs to be taken to minimize the possibility of exposure to humans until the vaccination status of the animals involved is known. We recommend checking with your state's public health department for specific policies. For example, our BVNS locations in Virginia adhere to the Virginia Department of Health Guidelines for Rabies Prevention and Control. This can be found at ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"https://www.vdh.virginia.gov/animal-contact-human-health/rabies-control/virginia-guidelines-for-rabies-prevention-and-control/"},"content":[{"nodeType":"text","value":"https://www.vdh.virginia.gov/","marks":[],"data":{}}]},{"nodeType":"text","value":"","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"https://www.vdh.virginia.gov/animal-contact-human-health/rabies-control/virginia-guidelines-for-rabies-prevention-and-control/"},"content":[{"nodeType":"text","value":"animal-contact-human-health/rabies-control/","marks":[],"data":{}}]},{"nodeType":"text","value":"","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"https://www.vdh.virginia.gov/animal-contact-human-health/rabies-control/virginia-guidelines-for-rabies-prevention-and-control/"},"content":[{"nodeType":"text","value":"virginia-guidelines-for-rabies-prevention","marks":[],"data":{}}]},{"nodeType":"text","value":"","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"https://www.vdh.virginia.gov/animal-contact-human-health/rabies-control/virginia-guidelines-for-rabies-prevention-and-control/"},"content":[{"nodeType":"text","value":"-and-control/","marks":[],"data":{}}]},{"nodeType":"text","value":"","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"PREVENTION","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Vaccination of dog and cat pets is the best and most effective strategy for preventing rabies. Elimination of stray or feral unvaccinated dog and cat populations is expensive, controversial, and ineffective. Control of wildlife populations is also not effective or practical.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"While modified live vaccines generally provide better immunity to disease, rarely reported vaccine-induced rabies has prevented their use. Currently, rabies vaccines utilize inactivated (killed) virus and provide good immunity. Recombinant or DNA vaccines have been developed and may prove to be a better alternative in the future.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In Virginia, the law (*see reference above) requires every dog and cat receive a rabies vaccination before 4 months of age (whenever possible). The second vaccination (ie. booster) should be administered within 12 months of the first. Subsequent vaccinations should be administered based on the formulation of the previous vaccine given (ie. 1-year vs 3-year). Proper vaccination is essential for the protection of your pet and for the protection of veterinarians and their staff. If your pet has clinical signs compatible with rabies and no history of rabies vaccination, your pet will not be seen or examined by our staff. Examination of pets with outdated vaccine status depends on several factors but is typically handled on a case-by-case basis.\n","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"SUMMARY ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Rabies is a very rare disease in our domesticated pets; however, the risk of contracting the disease is\nvery real. Because rabies can present with subtle or variable clinical signs, care should be taken with any animal displaying abrupt neurologic dysfunction. Knowing that it is invariably fatal once neurologic signs develop, we feel strongly that every animal needs to be properly vaccinated.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}}
1007,"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"1nWS2H4WqC31sRTuza2cMo"},"name":"IMAGE CONTAINER - NVA - MASTER - BLOG - OUTDOOR - Dog Lying on Grass Next to a Plant Pot Outside","title":null,"altText":"A Brown Dog Lying on Grass Next to a Plant Pot Outside","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - NVA - MASTER - BLOG - OUTDOOR - Dog Lying on Grass Next to a Plant Pot Outside","url":"https://images.ctfassets.net/rt5zmd3ipxai/5qAQpboCMLT5Ltm2BJqdGF/5c3c1a63c06c2a925b0d7dee717545a4/iStock-1330460234-1200x800.jpg","size":194391,"width":1255,"height":685,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Ziva","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Ziva","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Ziva was adopted by her family at 7-years-old. Her background medical history includes coxofemoral osteoarthritis and previous treatment for heartworms. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2022"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"ZIVA'S HISTORY","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Ziva was adopted by her family at 7-years-old. Her background medical history includes coxofemoral osteoarthritis and previous treatment for heartworms. She presented to Bush Veterinary Neurology Service in Richmond, VA due to an acute onset of seizure activity. Her guardians noted that Ziva had her first seizure in mid November, 2021. She had facial twitching and went into a tonic clonic seizure that lasted 2-3 minutes. A couple of days later, she presented to her primary care veterinarian for bloodwork which came back within normal limits. Almost a month later, Ziva had her second seizure.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"BRAIN TUMOR","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Brain tumors are not always the âend of the roadâ for pets and are usually treatable in some way, shape or form.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"SEIZURES","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Seizures originate in the forebrain (cerebrum/thalamus). The differentials for this localization are late onset genetic-based, immune disease, vascular disease, neoplasia or others.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"AT HOME CARE","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Managing a pet with seizures or a brain tumor will most frequently require medical management, monitoring any\nchanges in behavior or routine, and regular follow-ups with your local neurologist. There will always be options available for treatment depending on each case.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MRI","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Dr. Martin Young at Bush Veterinary Neurology Service recommended and performed diagnostics including MRI of\nthe brain. T1 post contrast sequences show an increased signal mass lesion within the left parietal lobe. The mass\nmeasured 0.8cm X 1cm. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Summary: these findings are consistent with a small left forebrain meningioma.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"PROGNOSIS \u0026 TREATMENT","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Based on the diagnostics, the prognosis for Ziva is fair to good depen
1007ding on the treatment course. With medical management of steroids and an anticonvulsant medication, there would be an anticipated survival up to 6 months, with the addition of chemotherapy, about 8-10 months, and with radiation therapy, there would be an expected survival of 14-18 months. If decompressive surgery is considered, survival rate of over 18 months is expected. A combination of therapy would anticipate a longer survival which has been reported out to 3 years. After the MRI diagnosis, Ziva started a steroid medication to reduce edema and inflammation and an anti-convulsant medication to manage seizures prior to decompressive craniotomy.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"SURGICAL INTERVENTION","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Ziva continued to have some seizure activity at home, including facial twitching. It was decided that Ziva should undergo a left lateral rostrotentorial craniotomy performed by Dr. Young. During this procedure, an injection of Fluorescein was administered IV to highlight the tumor.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Fluorescein is absorbed by tumor cells, making abnormal tissue light up neon green while the remaining normal brain\ntissue glows blue when using a 497 nm wavelength light source. In this case, the Myriad (a surgical aspirator) with light source highlighted the tumor which was aspirated providing complete excision of the mass. The light source revealed that no contrast enhancing tumor remained in the field after aspiration was complete.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"All samples were submitted to Virginia Tech College of Veterinary Medicine diagnostics lab. Results noted benign meningioma that is likely not to recur.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{}
1007,"content":[{"nodeType":"text","value":"BENEFITS OF TECHNOLOGY","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The canine and the human brain are very closely correlated when it comes to structure and tumor types. Therefore, we can use the canine brain as a base model to help improve technology and advancements in both veterinary medicine and human medicine. Having the best and most innovative tools at the surgeons fingertips can help on many levels:","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Improved diagnostic potential and surgical performance","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Reduce error, labor time, and anesthesia time","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Boost productivity","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Enhance quality of patient care","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Revolutionize the way doctors diagnose and treat patients","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In Zivaâs case, Dr. Young has used the NICO Myriad device with light source for maximal safe tumor removal.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"CONCLUSION","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Ziva continues to do well at home. She enjoys going on walks and playing frisbee! Dr. Young and Bush Veterinary Neurology Service look forward to continuing her care and aiding in her recovery.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"*All photographs included are from Zivaâs case with permission.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"*Special thank you to Ziva and her family","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"ANVVoYMVcZQqEMT7UWXN5"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Ziva","title":null,"altText":"A brown dog laying on the floor with stitches in her head","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Ziva","url":"https://images.ctfassets.net/rt5zmd3ipxai/5VIvJOwmYZwQZPFHXwJ3Bw/6ebd27a9bb31e8ef4c4e8fb415cd60a0/ziva.png","size":395850,"width":1255,"height":685,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Henrietta","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Henrietta","blogAuthor":null,"blogDate":null,"url":"henrietta","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Henrietta is a four-year-old spayed female cat whom presented with a sudden onset of abnormal head movements. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2023"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MEET HENRIETTA ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Henrietta is a four-year-old spayed female cat whom presented with a sudden onset of abnormal head movements. When a patient presents for abnormal head movements â what would you do? The best approach is to localize the lesion and create an accurate list of possible causes for the symptoms. What do you think? 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More specifically, normal reflex and fatigue of palpebral reflex suggest nerve-muscle junction disease.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"WHAT ARE THE TOP DIFFERENTIALS?","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Immune / infectious / metabolic disease of the muscle / nerve or junction.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"WHAT IS THE SEQUENCE OF RECOMMENDED TESTING?","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"CBC","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Chemistry","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Creatine Phospohokinase (CPK)","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Thoracic radiographs","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Neostigmine Response Testing","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"+/- Acetlycholine Antibody Testing","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"+/-Thyroid and Adrenal Testing","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"+/- Protozoal Testing (Toxoplamosis gondi or Neopsora caninum)","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\n","marks":[],"data":{}},{"nodeType":"text","value":"INITIAL DIAGNOSTIC RESULTS","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"CBC - normal","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Chemistry - normal","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"T4 -low normal","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"CPK- normal","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{}
1007,"content":[{"nodeType":"text","value":"Thoracic Radiographs - non-remarkable - no megaesophagus","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Next Step - Investigate Myasthenia Gravis","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MYASTHENIA GRAVIS TESTING","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In Myasthenia gravis antibodies bind to acetylcholine (ACH) receptors\non the muscle endplate preventing muscle contraction.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Acetylcholinesterase breaks down ACH. Inhibition of synaptic\nacetylcholinesterase, increases acetylcholine, and improves muscle\ncontraction and strength with MG.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Oral acetylcholinesterase inhibiton with Mestinon (Pyridostigmine) is a useful treatment for MG. 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In MG there is an insufficient concentration of ACH.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"NEOSTIGMINE CHALLENGE TEST (NCT)","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Neostigmine Dose 0.02, IV, observe for improved gait and prolonged ability to walk before becoming weak - typical response time is 2 minutes (range of 1-20 mins)","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Possible side-effects from increased ACH:","marks":[],"data":{}}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Muscarinic receptor binding can cause hypersalivation (and less commonly vomiting, diarrhea, bronchoconstriction, AV block). Atropine will block the muscarinic receptor and reduce these side effects.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Nicotinic receptor binding can cause muscle fasiculation (and\ntheoretically flaccid paralysis and respiratory failure). Atropine will\nnot block nicotinic receptor and prevent respiratory failure.","marks":[],"data":{}}]}]}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"When performing neostigmine challenge test (NC T):","marks":[],"data":{}}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Closely observe for 30 minutes","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Consider pre- or post-treatment with atropine 0.02 mg/kg, IV","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"ET tube ready for intubation from respiratory failure","marks":[],"data":{}}]}]}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"CHLOE'S OUTCOME","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"ACH Antibody Test Result:\nACH antibody test - 0.08 (positive is \u003e 0.05 nmol/L)","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\n","marks":[],"data":{}},{"nodeType":"text","value":"Treatment:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Mestinon 1 mg/kg, BID resolved clinical signs but was increased to TID because she was weak prior to next dose ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{}
1007,"content":[{"nodeType":"text","value":"Cyclosporine 6 mg/kg, BID was NOT started because of low titer and relatively mild signs","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Prednisone is contraindicated because can cause neuromuscular weakness and muscle atrophy\n","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Prognosis:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Among all dogs with MG about 65% survive. Chloe's prognosis was\nconsidered good because of relatively low titer, absence of\nmegaesophagus/regurgitation/pneumonia, and younger age.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Normal at 6-month and 12-month follow-up, Mestinon was then successfully\ntapered and eliminated.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"6mm52ygCsskAELkF5uoGay"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Chloe","title":null,"altText":"Chloe a white dog.","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Chloe","url":"https://images.ctfassets.net/rt5zmd3ipxai/6c8cJPfvY2ArxNEX9UvTHI/f12fa893a23b0e94983f41e2f89412a4/Chloe.png","size":111721,"width":300,"height":251,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Stella","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Stella","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Stella has a long history of being a hunting dog and had been on a hunting trip -3-4 weeks prior to the onset of clinical signs. 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Strong consideration was given to the latter considering the clinical signs. A presumptive diagnosis of tetanus was assigned.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Outcome","nodeType":"text"},{"data":{},"marks":[],"value":"\nStella has a long history of being a hunting dog and had been on a hunting trip -3-4 weeks prior to the onset of clinical signs. We believe she may have suffered a wound or was otherwise exposed at that time. No external wound was found. Overall, Stella did very well in that the condition was recognized and treatment (with metronidazole) was started prior to an overwhelming and widespread contraction of all of her muscles. Her signs gradually resolved over 2-3 weeks.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Tetanus Disease Summary","nodeType":"text"}],"nodeType":"heading-3"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Clinical Signs","nodeType":"text"},{"data":{},"marks":[],"value":"\nSigns start 5-10 days after exposure and may persist for up to 3 weeks. Affected animals commonly have rigidity of the limbs, extension of the neck, clenching of the jaw (trismus), a characteristic facial expression (risus sardonicus) and less commonly cardiac arrythmia and seizure.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Pathophysiology","nodeType":"text"},{"data":{},"marks":[],"value":"\nThe signs of tetanus are caused by a neurotoxin produced by Clostridium tetani, an obligate anaerobic spore forming Gram-positive bacteria. Spores found in the environment will germinate in response to anaerobic conditions (such as in a deep penetrating wound, or in teething animals) and produce various toxins. The toxins invade peripheral nerves at the axonal terminals and ascend to the spinal cord. The most significant of these toxins (ie. tetanospasmin) blocks inhibitory neurotransmitter release at interneurons in the spinal cord and brain. This results in the inability for muscles to relax.\n","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Diagnosis","nodeType":"text"},{"data":{},"marks":[],"value":"\nA diagnosis of tetanus is usually based on solely on clinical signs. Blood samples for complete blood count (CBC) and biochemistry will often be unhelpful although an elevation in creatine kinase may be noted. A wound may be detected; however, in the majority of cases, one is never found. Isolation (culture) of C. tetani can be attempted but this requires anaerobic conditions and special culture media. Growth is slow and will often take longer than 12 days.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Treatment","nodeType":"text"},{"data":{},"marks":[],"value":"\nTreatment of tetanus may include wound debridement, intravenous antitoxin, sedation/muscle relaxation, antibiotics, and intense nursing care (feeding, maintaining hydration, preventing soiling, etc). Untreated cases are often fatal due to respiratory complications.\n","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Wound debridement followed by topical antiseptics is important to remove any necrotic tissue found and inhibit further bacterial growth.\n","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Antitoxin neutralizes any free or unbound toxin and (if used) should be given as soon as possible after the onset of clinical signs. Unfortunately, intravenous administration of antitoxin is associated with a high prevalence of anaphylaxis.\n","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Muscle relaxants and sedatives are indicated in cases with marked muscle rigidity and hyperexcitability. Diazepam or clorazepate can be used for muscle relaxation and/or seizure activity. Phenothiazine derivatives (e.g., acepromazine) have a sedative effect and a weak anticholinergic action.\n","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Antibiotic therapy is indicated to eliminate vegetative C. tetani organisms and prevent further toxin formation. It is important to realize antibiotics have no effect on toxin that has already bound to the nerves. Penicillin has long been thought to be the drug of choice but a 1985 study found metronidazole to be more effective than penicillins. It suggested dogs receiving metronidazole had an improved response, with a significantly lower mortality rate and a shorter stay in the hospital.\n","no
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Read articles and case studies written by our staff on a variety of relevant topics.","ogimage":null,"doNotCrawl":null,"overrideContactInformation":null,"itemsCollection":{"__typename":"TemplateDynamicLayoutPageItemsCollection","items":[{"__typename":"PromoBanner","sys":{"__typename":"Sys","id":"6Ds6uZfCuLlLtAaxttwEBF"},"name":"PROMO BANNER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Neurotransmitters Case Studies","fontColor":"Light","anchorLink":null,"categoryTitle":null,"linkedFrom":{"__typename":"PromoBannerLinkingCollections","templateDynamicLayoutPageCollection":{"__typename":"TemplateDynamicLayoutPageCollection","items":[{"__typename":"TemplateDynamicLayoutPage","sys":{"__typename":"Sys","id":"vifQlLdaeq3NrS69bZytq"}},{"__typename":"TemplateDynamicLayoutPage","sys":{"__typename":"Sys","id":"5vga3JvIufZgqBIl2pKbYs"}}]}},"backgroundImage":null,"overrideBackground":{"__typename":"OverrideBackground","backgroundId":"#0E4C8C","colorBackground":"#0E4C8C","colorVariable":null,"imageBackground":null,"imageBackgroundEntry":null},"headline":"Neurotransmitters Case Studies","subheadline":null,"textBlock":null,"cta":null,"multipleCtaCollection":{"__typename":"PromoBannerMultipleCtaCollection","items":[]},"customCode":null},{"__typename":"Spacer","space":"Small","name":"SPACER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Bright Blue - Small","background":{"__typename":"OverrideBackground","backgroundId":"#0D96D4","colorBackground":"#0D96D4","colorVariable":null,"imageBackground":null,"imageBackgroundEntry":null}},{"__typename":"BlogBlade","name":"BLOG BLADE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Neurotransmitters Case Studies","anchorLink":null,"itemsCollection":{"__typename":"BlogBladeItemsCollection","items":[{"__typename":"Blog","featured":false,"title":"Boudreaux","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Boudreaux","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Boudreaux is a 4 year old male neutered Papillion that the owners brought to BVNS for recurrent back pain. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Boudreaux is a 4 year old male neutered Papillion that the owners brought to BVNS for recurrent back pain. He had several past episodes of having a hunched back, walking slowly and exhibiting signs of pain. Each episode responded to rest and pain medications. The family veterinarian had performed general lab work and radiographs of the thoracolumbar spine with no apparent abnormalities. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting complaint","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Recurrent back pain","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Examination Abnormalities and L
1007ocalization","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Boudreauxâs general physical examination was within normal limits. On neurologic exam his gait, cranial nerve exam, reflexes and mentation were all normal. He did, however, experience moderate pain on direct palpation of the cervical spine and mild pain in the lumbar spine.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Possible differential diagnoses for a dog of this breed and age included: 1) Intervertebral disc extrusion, 2) Inflammatory disease (i.e. meningitis â infectious or auto immune), 3) Malformations (i.e. Caudal Occipital Malformation Syndrome, Atlanto-Axial subluxation), 4) Neoplasia (less likely).","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Because of the recurrent back and neck pain, an MRI of the thoracolumbar and cervical spine was recommended. Pending those results a spinal fluid analysis was also recommended.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The MRI of the thoracolumbar spine was performed first and did not reveal any significant abnormities other than degenerative intervertebral discs without evidence of herniation. No obvious cause of the back pain was found.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The MRI of the cervical spine revealed a markedly widened C1-C2 joint space. The cranial aspect of C2 was tipping dorsally causing compression of the spinal cord. The dens on C2 appeared to be hypoplastic. Additionally, there was mild hyperintensity noted within the spinal cord near the area of compression that most likely represented edema or scarring from chronic compression. These MRI findings were consistent with an Atlanto-Axial (A-A) subluxation with subsequent spinal cord compression.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Given the severity of the MRI findings and Boudreauxâs neurologic status, surgical stabilization of the A-A joint was recommended. Several factors are considered in determining the prognosis with surgical stabilization:","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Age","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" - younger patients tend to do better than older patients","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Length of time symptoms have existed -","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" chronic symptoms is a negative prognostic indicator","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Severity of neurologic status ","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":"- dogs that are currently ambulatory tend to do better","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Size of dog ","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":"- very small dogs can be difficult to stabilize","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Because of the sensitive region of the nervous system involved with this type of problem, surgical mortality rates can be as high as 25-40%. Nevertheless, given Boudreauxâs current status, we felt that surgical stabilization was the preferred method of treatment and that his prognosis would be good. The owner agreed and surgery was scheduled. The alternative would have been to place Boudreaux in a neck brace for 8-10
1007weeks. While this is a viable option, neck braces are inherently difficult to place and frustrating to maintain. They are often placed incorrectly, slip, become soiled and need to be frequently changed. The bulk of bandage needed to truly stabilize the A-A joint can often interfere with eating and drinking.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"There are several ways to surgically stabilize the A-A joint. In this case, we reduced the luxation by using bone forceps to pull C2 ventrally. We then placed 2 threaded pins dorsal-laterally through the A-A joint from a ventral approach. Several small cortical screws were also placed in various locations in the ventral aspect of C1 and C2. These screws were then incorporated into bone cement to help hold the fixation. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Itâs been about 9 months since his surgery and he has remained pain free and is off all medications. Repeat radiographs were performed about 3 months after surgery and all implants were in their proper location. Even though Boudreaux didnât know how to express his thanks, his owners were very happy with his outcome.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take Home Points","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Donât exclude A-A luxation as a differential in adult dogs.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Dogs with cranial cervical malformations (AA luxations, Chiari malformations) often will have spinal pain in areas other than their neck (i.e. back). Changes in spinal fluid dynamics and pressure can account for this pain.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"An A-A luxation is occasionally just one part of a combination of concurrent cranial cervical malformations. Sometimes, multiple advance imaging studies such as MRI, flexed and extended CT scans, and 3D reconstructions are needed to gather the full clinical picture.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Several factors determine the prognosis with surgical management. Every patient is evaluated separately.5 â Surgical management is typically the best way to manage this problem. Neck braces can be used but are inherently cumbersome, frustrating and cause numerous potential complications.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"This case was referred by Dr. Bethany Birch of Banfield of Alexandria. For more information or to discuss this case please contact","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":" Dr. Brewer","marks":[],"data":{}}]},{"nodeType":"text","value":" or ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":"Dr. Jarboe","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}}
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","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hobbes is a 2-year-old Weimaraner who presented to our Springfield location in August 2010. Cerebrospinal fluid analysis (CSF) revealed severe neutrophilic pleocytosis and treatment with antibiotics and immunosuppressive doses of steroids were initiated.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"History","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Episodes of fever (104-105), not eating, unwilling to move, intermittent lameness that would last for 10-14 days and resolve while on Rimadyl. A neurologist from a different institution had examined him already and not found any specific deficits.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Examination Abnormalities and Localization","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Neck pain appreciated by reduced range of motion in all directions as well as discomfort demonstrated during lumbosacral palpation. Due to the presence of fever, inflammatory or infectious disease of the meninges or the bone/muscle/nerve of the spinal column was considered most likely. More specifically, we considered steroid-responsive meningitis arteritis, bacterial or fungal diskospondylitis, GME, or infectious meningomyelitis to be highly likely.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Radiographs of Hobbesâs cervical and lumbosacral spine were normal and showed no signs of diskospondylitis. Hobbes was placed under general anesthesia and a spinal tap was performed.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hobbesâs CSF showed a severe neutrophilic pleocytosis (elevated neutrophils in the CSF) and an elevated protein. These findings as well as Hobbesâs signalment were consistent with sterile meningitis, also known as steroid-responsive meningitis arteritis. However, infection could not be ruled-out so Hobbes was started on doxycycline, clindamycin and immunosuppressive doses of corticosteroids.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnosis","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cerebrospinal fluid bacterial culture, toxoplasma/neospora and a PCR tick panel were found to be normal, as a result antibiotics were later discontinued. The C-reactive protein (CRP) was markedly elevated at 60 mg/dL. These findings, coupled with his signalment, history and response to medications (see below), provided for a diagnosis of steroid-responsive meningitis arteritis (SRMA).","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"On recheck examination one month later, Hobbes was pain free, afebrile and back to his normal self at home. A follow-up C-reactive protein was submitted and was normal at 0.1 mg/dL. Hobbes was continued on his tapering course of steroids and received a total of 8 weeks of therapy. He later relapsed based on examination and an elevated CRP and is now well controlled on cyclosporine.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take Home Points","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In a large breed and young dog (typically 8 months of age or older) exhibiting a waxing and waning fever, examine for neck pain and be highly suspicious of SRMA. The Boxer, Bernese Mountain Dog, Great Pyrenese and Newfoundland are at a particularly high risk.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Elevated neutrophils in the CSF (neutrophilic pleocytosis) are common in autoimmune and infectious conditions of the spinal cord. Infectious disease testing and a trial with antibiotics are recommended under these conditions.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"C-reactive protein (CRP) is a marker of inflammation and is typically elevated in dogs with SRMA. This is a very useful test for assisting in the diagnosis of SRMA and documenting relapse of this condition.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In addition to prednisone, immune-modulating drugs like cyclosporine, azathioprine, leflunomide or mycophen
1007olate can also be effective in the treatment of SRMA.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"To discuss this case or to ask a question related to this case please email","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":" Dr. Neary","marks":[],"data":{}}]},{"nodeType":"text","value":". This case was referred by Dr. Tracy Appelbaum of ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://www.rockygorgevet.com/"},"content":[{"nodeType":"text","value":"Rocky Gorge Animal Hospital Resort \u0026 Spa","marks":[],"data":{}}]},{"nodeType":"text","value":". Hobbes was seen by Dr. Tiches and Dr. Neary.","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"4ns6QKxDF09uZk3stsfawY"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Hobbes","title":null,"altText":"Woman in a blue shirt smiling next to Hobbes, a Weimaraner","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Hobbes","url":"https://images.ctfassets.net/rt5zmd3ipxai/2lligfLbDCXTqGhK5kGsgx/b384ae19923a5bcff9b975fe2b781eef/Hobbes-Owner-Picture-Edit-1024x772.jpg","size":131044,"width":1024,"height":772,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Max","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Max","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Max is a 19 year-old, male castrated mixed breed that presented to BVNS for circling and a head tilt. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Max is a 19 year-old, male castrated mixed breed that presented to BVNS for circling and a head tilt. He was diagnosed with two meningiomas and ten months later he is thriving at home.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting Complaint","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"One month lethargy, 4 days of stiffness after walks, not jumping into the car and suddenly circling to the right, head tilt right.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Examination Abnormalities and Localization","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Max had a right head tilt, fast phase nystagmus to the left, and would lean and fall to the right but also make large circles to the right. His right eye was droopy, the third eyelid was prolapsed and he did not menace well on the right. A central vestibular problem was likely due to the poor menace with a normal palpebral response. However, a poor menace response and large radius circling can indicate forebrain dysfunction. Therefore disease in more than one area was also considered.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MRI of the brain showed a large, right-sided mass at the level of the pons and a second mass in the left olfactory lobe.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The characteristics were the most compatible with TWO meningiomas. However, lymphoma or a fungal infection called Cryptococcus were also considered. A CSF analysis was inconsistent with lymphoma and Cryptococcus antigen testing was negative, therefore Max was diagnosed with TWO meningiomas.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Palliative or symptomatic treatment with prednisone allowed Max to do so well that definitive treatment was considered. BVNS worked with Dr. Rick Joseph and Dr. Sarah Charney at the Animal Specialty Center in Yonkers, New York to obtain ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://www.vcaspecialtyvets.com/animal-specialty-center/departments-doctors/departments/radiation-oncology"},"content":[{"nodeType":"text","value":"cyber knife radiation treatment","marks":[],"data":{}}]},{"nodeType":"text","value":" for Max. This technologically advanced form of radiation therapy can direct the radiation such that larger doses of radiation can be given per treatment, reducing the number of anesthetic episodes from 15 to 3.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Max is currently about six months out from his radiation and is doing well. We received this update from his family recently: âMax is still doing fantastic! â¦chasing bikers, joggers, deer and puppy wrestling. His hearing is good, sight seems very good too. He sleeps very well and is alert and active when heâs awake. Heâs walking 1-2 miles/day, and back to playing with stuffed animals and throwing them around, and playing with squeaky toys (He can hear them again!).â While Max was in Yonkers he met another dog who was twenty-four years old and was going in his for second round of radiation therapy four years after his first treatment of a meningioma, and was otherwise happy and healthy.We are thrilled with Maxâs progress and look forward to hearing more positive updates from his family in the future.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take Home Points","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Patients with head tilt + poor menace and a normal blink reflex have disease within the brain and therefore do not have Old Dog Peripheral Vestibular Disease. Furthermore, when the signs just do not seem to fit, often more than one lesion
1007is present or at a minimum the disease is within the brain rather than Old Dog Peripheral Vestibular Disease.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Meningiomas are the most common type of primary brain tumor in cats, dogs, and humans. Surgery and/or full course radiation have been the mainstay of treatment. Technological advances and research are providing excellent long term outcomes with a high quality of life in many patients.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"BVNS strives to offer as many treatment options as possible and partners with many different experts nationwide. Current treatment options and average survival times are as follows.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Steroid alone - 3 months","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Steroid + Hydroxyurea - 6 months","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Conventional surgery - 10 months","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Full course radiation or cyberknife - 12-14 months, may be longer with cyber knife","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Surgery + Autologous Vaccine - pilot date shows 75% of dogs alive 600 days post-treatment","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"BVNS is working with Dr. John Ohlfest at the University of Minnesota","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://www.braintumorlab.com/"},"content":[{"nodeType":"text","value":" Brain Tumor Lab","marks":[],"data":{}}]},{"nodeType":"text","value":" where the patientâs meningioma is developed into an intradermal vaccine that is then administered along with a topical immunostimulant every 2 weeks for 12 weeks. The patients we have treated had complete excisions of their tumors prior to vaccine and are doing exceedingly well.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"To discuss this case or to ask a question related to this case please email Dr. Young. Case referred to BVNS by Dr. Renee Welch at the ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://www.acah.com/"},"content":[{"nodeType":"text","value":"Andersonâs Corner Animal Hospital","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"51Jg7ssTKaJvdEjGXoVpxT"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Max","title":null,"altText":"Max, mixed breed dog, outside standing on leaves","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Max","url":"https://images.ctfassets.net/rt5zmd3ipxai/71q9xx9hrkOvPFuUNMpxl3/f7ac63f0ca3b4ae39ae0b22d2d353fde/max1.jpg","size":126289,"width":524,"height":504,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Prinz","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Prinz","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Prinz is a 9-year-old German Shepherd mix referred to BVNS for an inability to walk in the hind legs and severe back pain of less than 24 hours duration. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Prinz is a 9-year-old German Shepherd mix referred to BVNS for an inability to walk in the hind legs and severe back pain of less than 24 hours duration. The prior afternoon, Prinz had been playing ball. He jumped to catch the ball, and upon landing, cried out, and was immediately paralyzed in the back legs. Over the next 15 minutes, he regained movement in the back legs but was unable to walk. He continued to be extremely painful, even biting his owner when they tried to help him, very atypical behavior for him as heâs normally a lover and very playful. He was rushed to an animal emergency hospital and treated supportively with anti-pain medications, NSAIDs, and fluids.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting Complaint:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Peracute paraplegia (loss of conscious movement in the pelvic limbs) and severe back pain after a jump while playing ball.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Slightly improved neurologic grade, non-ambulatory paraparesis (conscious movement present in the pelvic limbs but unable to walk) and continued intense pain de
1007spite analgesics (anti pain medications).","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Assessment (Neurolocalization):","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Severe non-ambulatory paraparesis, absent postural and placing responses in the pelvic limbs, brisk spinal reflexes with intact superficial pain perception, cutaneous trunci reflex present cranial to T12 on the left and present cranial to L1 on the right, left sided muscle spasms and discomfort extending from T12 to L4/L5.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Prinzâs deficits localized to a left lateralizing T3-L3 myelopathy with the primary differentials being a Type I or Type III disc extrusion.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Spinal radiographs taken by the emergency hospital revealed predominant finding of a subtle narrowing of the T12-T13 intervertebral disc space.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"An MRI of the thoracic to sacral spine was performed. E
1007xtra-dural hemorrhagic material was dispersed along the left canal extending from T11 to T13 causing mild cord deviation towards the right of the canal. Nearly 75% of the spinal cord parenchyma, slightly left lateralizing but predominantly central in distribution, demonstrated increased T2W signal consistent with edema, dorsal to the T12-T13 disc space. The left paraspinal muscles extending from T9 to L2 were diffusely swollen and edematous.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"These findings were most consistent with a high velocity, low volume disc extrusion at T12-T13 and likely concurrent neurogenic myositis or vasospasm with infarction to the left paraspinal musculature.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"A left hemilaminectomy was performed from T11 to T13. Upon fascial incision, the left paraspinal muscles everted out the incision margins and were grossly swollen, edematous, and pale. Biopsies were obtained of the abnormal musculature. Upon entry into the canal, the epidural adipose tissue was discolored and intermixed with hemorrhagic material. Tannish fluid like material was removed from the ventral canal dorsal to the T12-T13 disc space. Samples of each were also submitted for histopathological evaluation. Cultures were also collected and submitted. The venous sinus structures lining the floor of the canal were dilated and pulsating. Histopathology results demonstrated myofiber necrosis with neutrophilic inflammation and mineralized cartilage removed from the spinal canal samples. Cultures were negative for bacterial growth.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnosis:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hansen Type III disc extrusion (high velocity, low volume) at T12-T13 causing internal cord injury and secondary inflammatory muscle necrosis.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Prinz recovered to his normal, active, happy self over the following days and was discharged several days later so he could travel with his family to California where they had recently been stationed. We continue to receive updates from the ownerâs regarding Prinz and his life as a âbeach dogâ! We remain humbled by Prinzâs endearing zest for life and for his military family serving our country.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take Home Points:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Review of the three primary classifications of Intervertebral Disc Disease:","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hansen Type I: an acute extrusion, under varying velocities, of the nucleus pulposus (inner portion of the disc, normally gelatinous but can become rock like when degeneration occurs) causing moderate to severe cord compression. Often requires surgical intervention to remove compressive elements and continued cord injury. If the disc material ruptures under high velocity forces,internal cord injury occurs. Less than 1% of patients will develop life ending myelomalacia up to 5-7 days following the injury, despite emergent surgical decompression. MRI often helps identify significant intraparenchymal cord injury and can better help predict prognosis following surgical decompression.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hansen Type II: a slow, chronic protrusion or prola
1007pse of the dorsal annulus (ligamentous structure surrounding the nucleus pulposus) into the spinal canal causing slow compression of the spinal cord. One caveat is an âacute on chronic discâ presentation where acute decompensation can occur. If the spinal cord impacts/strikes a mound of protruding dorsal annulus, severe internal cord injury can occur resulting in rapid decompensation.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hansen Type III: a high velocity or âexplosiveâ, low volume disc extrusion causing severe internal cord injury. Also referred to as acute non-compressive nucleus pulposus extrusion or ANNPE. If severe enough, myelomalacia, a potentially fatal break down process of the spinal cord, can occur up to 5-7 days from the injury.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"To ask a question related to this case or discuss any aspect of it please email ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":"Dr. Jarboe","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Case referred to BVNS by Dr. Roque Pereira at the ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://www.aecfred.com/"},"content":[{"nodeType":"text","value":"Animal Emergency Clinic of Fredericksburg","marks":[],"data":{}}]},{"nodeType":"text","value":", Prinzâs primary care veterinarian is Dr. Gary Dunn at ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://www.woahvets.com/"},"content":[{"nodeType":"text","value":"White Oak Animal Hospital","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"375UkvHsdtEUjuLrOX8Dlj"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Prinz","title":null,"altText":"Two people smiling next to Prinz, a German Shepherd mix","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Prinz","url":"https://images.ctfassets.net/rt5zmd3ipxai/426qXuXmFlwEsaBYZT68Ch/d4b24babf0c274b19f1493a93d64e493/Prinz-300x224.png","size":128960,"width":300,"height":224,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Tiki","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Tiki","blogAuthor":null,"blogDate":null,"url":"tiki","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Tiki is a 4 year-old spayed female Maltese referred to Bush Veterinary Neurology Service after one week of 30-60 second episodes of lethargy, shaking and keeping her head down. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Tiki is a 4 year-old spayed female Maltese referred to Bush Veterinary Neurology Service after one week of 30-60 second episodes of lethargy, shaking and keeping her head down. She became progressively worse, started crying out during the episodes and would intermittently circle to the left.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The owner brought a video of the episode, which showed a two-minute episode of vestibular ataxia, mild left head tilt and holding her head down. Tiki would also hold her right pelvic limb up during the episode and appeared alert and aware (would wag her tail when the owner called her name). Immediately after the episode, Tiki moved normally. Neurologic examination showed evidence of an abnormality in the caudal fossa (caudal cerebrum and cranial brainstem), lateralized to the left. Her intermittent episodes were most likely due to an increase in intracranial pressure, rather than seizure activity.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"An MRI of the brain was consistent with diffuse encephalomyelitis and cerebellar herniation. A cerebrospinal fluid anal
1007ysis was recommended to confirm the diagnosis for inflammatory disease, but considered of increased risk due to the foramen magnum herniation. Despite concerns for her long-term prognosis (due to how severe the changes seen on her MRI and her progressive clinical signs) she has continued to do well on medications.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting Complaint:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Increasing frequency of episodes of keeping her head down and mental dullness, lethargy, decreased appetite, and circling to the left.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Assessment (Neurolocalization):","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Left lateralized caudal fossa","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"1. Dull mentation\n2. Tendency to hold head and neck down\n3. Circling to the left\n4. Vestibular ataxia, with intermittent crossing in all four limbs\n5. Decreased placing reactions in the left limbs\n6. Pain on palpation over the head","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"An MRI of the brain shows moderate enlargement of all ventricles and a non-contrast enhancing hyperintensity within the cervical spinal cord parenchyma. On the post contrast T1W post sagittal image, the caudal aspect of the cerebellum was herniated through the foramen magnum.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Tiki was administered mannitol (1g/kg) intravenously after her MRI to decrease intracranial pressure. Due to her signalment, examination and MR findings, we were most suspicious of an immune-mediated meningioencephalitis, specifically granulomatous meningioencephalitis (GME). Tiki was admitted to the hospital for empirical therapy for her inflammatory disease. She was started on steroid medication (prednisone 0.5mg/kg PO q12h) and immunomodulatory medication with a CRI of intravenous cytarabine (Cytosar) over 48 hours and cyclosporine (5mg/kg PO q12h). She was also placed on famotidine (0.5mg/kg) for gastroprotection while on the steroid. Tiki was discharged from the hospital two days later with an improved neurologic examination (less compulsive circling, mild ataxia and improved postural reactions).","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In the few months after her hospitalization, Tiki has shown progressive improvement and is now neurologically normal. She has not required any additional cytarabine therapy and is currently being maintained on daily cyclosporine and a low dose of steroids, which we have been tapering slowly over the past several months. We suspect that due that her prognosis is good, though relapse in patients with immune-mediated inflammatory central nervous system disease is always possible.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take Home Points:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Having clients videotape episodic neurologic abnormalities can be helpful when considered along with the history and neurologic examination in determining a patientâs neurolocalization. This is especially true in cases like Tikiâs, where the neurologic examination is normal between episodes.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cerebellar herniation is a dynamic process and is observed in patients with an increase in intracranial pressure.\n","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The prognosis for immune-mediated brain disease like GME was once poor but with the advent of new medications and protocols, the prognosis is much better. A recent retrospective showed that 60% of dogs were normal and the other 40% much improved on azathioprine, the dogs in this study had an average survival of almost 6 years. At BVNS we use prednisone to manage the acute symptoms but try to replace this medication with immune modulators like azathioprine, cyclosporine, leflunomide and/or chemotherapies like cytosar, procarbazine, and lomustine.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"To ask a question related to this case or discuss any aspect of it please email ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":"Dr. Hague","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"A special thank you to Dr. Jennifer Lauer at the ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://www.pendervet.com/"},"content":[{"nodeType":"text","value":"Pender Veterinary Center","marks":[],"data":{}}]},{"nodeType":"text","value":" who referred this case. Dr. Lauer is an Ohio State University classmate of Dr. Hagueâs and is now practicing at ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://vverc.com/"},"content":[{"nodeType":"text","value":"Valley Veterinary Emergency and Referral Center","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}}
1007,"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"3RpMfglC8PRJoRJoZ3L4O4"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Tiki ","title":null,"altText":"White maltese dog named Tiki ","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Tiki ","url":"https://images.ctfassets.net/rt5zmd3ipxai/6Ns37zsdCezjHUawA3m55C/09bfd8d5a550cf29c15889102435b56b/Tiki.jpg","size":69426,"width":524,"height":393,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Squirrel ","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Squirrel ","blogAuthor":null,"blogDate":null,"url":"squirrel","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Squirrel is a 10 year old, male, castrated cat that presented to BVNS for persistent, intermittent 15 second seizures (non-responsive, left side facial twitching progressing to generalized twitching, salivation) despite treatment with multiple doses of valium and 10 mg/kg of phenobarbital.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Squirrel is a 10 year old, male, castrated cat that presented to BVNS for persistent, intermittent 15 second seizures (non-responsive, left side facial twitching progressing to generalized twitching, salivation) despite treatment with multiple doses of valium and 10 mg/kg of phenobarbital. Squirrelâs examination suggested multifocal brain disease because there was a tendency to turn head to right, poor postural ability on right side, circling left, and a poor menace and poor palpebral response on the left. Infection, inflammation, or a neoplastic process were considered most likely. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Chemistry, CBC, and later, MRI, spinal tap, and infectious disease titers were all negative and treatment was initiated for infection (likely viral) and seizure. Squirrel was treated with zonisamide, levetiracetam, and phenobarbital as well as low doses of prednisolone and clindamycin. Thirty hours later he had the following story: ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting Complaint: ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Fever, confusion, dull, non-ambulatory, intermittent eyelid twitching, squinting, and right head turn. To view a video of Squirrel shortly after his admission at BVNS, visit our site: www.bvns.net/neurotransmitter. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Assessment: ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Mutlifocal brain disease was noted. Brainstem disease was suggested by weakness, dullness and poor palpebral response; right forebrain disease was suggested based on confusion and head turn. The patient was thought to be having a constant seizure (Status Epilepticus or SE) based on eyelid twitching and fever, however, there are many other causes for fever and eyelid twitching. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics: ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Dr. Mark Stecker, who is a physician, neurologist and world expert on EEG that has been helping Dr. Bush perform EEG for over 10 years, was asked to assist with Squirrelâs care. An electroencephalogram (EEG) was recorded (video at: www.bvns.net/neurotransmitter) in a double banana montage and read real time by Dr. Cuff, Dr. Bush and Dr. Stecker. Dr. Stecker remotely viewed the EEG in order to provide ongoing feedback and consultation. This allowed us to titrate treatment to the dissipation of epileptiform activity with 100 mg/kg of phenobarbital. Phenobarbital was selected because barbiturates are the most useful drugs in this situation in people as opposed to diazepam, propofol or levetiracetam. The patient was intensely monitored (end tidal CO2, blood gas, blood pressure, ECG) but did not require cardiorespiratory support during the 12 hour loading with phenobarbital. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome:","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Squirrel developed serious heart disease and azotemia while being treated for SE. A heart murmur had been noted 2 years ago and current thinking is that this disease may have become clinical due to administration of low doses of fluids and prednisone or possibly related to the cardiovascular effects of the diluent in phenobarbital (a phenomenon reported in the 1940âs in people). After 2 weeks of intensive care from the Critical Care Service at TLC, CVCA, and BVNS, Squirrel was healthy enough to go home. Here he is pictured with the owners and Dr. Cuff. Squirrel is about 2 months out from his presumed severe viral brain problem and doing very well. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take Home Points","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": ","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Status Epilepticus leads to death of inhibitory neurons, release of excitatory neurotransmitters and generates other pockets of abnormal electrical activity (kindling) leading to more seizure and occasionally death. ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Patients can have active severe EEG seizure without any autonomic signs (salivation, urination, defecation, pupil dilation or constriction) and without obvious muscle movement. ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment of SE, ideally guided by the EEG, can require very high doses of phenobarbital. ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}}
1007,"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"2Qzta2JZHIT0sXhGY8mEUV"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Squirrel ","title":null,"altText":"Squirrel the cat surrounded by doctors ","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Squirrel ","url":"https://images.ctfassets.net/rt5zmd3ipxai/2IzuPqdsbt7WCTfMlJOvlk/7f6e89d618cc7a31cb766b7497812c85/Squirrel-lg11.jpg","size":186831,"width":524,"height":359,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Dallas","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Dallas","blogAuthor":null,"blogDate":null,"url":"dallas","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Dallas is a 3-year-old Beagle that presented to our Springfield location for back pain and the inability to walk in the rear limbs. ","marks":[],"data":{}}]}]}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Dallas is a 3-year-old Beagle that presented to our Springfield location for back pain and the inability to walk in the rear limbs. On examination, Dallas had no motor ability in the left rear limb and minimal ability to move the right rear and cranial lumbar back pain. Dallas was treated for several days prior to referral with a combination of NSAIDs, muscle relaxants and analgesics, but his signs worsened. Eight months prior to this presentation, Dallas had a left hemilaminectomy performed by Dr. Bush for a herniated L5-6 disc and made a full recovery. MRI showed a right-lateralized herniated disc and extra-dural hemorrhage extending from L2 to the middle of L4. There was a concern that the area of compression overlapped the previous surgery site and instability of the spine would result in a poor long term prognosis.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Presenting Complaint:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"⢠Unable to walk, painful\n⢠Paralysis of the left pelvic limb, weak on the right pelvic limb","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Neurolocalization:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"⢠Left side T3-L3 spinal cord disease evident from paralysis and back pain.\n⢠Absent left patella reflex with increased cranial tibial and gastrocnemius reflexes indicates involvement of the L4-5 segments.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Diagnostics:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"⢠High-field MRI shows herniated disc material and blood clots severely compressing the spinal cord from L2 to mid-L4 on the right side.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Outcome:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"A hemilaminectomy was performed from L1-L5 on the right, dorsal laminectomy at L5 to accommodate for compression as a consequence of past hemilaminectomy on the left. In effect, 3 sides of the box that contains the spinal cord were removed leaving only the base of the box to support the spine. Dallas showed rapid improvement and began to move his left hind limb two days post-operatively. At his 2 week recheck, he was pain-free and ambulatory without assistance.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Take Home Points:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"blockquote"},{"data":{},"content":[{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Neurological grade and MRI findings are the best indicators of success with surgery.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"A decreased patella reflex can help to localize the spinal cord lesion in patients with rear limb paralysis.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"The odds of recovery and recurrence are no different in a patient that has already recovered from a previous spinal surgery compared to patients undergoing spinal surgery for the first time.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Bilateral hemilaminectomy and removal of dorsal spinous processes can result in a positive clinical outcome without clinically relevant spinal column instability.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"}],"nodeType":"ordered-list"},{"data":{},"content":[{"data":{},"marks":[],"value":"This case was referred by ","nodeType":"text"},{"data":{"uri":"http://www.friendshiphospital.com/"},"content":[{"data":{},"marks":[],"value":"Friendship Hospital for Animals","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":".","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}}
1007,"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"4gfj2i9rxCKOhFllHs0lx"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Dallas","title":null,"altText":"Vet holding dog named Dallas ","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Dallas","url":"https://images.ctfassets.net/rt5zmd3ipxai/dIcSX6PKSx7syMqX8eLPt/854e27f3dfb85a72fde6339617b161b2/dallas-hires.jpg","size":169514,"width":524,"height":635,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Cooper ","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Cooper ","blogAuthor":null,"blogDate":null,"url":"cooper","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Cooper is a 9 year old Airedale Terrier referred to BVNS for the inability to walk and severe neck pain. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Cooper is a 9 year old Airedale Terrier referred to BVNS for the inability to walk and severe neck pain. The pain had been intermittent for 3 weeks and acutely worsened two days before presentation. Cooper had also been having difficulty rising and was non-ambulatory at the time of presentation.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Presenting Complaint:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"⢠3 weeks progressive neck pain which became severe\n⢠2 days progressive weakness in all 4 limbs resulting in an inability to rise upon admission\n⢠Depressed and inappetent","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Assessment (Neurolocalization):","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"⢠Non-ambulatory with severe tetraparesis; low head and neck carriage; proprioception slow in the thoracic limbs and absent in the pelvic limbs; hopping absent in all limbs; intense pain response with palpation of the cranial cervical region (between the occiput and C2); distended urinary bladder.\n⢠Cranial cervicalmyelopathy with primary differentials being neoplastic, immune mediated or infectious disease process","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Diagnostics:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"⢠Bloodwork revealed leukocytosis and thrombocytopenia.\n⢠MRI of the cervical spine showed a paraspinal abscess, primarily right-sided in the C1 region with probable extension of the mass into the epidural space. There was also evidence of meningitis from the posterior fossa through C2-C3.\n⢠Fine-needle aspirate and cytology revealed cocci and neutrophils (both present in quantities too numerous to count)","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Outcome:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Initial treatment with intravenous fluids, antibiotics and analgesics provided subtle improvement; however, Cooper remained non-ambulatory and the thrombocytopenia worsened. The decision was made to proceed with an exploratory surgery of the right paraspinal cranial cervical musculature together with a modified laminectomy of C1. Much of the tissue in the region was found to be necrotic and discolored. The abscess within the muscle was opened and flushed and a small tubular structure was removed from within; histopathology later revealed this to be foreign material resembling plant matter. After laminectomy, fibrin adhesions were detached from the dura and the spinal cord was decompressed. A drain was placed and Cooper was hospital
1007ized for several days after surgery for continued supportive care. At the time of release, Cooper was able to walk with minimal support and was able to move his head and neck with improved range of motion and comfort. He went on to show continued improvement and made a full recovery over the following weeks.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Take Home Points:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"blockquote"},{"data":{},"content":[{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":" Weakness and neck pain can be associated with cervical spinal cord disease.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Foreign body migration is an uncommon cause of spinal cord disease, but a favorable outcome can often be achieved with advanced diagnostics and surgical intervention.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"}],"nodeType":"ordered-list"},{"data":{},"content":[{"data":{},"marks":[],"value":"Case referred by Dr. Meryl Lessinger at the ","nodeType":"text"},{"data":{"uri":"https://vcahospitals.com/merrimac"},"content":[{"data":{},"marks":[],"value":"Animal Clinic and Wellness Center","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":" in Williamsburg, VA. For more information or to discuss this case please email ","nodeType":"text"},{"data":{"uri":"mailto:[email protected]"},"content":[{"data":{},"marks":[],"value":"Dr. Jarboe","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":" or ","nodeType":"text"},{"data":{"uri":"mailto:[email protected]"},"content":[{"data":{},"marks":[],"value":"Dr. Cuff","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":". ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"5VrerpRMLtHUdwnFmsHycr"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Cooper ","title":null,"altText":"Cooper the dog in front of a brick wall ","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Cooper ","url":"https://images.ctfassets.net/rt5zmd3ipxai/5ctjsvRlbdcLuvWRb98fP/8ef20bf65a674ec4ce68b69230d45b8b/Cooper-727x1024.jpg","size":192371,"width":727,"height":1024,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"King ","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - King ","blogAuthor":null,"blogDate":null,"url":"king","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"King is a 12 year old mixed breed referred to BVNS for the inability to get up. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"King is a 12 year old mixed breed referred to BVNS for the inability to get up. Kingâs story started 9 years ago when he was rescued by the current owners after surviving being dragged behind a truck on a highway.When referred King was unable to get up when laying on his side and once assisted to rise he would cross over his back legs, knuckle them and was drunk and weak on the back legs. He was also stiff in his low neck and taking little short steps on the thoracic limbs. King had been examined 1 year ago for back pain and the current problem started 2 months ago. He had not been able to get up for the last 5 days and his symptoms were unresponsive to medication. Examination supported a neck problem and MRI showed a tumor was severely pressing on the spinal cord. There was a concern that surgery may not remove all of the tumor, the tumor would come back, or that King would never regain the ability to walk, even with surgery. Below is a summary of the case:","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting Complaint:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"⢠Unable to rise when laying on his
1007side, progressive weakness and ataxia of pelvic limbs (PL), short strided and crossing of the thoracic Limbs (TL)","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Assessment (Neurolocalization):","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Low cervical spinal cord disease evident:","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"1. Pelvic limbs were weak, long strided, high stepping, circumducting and had poor proprioception,\n2. Thoracic limbs are short strided,\n3. Neck held in a persistently flexed position.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"High field MRI pre- and post-surgery performed showing a tumor invading the spinal canal and severely compressing spinal cord segments C6 and C7.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Owners opted for surgery knowing that prognosis was good for a return to function but potentially poor for maintenance of long term function. Post-operative MRI shows reduction of tumor to microscopic disease and biopsy showed synovial myxoma. Five days after surgery King was stronger, playful and much improved from pre-surgery status. Biopsy revealed the tumor to be a synovial myxoma which is a slow growing benign tumor and the prognosis is thought to be good.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take Home Points:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Patients with low cervical spinal cord are short strided on the TL, hold their head flexed and are long strided, weak and ataxic on the PL. Neck pain is not always obvious or present.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Surgery can be effective at rapidly improving clinical signs and producing good long term outcomes even when there is severe compression from a tumor.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Performing a MRI after surgery and while still under anesthesia is useful in assessing decompression, tumor resection, and prognosis.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Case referred to BVNS by Dr. Steven Skinner at the ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://hartfieldanimalhospital.com/"},"content":[{"nodeType":"text","value":"Hartfield Animal Hospital","marks":[],"data":{}}]},{"nodeType":"text","value":". For more information or discuss this case please email ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":"Dr. Bush","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"7kAE18prbyaAepDmAG2hC8"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - King","title":null,"altText":"King the dog sitting in grass","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - King","url":"https://images.ctfassets.net/rt5zmd3ipxai/4G4P8VnzaZpItq9WbyYxK3/e2fe409bf8d4d778a8b419b2cf6ba0b6/King_web.jpg","size":15600,"width":250,"height":188,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Lucy","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Lucy","blogAuthor":null,"blogDate":null,"url":"lucy","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{}
1007,"marks":[],"value":"This morning Lucy was discovered in her crate with large amounts of saliva, urine and feces. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Lucy is a 3 year-old, FS, Shih Tzu referred by Animal Emergency \u0026 Critical Care and Dr. Dove of Companion Animal Clinic.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting complaint/History","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"This morning Lucy was discovered in her crate with large amounts of saliva, urine and feces. She was twitching, unsteady when she walked and had a glazed appearance. The emergency clinic noted profuse salivation and twitching and treated for possible organophosphate toxicity with atropine, anti-emetics and methocarbamol. Lucy was transferred later that day for progressive twitching on the right more than left-side and right side postural deficit.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Lucy was thought to be having a seizure-like episode or\npossibly a non-convulsive seizure. The underlying cause was\nthought to be inflammation or infection of the brain.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"EEG showed that Lucy was having constant right-side seizure or non-convulsive status epilepticus (NCSE).In-house MRI showed a left forebrain inflammatory lesion while in-house CSF analysis and infectious disease testing were normal.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In house MRI: Blue arrow shows increase T2 signal (inflammation) in the left parietal lobe. This is the motor area for the right side of the body which explains the right side twitching seen on the video.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnosis","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Meningoencephalitis of Unknown Etiology (MUE) manifested as non-convulsive status epilepticus.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"NCSE was treated with Keppra 60 mg/kg IV in addition to about 20 mg/kg of phenobarbital. MUE was treated with dexamethasone 0.2 mg/kg, BID, Cytosar 200 mg/M2 CRI and cyclosporine 6 mg/kg, BID.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Lucy made a rapid recovery and was sent home 3 days later on prednisone 0.5 mg/kg, BID, cyclosporine 6 mg/kg, BID\nand zonisamide 10 mg/kg, BID. Happily Lucy remains well 9 months after her diagnosis on every other day prednisone, cyclosporine and zonisamide every other day.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take Home Points:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"25% of dogs (and people) in Convulsive Status Epilepticus will die from that disease. Human patients with abnormal mentation and NCSE have an even worse prognosis.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"âTwitchyâ veterinary patients are common in veterinary medicine â many have encephalitis and NCSE. If these disease entities can be recognized and treated, a good outcome is likely. If these diseases are not recognized and treated, death is likely.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"BVNSâ clinical and research program using EEG has established that similar to human medicine, NCSE is an important and not uncommon disease entity. BE AWARE that all twitchy or dull dogs or cats may be having constant, global electrical seizure and require treatment.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Keppra 60 mg/kg IV and/or Phenobarbital 30-60 mg/kg, divided into doses of 6-8 mg/kg are recommended treatments stopping Convulsive or Non-Convulsive Status Epilepticus.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"For more information or to discu
1007ss this case please contact","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":" Dr. Bush","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"3k62nxMXmYvCDFQ0clPKk0"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Lucy","title":null,"altText":"Close up of Lucy the dog","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Lucy","url":"https://images.ctfassets.net/rt5zmd3ipxai/3oZIW3JrvrOe4yGzRdkAN6/2245e438596cae4d9158508b409ae012/Lucy-July-NT.jpg","size":53485,"width":550,"height":381,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Misty","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Misty","blogAuthor":null,"blogDate":null,"url":"misty","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Misty, an indoor / outdoor cat, was discovered non-responsive with dilated pupils. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Misty, a 12-year-old, Siamese, was referred by the","nodeType":"text"},{"data":{"uri":"http://www.vetreferralcenter.com/emergency-critical-care.htm"},"content":[{"data":{},"marks":[],"value":" Emergency Service","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":" of ","nodeType":"text"},{"data":{"uri":"http://www.vetreferralcenter.com/"},"content":[{"data":{},"marks":[],"value":"Regional Veterinary Referral Clinic","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":" in Springfield. Mistyâs primary care veterinarian was Dr. Lynn Gulledge at ","nodeType":"text"},{"data":{"uri":"http://www.kingstownecatclinic.com/"},"content":[{"data":{},"marks":[],"value":"Kingstowne Cat Clinic","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":".","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Presenting Complaint/History:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Misty, an indoor / outdoor cat, was discovered non-responsive with dilated pupils. She was rushed to the emergency service, resuscitated and presented to Dr. Bush 36 hours later for confusion, poor balance and behavior changes.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Exam Findings:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Misty was mildly confused, not feisty (unusual for her despite her angelic picture), side stepped when elevating her head while walking, had subtle right side placing deficits and dilated, non-responsive pupils with a normal retinal exam.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Localization / Assessment:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"A right forebrain lesion was suspected based on behavior changes and postural deficit, however the side-stepping and postural deficits along with pupil changes also supported a midbrain lesion. A brain problem was certain, but its exact location and whether it was one mass lesion or multifocal disease was less clear. The disease was a sudden onset and mildly improving so an infar
1007ct (stroke) was suspected; however, lymphoma, infection and a meningioma were also suspected.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Diagnosis Findings:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"MRI of the brain showed compression of the cerebellum indicating there was high brain pressure and brain herniation. There was increased T2 signal in the left piriform lobe consistent with a stroke, infection, or lymphoma. CSF analysis was performed to narrow the list of possible causes and demonstrated moderate inflammation with eosinophils, most consistent with parasitic infection.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Diagnosis:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"The sudden onset of signs and recovery along with MRI and CSF changes in an indoor/outdoor cat presenting in the northeast during the fall is most consistent with Cuterebra infection.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Pathogenesis:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Botfly eggs stick to the fur of small rodents and the larvae develop under the skin. In the cat, an abberant host, the larvae can take an atypical course and migrate from the nose into the brain. Inflammation, necrosis and vasospasm / stroke are common histopathological findings in this disease. The goals of treatment are to kill the larvae and eliminate an anaphylactic and inflammatory response as well as treat any secondary bacterial infection that may have occurred from the migrating larvae.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Treatment:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"1. Benadryl 4 mg/kg and then 2 hours later ivermectin on Day 1, Day 2 and then Day 4","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"2. Steroid therapy (we gave depo medrol 20 mg)","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"3. Baytril (antibiotic for bacterial infection from migrating parasite).","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Outcome:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Cats that do recover from this disease typically have behavior changes such as poor eating, aggression, seizure and loss of house training. Remarkably, Misty has returned to herself with the exception of no longer biting when getting restrained or her medication.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Take Home Points:","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"blockquote"},{"data":{},"content":[{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Migrating Cuterbra larvae cause inflammation and stroke within the brain of indoor /outdoor cats in the fall generating rapid onset of clinical signs that can include seizure, behavior changes, coma, hypothermia and dilated pupils.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Signs can be recurrent and progressive due to continued larval migration. Treatment should be directed at killing the migrating larvae and treating the secondary inflammation and potential infection","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Many cats survive, however most are left with significant behavior changes and a diminished quality of life. Misty was lucky.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"}],"nodeType":"ordered-list"},{"data":{},"content":[{"data":{}
1007,"marks":[],"value":"For more information or to discuss this case please contact ","nodeType":"text"},{"data":{"uri":"mailto:[email protected]"},"content":[{"data":{},"marks":[],"value":"Dr. Bush","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":".","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"60qb1wJZD1r52PedA7inYR"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Misty","title":null,"altText":"Close up of Misty","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Misty","url":"https://images.ctfassets.net/rt5zmd3ipxai/Qw6KNGcZivUx4THojas2R/eadf4d7853e49b1784eeae8691f2c1fd/Misty-Duff-955x1024.jpg","size":139599,"width":955,"height":1024,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Riley","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Riley","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Riley, 2 year-old male Cocker Spaniel, was referred by Apple Valley Animal Hospital for left-side weakness and concern for spinal cord lesion.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Riley, 2 year-old male Cocker Spaniel, was referred by ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"https://www.applevalleypet.com/"},"content":[{"nodeType":"text","value":"Apple Valley Animal Hospital","marks":[],"data":{}}]},{"nodeType":"text","value":" for left-side weakness and concern for spinal cord lesion. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting Complaint/History:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Playing vigorously in yard when yelps out and then very weak on the left side. Referred for left-side weakness and concern for spinal cord lesion.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Exam Findings:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Riley was ambulatory but would drag and scuff his left thoracic and pelvic limbs. Left side postural reactions (hopping, paw flip test) delays along with decreased withdrawal response and tone on the left thoracic limb. Although bright and responsive and non-painful, Rileyâs left pupil was too small and the third eyelid elevated. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Localization / Assessment:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Localization was left side cervical spinal cord based on left-side weakness and postural deficit. The decreased tone and reflex made a lesion within the intumescence or C6-T2 region the most likely. Furthermore, the miosis and prolapsed nictitans were thought to be from disease of the Hornerâs tract as it passes through cervical spinal cord. Lastly, because there was no discomfort on exam, a lesion within the spinal cord was suspected. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MRI showed disease within the spinal cord just above the C4 disk space on the left consistent with a high velocity, low volume hydrated disk extrusion or acute non-compressive nucleus pulposus extrusion from C4-C5 disk.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnosis:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Low volume high velocity nucleus pulposus (disk) extrusion at C3-C4.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Discussion:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Traumatic disc extrusions have several common synonyms in veterinary literature including acute non-compressive nucleus pulposus extrusions, low volume high velocity disc extrusions, and Type 3 disc extrusions. They occur from vigorous activity or trauma where the normal intervertebral disc is placed under stress which exceeds it structural capacity and a small amount of nuclear material is extruded under high pressure and velocity. The extruded disc material strikes the spinal cord causing a contusion and clinical signs. This mimics the clinical course of fibrocartilagenous embolism (FCE) and the two diseases are often indistinguishable unless the MRI is closely scrutinized. Prognosis for each disease is similar and interesting the prognosis is best predicted by MRI. Treatment is predominantly directed at bladder management with phenoxybenzamine or prazosin and valium, pain medication if needed, 2 weeks rest and physical therapy if needed. Although the disease is from disk extrusion there is no compression and therefore no need for surgery. Hornerâs syndrome is from a lack of sympathetic influence to the eye and features miosis, enopthalmos, ptosis, 3rd eyelid elevation and dilation of the scleral blood vessels. The pathway, a circuitous one, starts in brainstem, runs down cervical spinal cord, leaves the vertebral column in the thoracic spine and runs back up the neck entering the skull where it passes adjacent to the middle ear in route to the eye. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"At a recheck several months later, Riley had made a full recovery and was still pain-free. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take home points:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Two common, non-surgical diseases of the inside of the spinal cord are called low volume, high velocity traumatic disk extrusions and FCE","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnosis and prognosis is made with MRI and cross sectional area strongest predictor of outcome","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Bladder management (expression, drug therapy), restricted activity, and physical therapy / rehab are hallmarks of therapy in cat and dogs","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hornerâs syndrome, when noted with spinal cord disease, localizes lesion to the cervical spinal cord and typically involves non-surgical lesions of the inside of the spinal cord.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"For more information or to discu
1007ss this case please contact ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":"Dr. Bush","marks":[],"data":{}}]},{"nodeType":"text","value":". ","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"4hED4DEsjU2UuXVyj8DfUk"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Riley","title":null,"altText":"A brown Cocker Spaniel look up at the camera","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Riley","url":"https://images.ctfassets.net/rt5zmd3ipxai/IA57ZtuPxj5sGQ2t5Tdql/a979907c29206991863f034cd2317180/Riley-300x291.png","size":144055,"width":300,"height":291,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Winston","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Winston","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Winston, a 6-year-old Cavalier King Charles Spaniel, was referred by Seneca Hill Animal Hospital for collapse with a concern for a seizure-like episode. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Winston, a 6-year-old Cavalier King Charles Spaniel, was referred by Seneca Hill Animal Hospital for collapse with a concern for a seizure-like episode. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting Complaint/History:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Winston was out for a walk when he collapsed on his side, went stiff and starting trembling. He remained stiff with an altered gait overnight and in the morning could walk a little but would stagger to the right.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Exam Findings:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Winston was ambulatory with marked ataxia. He would fall and list to the right and âcrab walkedâ to the right. He was hypermetric in the left thoracic and pelvic limbs. His right limbs had normal proprioception, but his left limbs had absent placing and hopping was delayed and exaggerated. He had a normal menace response bilaterally and a normal physiologic nystagmus. He was not painful on palpation of his head or spine.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Localization / Assessment:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Left vestibular system because of his tetra-ataxia, falling and listing to the right. Most concerned for a central lesion due to his left-sided CP deficits and specifically the cerebellum because of his absent menace response.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MRI showed a lesion in the left dorsolateral cerebellum most consistent with a cerebrovascular accident (stroke).","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"CSF centesis and analysis showed a neutrophilic pleocytosis (elevated number of WBC, specifically neutrophils). ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnosis:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Left cerebellar stroke.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Discussion:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cerebrovascular accidents (strokes) occur in dogs and cats from disease in the blood vessels that supply the brain. The most common area of the brain to be affected
1007is the cerebellum, with the rostral cerebellar artery being the most commonly affected blood vessel. However, strokes can occur anywhere in the brain. Signs of stroke vary depending on the area affected. With cerebellar strokes, the most common signs are ipsilateral ataxia, head tilt, nystagmus, opisthotonus, and menace deficits.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In about half of all dogs, an underlying etiology is never found. However, a variety of diseases including neoplasia, hypertension, hypothyroidism, sepsis, vascular malformations, coagulopathies, chronic renal disease, and hyperadrenocorticism have all been associated with strokes and searching for an underlying cause is recommended. The prognosis is generally good for dogs and cats with strokes with no underlying cause and in animals where the underlying cause is found and treated. Supportive care both in hospital and at home may be needed depending on their deficits and level of impairment. Most animals recover within a few weeks.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MRI is the gold standard for diagnosing strokes. We use a variety of sequences including diffusion-weighted imaging (DWI) to diagnose strokes and differentiate them from other possible lesions including neoplasia and inflammatory disease. CSF centesis and analysis is also sometimes performed and the results can range from normal to a mild to moderate monocytic or neutrophilic pleocytosis.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Within two to three days, Winston was walking well and was about 90% normal. A few weeks later, his family reported that he was completely normal.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take Home Points:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cerebrovascular accidents (strokes) can occur in any dog or cat breed.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"About half of dogs affected will have a primary disease process associated with the stroke and treating that primary disease will improve the chances of them not having another stroke.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Half of dogs who have strokes have no underlying disease process that can be identified. We often see them recover and never have another stroke.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Signs will vary with the region of the brain affected. Supportive care, both in hospital and at home, is usually what the dog needs most and most make an excellent recovery within a few weeks.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"32PSPdWHnjsBn4yZLECNwj"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Winston","title":null,"altText":"A Cavalier King Charles Spaniel siting in the grass looking up","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Winston","url":"https://images.ctfassets.net/rt5zmd3ipxai/1wNsYY5lSC5vOwxBqyxAiS/4e045ab975ad13d5025911abe3f9bb4d/winston-sc.png","size":413250,"width":1254,"height":1254,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Herschel","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Herschel","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Herschel is a 10 year old Poodle-Mix that presented to our Woodstock location for a 24 hour history of progressive back pain and the inability to walk in the rear limbs. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Herschel was referred by Dr. Leisa Jennings of ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"https://www.bridgemillvet.com/"},"content":[{"nodeType":"text","value":"Bridgemill Animal Hospital","marks":[],"data":{}}]},{"nodeType":"text","value":". ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Herschel is a 10 year old Poodle-Mix that presented to our Woodstock location for a 24 hour history of progressive back pain and the inability to walk in the rear limbs. On examination, Herschel was non-ambulatory with severe paraparesis (weakness of his rear limbs) and thoracolumbar back pain. MRI showed a right lateralized herniated disc at T12-T13 causing severe spinal cord compression. Surgery was recommended to provide Herschel with the best chance at a successful recovery.\n","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting Complaint:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Unable to walk, painful","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Severe weakness (paraparesis) of the pelvic limbs ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Neurolocalization:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"T3-L3 spinal cord segments as evident from normal cranial nerve exam / normal thoracic limb function, and pelvic limb paraparesis with
1007normal reflex function ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In-house high-field MRI shows herniated disc material compressing the spinal cord at the T12-T13 disc space on the right side with no evidence of internal spinal cord damage. Based on these findings, we predicted that Herschelâs prognosis for recovery with surgery was excellent.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"A hemilaminectomy was performed at T12-T13 on the right side to allow for removal of extruded disc material and subsequent decompression of the spinal cord. Herschel showed rapid improvement and was weakly ambulatory two days post-operatively. At his 2 week recheck, he was pain-free and ambulatory without assistance. \n","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Major Take Home Point:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Neurological grade and MRI findings are the best indicators of success with surgery for intervertebral disc disease. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"For more information or to discuss this case please contact ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":"Dr. Neary","marks":[],"data":{}}]},{"nodeType":"text","value":". ","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"3t7tuCxMrSnWa0cFKiLdbk"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Herschel","title":null,"altText":"A staff member sitting next to a man who is holding a black poodle mix","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Herschel","url":"https://images.ctfassets.net/rt5zmd3ipxai/5bPWumjGSRkvDkb1UWp3Vs/9c32bb7e9b111ca9210f728022313f39/Herschel.jpg","size":75474,"width":1100,"height":825,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Gus","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Gus","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Augustus âGusâ is a 1 year 10 month old Standard Poodle who presented to our Woodstock location for a 24 hour history of difficulty walking in the back legs. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2016"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Augustus âGusâ is a 1 year 10-month-old Standard Poodle who presented to our Woodstock location for a 24-hour history of difficulty walking in the back legs. The day before, Gus was on a walk with his owners and suddenly sat down and wouldnât get back up. He had to be carried home. On neurologic examination, Gus was reluctant to move and preferred to sit or stay sternal. He was able to walk albeit weakly and demonstrated extreme fatigue that worsened with exertion. Based on his history and neurologic examination, myasthenia gravis was suspected. A Tensilon test was performed and was positive.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting complaint:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Difficulty using back legs","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Extreme fatigue worsened by any exertion/activity including walking","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Neurolocalization","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":":","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Gusâ neurologic examination revealed abnormalities consistent with diffuse neuromuscular disease.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Two view thoracic radiographs: no clinically significant findings","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Tensilon test: positive response","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Baseline cortisol: 4.8 (normal)","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Acetylcholine receptor antibody test: positive serum antibody titer","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Serology for Toxoplasmosis and Neospora: negative","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Tick-borne disease panel: negative","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnosis","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Acquired myasthenia gravis","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment for myasthenia gravis typically involves daily administration of oral anticholinesterase agents, such as pyridostigmine, which act to enhance neuromuscular transmission by prolonging the action of acetylcholine at the neuromuscular junction. Immunosuppressive drugs are sometimes used to suppress the overactive immune system. Upright feedings are necessary if megaesophagus is present.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Outcome","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Gus was started on maintenance therapy for myasthenia gravis, the oral medication pyridostigmine, while in the hospital. At the time of discharge, Gus had shown a dramatic improvement in his strength and exercise tolerance. He walked for 2-3 minutes without any evidence of fatigue and was eating well with no evidence of regurgitation. An email update from his owners one month later indicated that Gus was doing extremely well and was almost back to 100% of his
1007normal self. ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"https://vimeo.com/178651398"},"content":[{"nodeType":"text","value":"He had resumed his one-mile hikes with his owners","marks":[],"data":{}}]},{"nodeType":"text","value":" and standard poodle housemate, Ari.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take-Home Points","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Prognosis for myasthenia gravis is good in less severe cases","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Prognosis is guarded in cases with concurrent megaesophagus or persistent underlying cause such as neoplasia","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Prognosis is poor with the development of aspiration pneumonia","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MG will spontaneously resolve in some animals after months of therapy","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The acetylcholine receptor antibody titer determined by radioimmunoassay performed by the UCSD Comparative Neuromuscular Laboratory is 98% accurate for generalized acquired myasthenia gravis","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Thank you to ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://ucpetvet.com/about-us/our-doctors/dr.-dwaine-zagrocki.html"},"content":[{"nodeType":"text","value":"Dr. Zagrocki","marks":[],"data":{}}]},{"nodeType":"text","value":" of ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"http://ucpetvet.com/"},"content":[{"nodeType":"text","value":"Union County Pet Hospital","marks":[],"data":{}}]},{"nodeType":"text","value":" for referring Gus to BVNS. For more information or to discuss this case, please contact ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":"Dr. Erin Akin","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"5jkVgPcEwHtQrBEzr3MUCK"},"name":" IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Gus","title":null,"altText":"Black dog with red leash","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":" IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Gus","url":"https://images.ctfassets.net/rt5zmd3ipxai/10s7v8LsGvRdgXMiJRTVfv/b81552bc842cdcfea0a92b39bc763e88/Gus.jpg","size":201429,"width":752,"height":1022,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Fergie","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Fergie","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"When Fergie came to BVNS in Springfield, she was unable to jump and was having difficulty navigating steps and curbs. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2017"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"When Fergie came to BVNS in Springfield, she was unable to jump and was having difficulty navigating steps and curbs. After an MRI, Fergie was diagnosed with COMS (Caudal Occipital Malformation Syndrome), a common malformation of the breed. Dr. Bush and Dr. Barker performed a FMD (Foramen Magnum Decompression) to alleviate compression.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"This picture was taken the day Fergie was discharged, which just happened to be her birthday! Her mom was so happy to have her home and celebrate, but Fergie was happy to go home and sleep!","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"She truly stole the hearts of everyone at BVNS.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"To learn more about COMS, visit ","nodeType":"text"},{"data":{"uri":"https://bvns.net/coms"},"content":[{"data":{}
1007,"marks":[],"value":"www.bvns.net/coms","nodeType":"text"}],"nodeType":"hyperlink"},{"data":{},"marks":[],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"9frcwANPKgm01dJskZJdN"},"name":" IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Fergie","title":null,"altText":"brown dog, Fergie, lying on couch next to happy birthday balloon","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":" IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Fergie","url":"https://images.ctfassets.net/rt5zmd3ipxai/2PditPYPajN9KxL5uu6jPs/03d9dd86a0784cc781eaaec0e7568b49/Fergie-300x225.png","size":116138,"width":300,"height":225,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Lucy 2","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Lucy 2","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Lucy was discovered like this in her crate and is now being treated for organophosphate toxicity in the emergency room. What do you see in the video? What could be wrong? How would you prove it and treat it?","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2017"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"CHECK OUT THIS VIDEO","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Lucy was discovered like this in her crate and is now being treated for organophosphate toxicity in the emergency room. What do you see in the video? What could be wrong? How would you prove it and treat it?","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Video:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"There is right sided facial twitching more than left sided accompanied by confusion / stupor.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"What could be wrong? This could be continuous partial seizure which is often called non-convulsive epilepticus. An EEG could be used to prove it. An MRI coupled with a CSF analysis could identify the cause of the non-stop seizure.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnosis:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The persistent trains of left sided spikes allowed for diagnosis of non-convulsive status epilepticus. The MRI coupled with CSF showed a left sided inflammatory lesion (which makes sense because a left side lesion would be expected to cause twitching on the right).","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Lucy was treated for seizure with Keppra 60 mg/kg and 3 boluses of 10 mg/kg phenobarbital. This stopped the twitching and also converted the EEG to normal. She was also treated for non-infectious encephalitis (meningoencephalitis of unknown etiology) with cytosar, cyclosporine and prednisone. Lucy has very good seizure control at 1, 3 and 12 month follow-up.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"If you have questions about this case, please contact Bill Bush at ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":"[email protected]","marks":[],"data":{}}]},{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}}
1007,"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"6VF4XXEZbjhyqSJyQ6wMM2"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Lucy 2","title":null,"altText":"A white dog laying down on a tabletop","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Lucy 2","url":"https://images.ctfassets.net/rt5zmd3ipxai/2YRS8aSttYXQxek9UMS4x/27495420be3d28835bfb4553e085e8a2/Lucy_2.jpg","size":70176,"width":718,"height":406,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Duke","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Duke","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Duke is a 7 year old, MC, Pitbull presenting for right head tilt that was a gradual onset and progressive over the last 6 weeks. Hypermetria on the left thoracic limb was noted about 6 months ago. He is bright and responsive at home and does not seem painful.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2017"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Introduction:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Duke is a 7 year old, MC, Pitbull presenting for right head tilt that was a gradual onset and progressive over the last 6 weeks. Hypermetria on the left thoracic limb was noted about 6 months ago. He is bright and responsive at home and does not seem painful.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Video:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Based on this videotape where would you localize the lesion and why?","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Duke from ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"/"},"content":[{"nodeType":"text","value":"Bush Veterinary Neurology","marks":[],"data":{}}]},{"nodeType":"text","value":" on Vimeo.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Answer:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Central vestibular because he is non-ambulatory, extreme head tilt to the right, leaning right but no nystagmus.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Discussion:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Peripheral vestibular cases are familiar to us all. They have a sudden onset of a head tilt, veer and side-step to the side of the head tilt and have rapid (greater that 60 beats per minute) rotary and/or horizontal nystagmus whose fast phase is opposite the head tilt. Whenever a presentation deviates from this presentation then likely to be within the brainstem. In Duke's case he is non-ambulatory, has extreme head tilt but no nystagmus - definitely not what you would expect for a peripheral lesion.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Duke's MRI shows a brain tumor.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Thank you to Dr. Skinner of Hartfield Animal Hospital for referring Duke to BVNS. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"If you have any questions about this case, please contact Bill Bush at ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"mailto:[email protected]"},"content":[{"nodeType":"text","value":"[email protected]","marks":[],"data":{}}]},{"nodeType":"text","value":".","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}}
1007,"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"BVTaIH0EGqdX8HxX6si5e"},"name":"IMAGE CONTAINER Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Duke","title":null,"altText":"A brown and white Pitbull being held on the table","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Duke","url":"https://images.ctfassets.net/rt5zmd3ipxai/4DQMDLgtta3A65JqrK9agW/0662a7bb9fc5ce4f2a3113c01b217150/Duke.jpg","size":87013,"width":955,"height":540,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Cervical Spondylomyelopathy (CSM)","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - CSM","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"CSM is a disease that affects the cervical spine in large and giant breed dogs. The etiology is multifactorial and thought to represent a combination of genetic, nutritional, and degenerative causes. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2018"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cervical spondylomyelopathy (CSM) is often referred to as 'Wobbler Syndrome.' Why you may ask? Because affected dogs have a wobbly gait!","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"CSM is a disease that affects the cervical spine in large and giant breed dogs. The etiology is multifactorial and thought to represent a combination of genetic, nutritional, and degenerative causes. Important factors include congenital vertebral canal narrowing, vertebral body instability, disc degeneration and protrusion, joint capsule proliferation and osteophyte formation, and hypertrophy of the ligaments that surround the spinal cord. The most common clinical sign is a chronic, progressive gait disturbance which can range from mild to severe tetraparesis and proprioceptive ataxia affecting all 4 limbs. Cervical pain and low head carriage may also be seen. There are 2 types of CSM recognized in dogs: Disc-associated and Joint-associated.","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Disc-associated CSM","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" is seen in middle aged to older large breed dogs; Doberman Pinschers are most often affected followed by Rottweilers and Bernese Mountain Dogs. Spinal cord compression most commonly occurs at C5-6 and C6-7 due to Type II disc degeneration and protrusion (leading to ventral compression); thickening of the vertebral ligaments and vertebral body instability may also contribute to cord compression.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Joint ","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":"or ","marks":[],"data":{}},{"nodeType":"text","value":"osseus-associated CSM","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" is a disease of young adult giant breed dogs such as Great Danes and Mastiffs. Spinal cord compression usually occurs at C2-3 and C3-4 due to proliferation of the articular facet joints (leading to dorsolateral compression).","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DIAGNOSIS:","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Imaging of the cervical spinal cord with an MRI examination or a CT/myelogram study demonstrates the location and extent of cervical spinal cord compression. Lesions can also be classified as dynamic (compressions that worsen or improve with different neck positions) or static.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"TREATMENT AND PROGNOSIS:","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"There are two treatment options for CSM: Conservative medical therapy and surgical treatment:","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MEDICAL THERAPY:","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Medical therapy involves anti-inflammatory medication with prednisone or non-steroidal anti-inflammatory agents, physical therapy, periods of exercise restriction, and pain medication (often with gabapentin). Reports of success are variable; two large retrospective studies have found that between 45-54% of dogs treated medically improve in the short term; however, neurological deficits and pain progressed in the majority of affected dogs from both
1007studies over the long term. Progression of disease may result in humane euthanasia due to poor patient quality of life and the difficulty for pet owners in trying to manage a large breed dog with limited mobility.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"SURGICAL TREATMENT:","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Surgical treatment may be recommended based on several factors including the degree of neck pain. severity of neurologic dysfunction, the degree of spinal cord compression seen on MRI examination, and lack of to medical management. There are many different types of surgical techniques described and in some instances there may be a disparity in agreement as to which procedure carries the best outcome. The treatment for disc-associated CSM is typically ventral slot surgery at the site of disc protrusion (stabilization may be necessary in cases with dynamic compressions). For joint-associated CSM, decompression of the spinal cord via dorsal laminectomy is most often performed. The majority of authors claim a 70-80% success rate with surgical therapy; therefore, the majority of surgically managed patients improve in the short term.3 However, over the long term, CSM can continue to progress in up to 50% of affected dogs in spite of surgical therapy again eventually resulting in poor patient and owner quality of life. This is due to several factors, most the development of spinal compression at other sites along the cervical spine (termed \"adjacent segment disease\").","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In summary, both medical and surgical treatment can benefit dogs with CSM in the short term. However, long term this disease has the potential to progress with either methodology. The choice of which treatment suits each individual patient must take into account many factors; most importantly, the short and long term expectations of each individual owner must taken into consideration so that an informed decision can be made on their dog's behalf.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"REFERENCES:","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"De Decker S et al. Clinical evaluation of 51 dogs treated conservatively for disc-associated wobbler syndrome. Journal Small Animal Practice. 2009; 50, 136-142.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Da Costa R, et al. Outcome of medical and surgical treatment in dogs with cervical spondylomyelopathy: 104 cases (1988-2004). 2008; 233(8),1284-1290.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Da Costa. Cervical Spondylomyelopathy (Wobbler Syndrome). Vet Clin North Am Small Anim Practice.2010 Sep;40(5):881-913.","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"xYLOJd9sumOfdoJ3gdq9q"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - CSM","title":null,"altText":"Cervical Spondylomyelopathy","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - CSM","url":"https://images.ctfassets.net/rt5zmd3ipxai/1fiyGukrU7
1007MqXoFXTXlymc/d60559d49d9e0554934a494e52027b02/CSM.png","size":71676,"width":367,"height":200,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Motley","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Motley","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Motley presented to BVNS to see Dr. Young in February 2018 due to lethargy and decreased motion of his tail. His owners had noticed that in previous weeks, Motley's outgoing energy and happy tail wag was diminishing.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2018"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Presenting Complaint: ","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Motley presented to BVNS to see Dr. Young in February 2018 due to lethargy and decreased motion of his tail. His owners had noticed that in previous weeks, Motley's outgoing energy and happy tail wag was diminishing.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Neurolocalization:\nDuring Dr. Young's exam, he noticed a dropped tail with blunted to absent superficial sensation, blunted deep pain perception, and little tone. An MRI was recommended.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Diagnostics:\nMRI of the tail and pelvis were performed, and findings were consistent with a mass lesion of L5 vertebral body.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Diagnosis:\nThis lesion was suspected to be a plasma cell tumor based on radiologist review. With decompressive surgery and radiation therapy survival beyond two years would be expected. With palliative care, we would anticipate survival to be limited to several months to 6 months.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Treatment:\nMotley's family decided to proceed with surgery. Dr. Young performed a left hemilaminectomy at L5-L6 and surgical biopsy of the body of L5. Stabilization was achieved with SOP plating. The biopsy was sent to Virginia Tech, which confirmed the tumor type as a plasma cell tumor. Motley then received radiation therapy and oncology care through The Oncology Service for the best prognosis.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Outcome:\nLess than 10 days following surgery, Motley's owners reported that Motley was comfortable and wagging his tail again!","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Take Home Points:\nMotley is now a happy, active dog and is enjoying his additional time with his family!","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"4PS8uY4KNKEEmbSlkeQ9YE"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Motley","title":null,"altText":"Motley the golden retriever.","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Motley","url":"https://images.ctfassets.net/rt5zmd3ipxai/4kyn2D61LBoTwY09w9w6aP/3c98932485d5848eac2f587b0c519dba/motley-1024x898.jpg","size":151994,"width":1024,"height":898,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Head Trauma in Veter
1007inary Medicine","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Head Trauma in Veterinary Medicine","blogAuthor":null,"blogDate":null,"url":"head-trauma","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Traumatic brain injury in dogs and cats can occur due to a variety of causes including motor vehicle accidents, falls from a height, crush injuries, or attacks by other animals. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2018"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Traumatic brain injury in dogs and cats can occur due to a variety of causes including motor vehicle accidents, falls from a height, crush injuries, or attacks by other animals. This event secondary to a serious accident can be terrifying for owners and is a veterinary emergency for the injured patient. Initial patient assessment and rapid initiation of appropriate treatment measures are critical to maximize the chance for a successful outcome. Appropriate guidelines for veterinary patients are somewhat limited and, therefore, often based on results of human trauma studies, experimental investigations, and clinical experience.\n","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"PATIENT ASSESSMENT","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\nMODIFIED GLASGOW COMA SCALE (MGCS)\nOne quantitative measure shown to be associated with survival in dogs with traumatic brain injury is the Modified Glasgow Coma Scale. This scale has been shown to predict the probability of survival in the first 48 hours in patients with traumatic brain injury.1 It is therefore most useful for initial patient assessment; however, it can also be used as an objective way to monitor progression of neurological signs on a serial monitoring basis. The MGCS provides a score that addresses the three domains listed below. A score of 1-6 is assigned to each category; the final score ranges from 3â18, with lower scores indicating more severe neurologic deficits. ","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Level of Consciousness\n⢠Alert and responsive: normal responses to sensory stimuli\n⢠Obtunded: slow/inappropriate responses to sensory stimuli\n⢠Stuporous: unresponsive except to noxious stimuli","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Pupil response to light and other brainstem reflexes\n(palpebral, corneal, gag)","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Posture and motor activity (1-6)\n⢠Ambulatory vs. non-ambulatory status\n⢠Abnormal postures\n » Decerebrate rigidity = stupor/coma, rigid extension of all 4 limbs, opisthotonus (brainstem lesion)\n » Decerebellate rigidity = conscious/mentally alert, rigid extension of thoracic limbs, flexion of pelvic limbs, opisthotonus (cerebellar lesion) ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In 38 dogs with head trauma, the MGCS predicted the probability of survival in the first 48 hours. The graph below illustrates there is a 50% probability of survival in a patient with a score of 8; patients with scores higher than 8 have a higher probability of survival compared to patients with lower scores. (2)","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DIAGNOSTICS:(1)(2)","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Complete bloodwork (an initial PCV/TS, blood glucose, and electrolytes followed by a complete cbc/chemistry panel) as well as assessment of the abdomen and chest for signs of trauma (if indicated) should be obtained. Radiogra
1007phs of the head can be taken to screen for the presence of skull fractures. Imaging of the brain in head trauma patients is via CT or MRI examination; these advanced imaging tests provide assessment of both skull and brain damage. In a recent study of 18 dogs with acute head trauma, dogs with parenchymal brain injuries affecting the caudal fossa (brainstem/cerebellum) alone or affecting both the rostral (forebrain) and cauda fossa typically had poorer outcomes.(3) If a patientâs neurological status continues to decline despite aggressive medical treatment, then evaluation of the extent of brain damage via CT or MRI exam and consultation with a veterinary neurologist is indicated.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"THERAPY:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The goals of treatment in traumatic brain injury include reducing intracranial pressure, maintaining blood pressure, and ensuring proper ventilation. Hyperosmolar therapy reduces brain edema. Mannitol is a hyperosmolar osmotic diuretic which is considered the first line treatment for reducing intracranial pressure; administration of mannitol (0.5-2 grams/kg as an IV bolus over 20minutes q6-8 hours) has been shown to have a beneficial effect on neurological outcome in human and veterinary patients with brain injury. Hypertonic saline (3-5ml/kg) is another hyperosmolar solution with effects similar to mannitol which can be used to reduce intracranial pressure and rapidly provide intravascular volume expansion. Other important steps in managing trauma patients include intravenous fluid therapy to prevent hypotension, placing patients in an oxygen-rich environment to prevent hypoxia, and close monitoring of ventilation to prevent hypercarbia. Analgesic care should be given as needed with opioids or other reversible medications. If there is a risk for infection, antibiotic therapy should be provided to reduce the risk of an abscess from developing. Importantly, glucocorticoids are contra-indicated and should not be given to patients with brain injury; administration of steroids is associated with worse outcomes in human adults with head trauma. A helpful clinical practice review article from the Journal of Veterinary Emergency and Critical detailing medical management recommendations for patients with traumatic brain in is provided below in the article references. (4)","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In the event that medical therapy is unsuccessful, surgical treatment (decompressive craniectomy) may be necessary for patient stabilization. This is the case with depressed skull fractures, large space occupying hematomas, or intracranial abscessation.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"PROGNOSIS:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"There is scarce available information that is predictive of prognosis in veterinary medicine for patients with traumatic brain injury. However, many patients can recover if systemic and neurological abnormalities are identified and treated early. Dogs and cats have an extraordinary ability to compensate and improve after sustaining brain damage. Long-term effects such as post-traumatic epilepsy are reported to occur in a small percentage of patients with head trauma; in one retrospective study of dogs with epilepsy, 15% of dogs had a history of prior head injury. (5) Ultimately, patient response and degree of improvement to treatment over time ultimately determines the prognostic outcome.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"REFERENCES: ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DeLahunta and Glass. Veterinary Neuroanatomy and Clinical Neurology, 3rd ed. St. Louis, MO: Elsevier Inc:2009. ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Platt SR, Radaelli ST, McDonnell JJ. The Prognostic Value of the Modified Glasgow Coma Scale in Head Trauma in Dogs. J Vet Intern Med 2001; 15:581-584. ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Yanai H, et al. Results of magnetic resonance imaging performed within 48 hours after head trauma in dogs and association with outcome: 18
1007cases (2007-2012). J Vet Am Med Assoc 2015;11(1):1222-1229. ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Sande A and West C. Traumatic brain injury: A review of pathophysiology and management. Journal of Vet Emerg and Crit Care 2010;20(2):177-190. ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Steinmetz S, et al. Epilepsy after head injury in dogs: a natural model of posttraumatic epilepsy. Epilepsia 2013; 54(4):580-8. ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"5QM5hAnR6JlSTDerOMGTdQ"},"name":"IMAGE CONTAINER - MASTER - Nature- Dog in Car Driving -Head out Window","title":null,"altText":"Head out the window dog in car","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"NVA - MASTER - Nature- Dog in Car Driving -Head out Window","url":"https://images.ctfassets.net/rt5zmd3ipxai/WjJECOyul39PYzi9Q7WnP/e3d675cb328f0919efa40beae165420a/ServiceCards-Dog.png","size":2523439,"width":1254,"height":1254,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Lufa","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Lufa","blogAuthor":null,"blogDate":null,"url":"lufa","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Lufa, an 8 year old Pomapoo (Pomeranian/Miniature Poodle mix) was referred by Veterinary Referral Center NoVA for seizures and impaired mentation.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2019"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Lufa, an 8 year old Pomapoo (Pomeranian/Miniature Poodle mix) was referred by Veterinary Referral Center NoVA for seizures and impaired mentation. Lufa had a history of seizures, was treated with levetiracetam (25 mg/kg) and he had not had a seizure for approximately two years. Two days before presentation, he had missed a dose of levetiracetam, and had two seizures. Since the seizures, Lufaâs behavior was abnormal. He wandered around the house, was more willing to be petted, and he walked into the ownerâs mirror. On exam at the referring veterinarianâs office, Lufa had a very stiff gait. He had no menace response, but a normal pupillary light reflex. Shortly after his exam, Lufa had a generalized clonic-tonic seizure and was given a dose of 30 mg/kg levetiracetam intravenously. While hospitalized, Lufa was seen to chew at the air in the corner of his cage. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"PRESENTING COMPLAINT ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Seizures, mental dullness, pacing. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"EXAM FINDINGS ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Lufa was obtunded. He was ambulatory with normal postural and reflexes. He had no menace response bilaterally, and had anisocoria (right pupil smaller than left). He was comfortable with palpation of his spine and skull.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Q/A","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Based on Lufaâs history and clinical signs, where would you localize? ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Localization: Lufaâs clinical signs localize to the forebrain. His anisocoria may indicate pathology within the left cerebral hemisphere. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"What is the cause of Lufaâs ongoing seizures and dullness? ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Differential Diagnoses: ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"(i) Lufa was previously diagnosed with idiopathic epilepsy. His current mental dullness and pacing could be post-ictal behavior, or ongoing seizure activity, such as non-convulsive status epilepticus. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"(ii) Lufaâs current clinical picture is also consistent with neoplasia, encephalitis (autoimmune vs infectious), or a cerebrovascular accident. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"What diagnostic plan should be considered? Based on the results, what treatments should be initiated? ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostic Plan: ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"(i) General wellness screening: ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"This was performed to rule out systemic disease as a cause for Lufaâs clinical signs. Blood work, blood pressure and ECG were normal. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"(ii) Electroencephalogram (EEG): ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"This was performed since our main concern was ongoing seizure activity. EEG was reviewed by Dr. Bush and Dr. Colette Williams, an expert in EEG. Lufaâs EEG indicated that he did not have seizures, but the had spike activity that may indicate some form of intracranial disease. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"(iii) MRI of the brain:","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Lufaâs MRI revealed changes consistent with inflammation within the left cerebral hemisphere ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Based on the results, what treatments should be initiated? ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment plan: ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MUE requires prompt treatment to reduce intracranial pressure and inflammation, and to halt ongoing seizures. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"OUTCOME ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{}
1007,"content":[{"nodeType":"text","value":"Lufa was hospitalized for seizure management and immunosuppressant therapy. He was treated with mannitol (0.5g/ kg) to relieve elevated intracranial pressure, and his MUE was managed with immunosuppressant drugs (steroids and cytarabine). Lufa recovered well and was discharged after 48 hours. He continues to receive immunosuppressant medications and anti-epileptic drugs to reduce his seizure frequency and severity. His neurological status has improved and his seizure frequency has decreased. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DISCUSSION ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MUE (meningoencephalitis of unknown origin) signs can range from discrete focal deficits to widespread dysfunction including changes in mentation and cranial nerve deficits. MUE can be life-ending, and requires prompt treatment. Inflammation within the brain causes increased intracranial pressure that compromises blood supply and causes swelling of brain tissue that results in herniation and death. Seizures place a high metabolic demand on the already compromised brain, and can cause further elevations in intracranial pressure. Immediate treatment includes reducing intracranial pressure, controlling seizures, and halting the ongoing immune attack on brain tissues. Long term prognosis for patients with MUE is mixed: while some animals recover fully, relapses are common, and in some patients, progression of the disease cannot be controlled. Sadly, a percentage of patients do not survive to discharge despite therapy. What makes Lufaâs case interesting is his prior history of seizures that pointed us to idiopathic epilepsy as our top differential, although our diagnostic tests indicated otherwise. Lufa is older than the typical patient that presents with a first episode of MUE, and we suspect that Lufaâs condition is in fact long-standing, with a relapsing and remitting course. TAKE HOME POINTS Clinical signs of MUE can vary, and can be easily overlooked, particularly when the disease has a waxing/waning course. However, awareness of the condition and early referral is critical to treatment for these patients and improves survival. Thanks to the prompt action of Veterinary Referral Center of NoVA, Lufaâs encephalitis was diagnosed quickly and treated appropriately. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"References: ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Coates JR, Jeffery ND (2014) Perspectives on meningoencephalomyelitis of unknown origin. Vet Clin North Am Small Anim Pract. 44:1157-85 ","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"5nw0t4nx7bFaxwfabSY3Mf"},"name":"IMAGE CONTAINER - MASTER - EE - Nature Outdoor Seasonal - VAR A - Contact Us (/contact-us) - Pomeranian standing in leaves ","title":null,"altText":"Pomeranian standing in a field of leaves ","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - MASTER - EE - Nature Outdoor Seasonal - VAR A - Contact Us (/contact-us) - Pomeranian standing in leaves ","url":"https://images.ctfassets.net/rt5zmd3ipxai/7hMmkiQNywdxaJTtqaUaTt/3b668e7e9a99f122504828f80734548b/HERO-CARD-MASTER-EE-NatureOutdoorSeasonal-VarA-Pomeranian-leaves-1-.jpg","size":258823,"width":1600,"height":580,"contentType":"image/jpeg"},"mobileImage":{"__typename":"Asset","title":"IMAGE - MASTER - EE - Nature Outdoor Seasonal - VAR A - Contact Us (/contact-us) - MOBILE - Pomeranian standing in leaves ","url":"https://images.ctfassets.net/rt5zmd3ipxai/ql73a3sdgGIxk5a5IbpzF/e9fb532509f60d9a43e8d305d36d5e33/HERO-CARD-Mobile-MASTER-EE-NatureOutdoorSeasonal-VarA-Pomeranian-leaves-1-.jpg","size":137483,"width":1006,"height":528,"contentType":"image/jpeg"}},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Travis","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Travis","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Travis, a 3-year old MN Dalmatian, presented to BVNS Richmond in April of 2017. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2019"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Travis, a 3-year old MN Dalmatian, presented to BVNS Richmond in April of 2017. A month before coming to us, he was seen at his primary care veterinarian as well as an internist for vomiting, letharg
1007y, and inappetence. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting Complaint","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Ataxia and falling over when walking. Suspected spinal disease. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostics Prior to Presenting to BVNS:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"GI biopsies: lymphoplasmacytic gastroenteritis\nNH3+: 18 (normal) ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"EXAM FINDINGS","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Mentation","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Subdued to dull","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Posture of Head and Body","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Limbs occasionally found in abnormal positions (ie. abducted, splayed, crossed)","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Gait","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": tetraparesis with general proprioceptive ataxia noted in all 4 limbs. Occasionally, the patient displayed subtle signs of vestibular ataxia","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Postural Reactions","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Normal to slightly delayed paw replacement in the forelimbs and very delayed in both rear limbs","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Thoracic Limb Reflexes","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Normal withdrawal reflexes bilaterally","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Pelvic Limb Reflexes","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Normal patellar and withdrawal reflexes bilaterally ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cutaneous Trunci","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Present bilaterally at L5 (normal)","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Perineal Reflex","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Normal","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Muscle Tone","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Normal tone","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cranial Nerve Function","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Normal cranial nerve function","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Retinal Exam","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Normal fundic exam OU","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hyperesthesia","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": No pain elicited on spinal palpation or cervical manipulation","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Other Findings","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": Patient resisted lateral recumbency and dorsal recumbency. After examination, patient altered between dull and stupor in the exam room. Stumbling and not appropriately responsive to auditory or visual stimuli","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Q \u0026 A ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Based on Travis' history and clinical signs, where would you localize?","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Localization","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":":","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Multi-focal localization. There were aspects of the exam that suggested intracranial disease (i.e. alternating mental status, reduced response to auditory and visual stimuli), and other aspects that suggested spinal cord disease (tetraparesis).","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"What diagnostic plan should be considered?","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnostic Plan","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":":","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"(i) ","marks":[],"data":{}},{"nodeType":"text","value":"Brain MRI","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": bilaterally symmetrical lesions within the brain most suggestive of metabolic, toxic, or degenerative disease. Given the hospital hepatopathy, the lesions are consistent with Wilson disease","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"(ii) ","marks":[],"data":{}},{"nodeType":"text","value":"Abbreviated Cervical MRI","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": normal","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"(iii)","marks":[],"data":{}},{"nodeType":"text","value":" Cerebrospinal Fluid Analysis","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":": normal","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"What is was the tentative diagnosis for Travis' case?","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Tentative Diagnosis","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":":","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Brain disease consistent with neurotoxicity (endogenous \u003e exogenous) or inborn error of cellular metabolism ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DEFINITIVE DIAGNOSIS AND TREATMENT ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"What were the follow-up diagnostics?","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Bile acid profile:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"pre:","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" 149.5 umol/L, (normal:0 â 6.9 umol/L)","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"post: ","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":"280.6 umol/L, (normal: 0 â 14.9 umol/L)","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Liver biopsy:","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" descriptive for copper storage disease ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Based on the results, what was the definitive diagnosis? What treatments should be initiated?","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Definitive Diagnosis:","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" Copper-storage disease with secondary brain pathology consistent with Wilson disease in humans","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Treatment:","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" Penicillamine, Prednisone, Denosyl, and Phosphatidylcholine ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"FOLLOW-UP DIAGNOSTICS (ABOUT 7 MONTHS LATER): ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Brain MRI:","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" mild, bilaterally symmetrical lesions noted in the body of the thalamic hemispheres, the rostral thalamic nuclei, and the body of the caudate nuclei. The previously noted midbrain and lentiform lesions were no longer present.\n","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DISCUSSION ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"We are often presented with patients with signs consistent with âroutineâ spinal disease. Travisâ medical history prior to coming to BVNS was extremely important in explaining his clinical signs. His exam changed and took on different qualities during his initial consultation at BVNS. While he was sent to us for problems walking, it became clear that he had intracranial abnormalities as well. The brain MRI showed symmetrical abnormalities that are typical of toxic or metabolic derangements. Given his age, breed, lab work abnormalities, and some additional ancillary tests, an accurate diagnosis was reached. Copper-associated liver disease is common in Dalmatians and can also result in brain pathology. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"TAKE HOME POINTS FROM DR. HIGGINBOTHAM ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"A patient's past medical history is extremely important.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"A patient's condition can change abruptly during an exam.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Bilaterally symmetrical brain disease is often associated with toxic or metabolic disease.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diseases such as Travis' are treatable and potentially reversible. ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{}
1007,"content":[{"nodeType":"text","value":"Thank you Cooke Veterinary Medical Center of Chesapeake, VA for referring this case. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"What you should expect from BVNS when you refer a case:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Faxed Referral Letter (with call to confirm receipt).","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Desire to discuss any case, whether it is a referred case or a consultation.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Dedication to provide superior service to you and your clients. ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\nFor more information on services offered, please visit us at www.bvns.net ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Selected References ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Brewer G. Wilson disease and canine copper toxicosis. Am J Clin Nutr 1998; 67(suppl):1087S-1090S","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Webb CB, Twedt DC, Meyer DJ. Copper-associated liver disease in Dalmatians: a review of 10 dogs(1998-2001). J Vet Intern Med 2002; 16:665-668 ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"159FcpTwvfP9liQYLjMeoM"},"name":"IMAGE CONTAINER - MASTER - STUDIO - DALMATIAN - BLUE","title":null,"altText":"dalmatian with food on blue background","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"NVA-Studio-Dog-Dalmation-Blue","url":"https://images.ctfassets.net/rt5zmd3ipxai/RLy1KcpoWd5uQIRVywlwn/d976b17e9c5d19ccf5e9294e398657a2/NVA-Studio-Dog-Dalmation-Blue.jpg","size":81070,"width":728,"height":545,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Suki Hall","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Suki Hall","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Suki is a one-year-old, female spayed Yorkie who was referred to BVNS by Dr. Mazur at Clocktower Animal Hospital in Herndon, VA.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2020"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"EXAM FINDINGS","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Suki became non-ambulatory over just a few hours, with severe pain that slowly subsided. By the time we saw her at BVNS Springfield, she was non-ambulatory paraparetic with
1007just a little bit of motor in her pelvic limbs. Her reflexes were normal in all four limbs and she had normal proprioception in the thoracic limbs but absent placement and hopping of the pelvic limbs. We could not elicit a cutaneous trunci reflex anywhere along her back. Her problem was localized to the T3-L3 region of the spinal cord and differentials discussed included IVDD, FCE and spinal GME. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MRI SCANS","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Based on Suki's history and clinical signs, where would you localize?\nHer problem was localized to the T3-L3 region of the spinal cord and differentials discussed included IVDD, FCE, and spinal GME.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DEFINITVE DIAGNOSIS","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Pre-anesthetic blood work was run, which was normal. MRI of the spine revealed a reduced volume of nucleus pulposus at L1-2 with focal T2w hyperintensity spanning from caudal-vertebral body T13 to mid L1 vertebral body. There was minimal compression of the spinal cord. Suki was diagnosed with an acute non-compressive nucleus pulposus extrusion (ANNPE) of the L1-2 intervertebral disc. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"WHAT IS ANNPE? ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"ANNPE is defined as a sudden extrusion of non-degenerate disc material from the nucleus of intervertebral disc. With ANNPE, there is minimal compression of the spinal cord but because it comes out of the disc space with a significant amount of force, concussive damage is done to the spinal cord. Prognosis varies depen
1007ding on which study you read, from 66-100% recovery, and correlates to the amount of concussive damage done to the spinal cord. ANNPE signs can be lateralized and can cause both urinary and fecal incontinence. A recent paper showed that treating with an appropriate NSAID significantly decreased the risk of long term urinary incontinence.\n ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"TREATMENT","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Suki was sent home on meloxicam, gabapentin and diazepam with instructions for strict rest. Strict rest should be instituted, as with any disc herniation, to prevent further disc extrusion that could cause further neurologic decline. This can be compared to treatment for an FCE (another type of non-surgical spinal cord injury), where pain management is less necessary and strict rest is not critical because we arenât worried about triggering recurrences. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Over the next 4-8 weeks, Suki grew stronger and stronger and is now doing amazing. Her family is keeping a close eye on her and decreasing the amount of dynamic leaping she is doing, but she has an awesome quality of life and is her happy, adorable self again. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"https://www.youtube.com/watch?v=8AZyMeUbfGY"},"content":[{"nodeType":"text","value":"Suki, 4 weeks into Recovery","marks":[],"data":{}}]},{"nodeType":"text","value":"","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"https://www.youtube.com/watch?v=uLnGgbRfVnA"},"content":[{"nodeType":"text","value":"Suki, 8 weeks into Recovery","marks":[],"data":{}}]},{"nodeType":"text","value":"","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"TAKE HOME POINTS FROM DR. BARKER","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\n1. Quickly becoming a âdown dogâ doesnât have to be life threatening and recovery doesnât always require surgery ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"2. An MRI can help determine if surgery should be considered and what medical management is most appropriate.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"3. Strict rest and NSAIDs are important treatment components for ANNPE.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Selected References","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\n1. De Decker et al. Acute Herniation of Nondegenerate Nucleus Pulposus Acute Noncompressive Nucleus Pulposus Extrusion and Compressive Hydrated Nucleus Pulposus Extrusion. Vet Clin Small Anim 48, 95â109. 2018","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"2. Mari et al. Outcome comparison in dogs with a presumptive diagnosis of thoracolumbar fibrocartilaginous embolic myelopathy and acute non-compressive nucleus pulposus extrusion. Veterinary Record, 10.1136/vr.104090. 2017","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"3. Mari et al. Predictors of urinary or fecal incontinence in dogs with thoracolumbar acute non-compressive nucleus pulposus extrusion. JVIM, 33:2693-3000. 2019 ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{}
1007,"content":[{"nodeType":"text","value":"Thank you Dr. Mazur and Clocktower Animal Hospital of Herndon, VA for referring this case! ","marks":[{"type":"italic"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"What you should expect from BVNS when you refer a case:","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Faxed Referral Letter (with call to confirm receipt).","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Desire to discuss any case, whether it is a referred case or a consultation.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Dedication to provide superior service to you and your clients. ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"2uCqgOpMnGo0FbWIFbKlZD"},"name":"IMAGE CONTAINER - MASTER - INCLINIC - DOG - TRIMMING ","title":null,"altText":"White Yorkshire Terrior getting a hair cut from two female groomers. ","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"NVA-Clinic-Dog-Trimming","url":"https://images.ctfassets.net/rt5zmd3ipxai/6JS4NqMMvpmMy3pgNwmzoK/a4f5dcd401fae32cf5d7b2850083d17f/NVA-Clinic-Dog-Trimming.jpeg","size":2117357,"width":3000,"height":2208,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Barney","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Barney","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"For this edition of the BVNS Neurotransmitter, Dr. Bush would like you to answer questions about a 10.5-year-old Labrador named Barney (pictured below) with sudden onset of weakness and poor balance.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2020"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Please play the video below and answer the questions provided.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"But wait... there's more:","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"If you participate, you will be entered into a drawing to win a $100 Amazon gift card!","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Barney from ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"/"},"content":[{"nodeType":"text","value":"Bush Veterinary Neurology","marks":[],"data":{}}]},{"nodeType":"text","value":" on Vimeo.","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"6Fc7jGBcHanIQY9PV2ZiG6"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Barney","title":null,"altText":"Barney","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405","url":"https://images.ctfassets.net/rt5zmd3ipxai/5btNe388EeCW89HaDFcfd6/5bddcd2ea81b40d5408c4a0e71800f5a/Barney.jpg","size":73163,"width":750,"height":562,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Sassy Chupacabra","
1007name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Sassy Chupacabra","blogAuthor":"Ashley Bensfield, DVM, DACVIM (Neurology)","blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Sassy is an 11-year-old female domestic short-hair cat.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2020"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Sassy has had intermittent âfightsâ with her own back legs for years. Owner describes that Sassy scratches her own ear with her back leg, and then, she seems surprised that her leg touched her. She then attacks the offending paw, which hurts, and then she proceeds to roll around and bite and scratch herself. She once got a hind claw stuck through her âeyebrowâ narrowly missing her eyelid. Episodes were only once a month or so. Owner says talking to Sassy during the episode makes her growl more, so they have not tried to interfere.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Recently, a second cat has been added to the household. The other cat is minimally aggressive toward Sassy. He will guard the litterboxes, but otherwise, he shows little interest in her. Since addition of second cat, the rolling and self attacking episodes have gotten more frequent and more violent. No skin wounds have been seen, but owners are concerned that Sassy will hurt herself. She is also now having episodes where her pupils dilate, she licks her lumbar region aggressively, she swings her tail around vigorously, and then she runs away as if something has bitten her.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\nSassy has had mild, very intermittent left forelimb lameness for approximately 5 years. Since adoption 7 years ago, she also has episodes when she is falling asleep where her ears and facial muscles with exhibit brief myoclonic jerking movements. She is very agile despite the forelimb issue hand has no difficulty jumping on and off tall furniture or playing vigorously with toys. She is sleeping well and eating well. She vomits about once every 2 weeks when she eats too quickly; the vomitus is always undigested food. No diarrhea, coughing, or sneezing have been noted. Her\nweight is stable. Her CBC, chemistry profile, urinalysis, and T4 are all WNL.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"EXAM FINDINGS","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":"\n","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Physical and neurological exam are completely normal. Sassy is outgoing, vocal, and mildly fractious during the appointment.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"\n","marks":[],"data":{}},{"nodeType":"text","value":"DIFFERENTIAL DIAGNOSIS","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":"\n","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Feline Hyperesthesia Syndrome, atypical seizures, and less likely pain episodes.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"TREATMENT","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Sassy was started on 2.5mg fluoxetine once daily. Within 2 weeks, the episodes had decreased by 90% in frequency and were much shorter and less violent than before. The occasional limping and also the face twitching episodes were unchanged.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"FINAL DIAGNOSIS:","marks":[{"type":"bold"},{"type":"underline"}],"data":{}},{"nodeType":"text","value":" FELINE HYPERETHESIA SYNDROME","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Feline Hyperesthesia Syndrome, also known as \"rolling skin disease,\" has been described as a form of Obsessive Compulsive Disorder in cats. It c
1007an be related to a primary behavioral issue, like inter-cat stress in Sassyâs case, or it can be a response to chronic pain. Some cats with Feline Hyperesthesia Syndrome go on to develop more readily identifiable true epileptic seizures.\n","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Testing is aimed at ruling out systemic causes of discomfort and ruling out seizures. Neurological tests that may be performed include a brain MRI with cerebrospinal fluid analysis, and electroencephalogram to check for seizure-like brain electrical activity, and/or a treatment trial with an anti-epileptic drug. If no neurological or pain cause is identified, then a treatment trial with a serotonin enhancing medication like fluoxetine or clomipramine can be helpful. Referral to a board certified veterinary behaviorist should also be considered.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"What you should expect from BVNS when you refer a case:","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Faxed Referral Letter (with call to confirm receipt).","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Desire to discuss any case, whether it is a referred case or a consultation.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Dedication to provide superior service to you and your clients. ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"4bw8MEAiHsVncks5SfV7Il"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Sassy","title":null,"altText":"Sassy Chupacabra ","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405","url":"https://images.ctfassets.net/rt5zmd3ipxai/6hLTTxh153oZq3p8F9Jgej/44bd9ff9ad41b29e18d721a66bd4b3ea/Sassy_ChupacabraEDITED.jpg","size":199075,"width":1536,"height":2048,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Buttercup","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Buttercup","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Buttercup is a 1-year-old female, spayed domestic shorthair cat.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2021"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"heading-3","data":{},"content":[{"nodeType":"text","value":"MEET BUTTERCUP ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"She was adopted as a kitten along with her âsister,â Sarahbellum, in Spring 2020. They were both adopted from a wonderful local cat rescue called Good Mews with a tentative diagnosis of cerebellar hypoplasia. On neurologic examination, Buttercup is very spastic in all four legs with exaggerated stepping movements - this is called hypermetria. Buttercup is also ataxic,\nmeaning wobbly in all four legs and she frequently loses her balance. Buttercup also has a pronounced intention tremor which is an involuntary, rhythm
1007ic, oscillatory movement of the head; in her case, the tremors are exaggerated by goal-oriented actions (when she intends to do something such as eating, drinking, or playing with a toy). ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"PRESENTING COMPLAINTS ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hypermetria","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Ataxia in all four limbs","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Intermittent intention tremor ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DIAGNOSTICS ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"CBC and chemistry: within normal limits","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Brain MRI to be scheduled","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"To view videos of Buttercup's gait and intention tremors, visit ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"bit.ly/3c2yoX5"},"content":[{"nodeType":"text","value":"bit.ly/3c2yoX5","marks":[],"data":{}}]},{"nodeType":"text","value":" ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"NEUROLOCALIZATION ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Buttercup's neurologic examination shows abnormalities consistent with diffuse cerebellar disease.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"TENTATIVE DIAGNOSIS ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cerebellar Hypoplasia.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"TREATMENT ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"There is no treatment for this condition.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"OUTCOME ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Buttercup has continued to thrive in our home alongside Sarahbellum and their three Dachshund housemates, Malcolm, Lucy Goo, and New Rock. You can see Malcolm get in on the laser pointer action in one of Buttercupâs videos. Buttercup has grown into a healthy, happy adult cat and we expect to enjoy many more years with her.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"WHAT IS CEREBELLAR HYPOPLASIA?","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cerebellar hypoplasia is a disorder in which the cerebellum fails to develop properly. The\ncerebellum is the part of the brain that controls purposeful movement, coordination, balance (has direct input to the vestibular system), and refines our motor skills. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"HOW DID BUTTERCUP GET CEREBELLAR HYPOPLASIA?","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Most commonly, kittens become affected with feline panleukopenia virus during the perinatal peri
1007od (in the last weeks of pregnancy and the first weeks after birth). During this period, the cerebellum is undergoing rapid growth making it susceptible to attack as the panleukopenia virus tends to damage highly active, rapidly dividing cells. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Clinical Signs ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cerebellar ataxia (including hypermetria) often noticed when the kitten starts walking ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Intention tremor","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Other neurologic signs can occasionally be seen if the virus has affected other areas of the brain ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"HOW DO YOU DIAGNOSE AND WHAT IS THE PROGNOSIS?","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cerebellar hypoplasia is not detected with routine laboratory tests. 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Gizmo found a forever home with the BVNS Neurologist who first evaluated him, Dr. Barker, and her wife Carolina.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Prognosis","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"blockquote"},{"data":{},"content":[{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Fair to good with spine stabilization, given the presence of superficial pain perception and improving voluntary motor movement in the pelvic limbs.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"}],"nodeType":"unordered-list"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Take-Home Points ","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"blockquote"},{"data":{},"content":[{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Sedated radiographs can help identify fractures, bone infections, and some bone and soft tissue cancers.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Spine subluxations and fractures often carry a good prognosis with spine stabilization when some degree of voluntary motor movement exists.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Bladder management is key for a non-ambulatory dog to reduce detrusor muscle injury and urinary tract infections.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"For spine trauma with inflammation, consider non-steroidal anti-inflammatory medication or anti-inflammatory doses of corticosteroids, rather than
1007immunosuppressant doses.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Minimally displaced spine fractures with pain perception can sometimes be managed medically with strict exercise restriction, physiotherapy, bladder management, analgesia, muscle relaxants, and NSAIDs or anti-inflammatory corticosteroids.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"}],"nodeType":"ordered-list"},{"data":{},"content":[{"data":{},"marks":[],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"1Zk22sbC3dCOoSOmSUQ15s"},"name":"[60/40] MASTER- IMAGE CONTAINER- DOG- OUTDOORS- PLAY- BALL","title":null,"altText":"Jack Russell Terrier sitting on green lawn with orange ball","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"NVA- DOG- OUTDOORS- PLAY- BALL- 6040","url":"https://images.ctfassets.net/rt5zmd3ipxai/7do5xNVQl0urQhWlPrOkdQ/a0b047292992f2bbcb2d54176b9225c7/master_jackruss_6040.jpg","size":205331,"width":920,"height":580,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Pseudolymphoma","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Pseudolymphoma","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Anti-epileptic drugs remain our primary treatment modality for seizure disorders but do come with the potential for side effects. ","marks":[],"data":{}}]}]}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2022"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"PSEUDOLYMPHOMA: A RARE SIDE EFFECT OF ANTI-EPILEPTIC DRUG THERAPY","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"\nAnti-epileptic drugs remain our primary treatment modality for seizure disorders but do come with the potential for side effects. More than 50% of dogs receiving phenobarbital experience at least one adverse effect, but these are usually mild and resolve with dose reduction or discontinuation. Adverse effects from phenobarbital are less common in cats. Type 1 drug reactions are those which are dose-dependent, whereas type 2 drug reactions are idiosyncratic. Known idiosyncratic reactions to anti-epileptic drugs are rare. Recently, there have been reports of pseudolymphoma in small animals receiving phenobarbital (2-4) and zonisamide (5).","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"DETAILS","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Pseudolymphoma is a rare, benign lymphoproliferative disorder (3). Symptoms may include peripheral and abdominal lymphadenopathy, hepatomegaly and splenomegaly (2-4). These signs may also be accompanied by high fever, lethargy and anorexia (1-4). Biopsied lymph nodes are consistent with benign lymphoid hyperplasia with normal lymph node architecture (2-4). Pseudolymphoma has been documented to occur in humans with exposure to drugs with an aromatic structure (phenobarbital, phenytoin, carbamazine, valproic acid) (2-4). It is thought that it may be a subset of anticonvulsant hypersensitivity syndrome (AHS), which is a severe idiosyncratic reaction with signs including fever, malaise, skin rash and multiple organ involvement (lymphadenopathy, hepatomegaly, splenomegaly, leukocytosis) (1-3). In dogs and cats, pseudolymphoma has been recognized secondary to both phenobarbital (2-4), zonisamide (5), propylthiouracil (3) and methimazole (3) administration. Signs present 3-12 weeks after initial administration, resolve 2-9 weeks after drug withdrawal, and are likely to recur if the pet is re-challenged with the drug (1-4). Diagnosis is made by excluding other causes of symptoms and documenting resolution of signs once drug is withdrawn +/- reappearance of signs if drug is restarted (1-4).\n","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Idiosyncratic reactions tend to be uncommon, but can be responsible for the onset of systemic disease in patients receiving drug therapy. Pseudolymphoma should be a differential for any patient with a recent history of starting a new anti-epileptic drug presenting for lymphadenopathy.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"REFERENCES","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"blockquote"},{"data":{},"content":[{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Djani, DM \u0026 Draper, WE. Suspected phenobarbital-induced fever in a cat. Journal of Feline Medicine \u0026\nSurgery 2019:1-3.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Lampe R, Manens J and Sharp N. Suspected phenobarbital-induced pseudo lymphoma in a dog. JVIM\n2017;311:858-9.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Lieser, J \u0026 Schwedes, CS. Pseudolymphoma in a cat on phenobarbital treatment. JSAP 2017;1-4.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Sohn, SJ et al. Phenobarbital-induced anticonvulsant hypersensitivity syndrome in a cat. Journal of\nVeterinary Medical Science 2019.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Collinet A and Sammut V. Suspected zonisamide-related anticonvulsant hypersensitivity syndrome in a cat.\nJ Am Vet Med Assoc 2017;251:1457-61.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Podell M et al. 2015 ACVIM small animal consensus statement on seizure management in dogs. J Vet Intern\nMed 2016;30:477-90.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Ackermann AL et al. Erythema multiforme associated with zonisamide in a dog. Vet Dermatol 2015;26:391-\ne89.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Bersan A et al. Phenobarbitone-induced haematological abnormalities in idiopathic epileptic dogs:\nprevalence, risk factors, clinical presentation and outcome. Vet Record 2014;10:247-51.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Koch T et al. Cutaneous adverse drug reactions in dogs treated with antiepileptic drugs. Frontiers in\nVeterinary Scie
1007nce 2016;3:1-10.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Schwartz M, Munana KR \u0026 Olby, NJ. Possible drug-induced hepatopathy in a dog receiving zonisamide\nmonotherapy for treatment of cryptogenic epilepsy. Journal of Veterinary Medical Science 2011;73:1505-8.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"}],"nodeType":"ordered-list"},{"data":{},"content":[{"data":{},"marks":[],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"4UGVgfF6lYizfsv3jaaXsA"},"name":"IMAGE CONTAINER - NVA - MASTER - BLOG - Dog laying down in dog bed","title":null,"altText":"Dog laying down in bed","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - NVA - MASTER - BLOG - Dog laying down in dog bed","url":"https://images.ctfassets.net/rt5zmd3ipxai/f3X9DrLQD8OnbCLptYNWa/9ff5cb8004a0f80fb7cb7cd1b04a3d62/MicrosoftTeams-image__287_.png","size":220720,"width":1255,"height":685,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Rabies","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Rabies","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Luckily, rabies is a disease that most people have no experience with, other than the vaccination of their pets. It is important to realize that rabies is fatal over 99% of the time and that more than 59,000 people worldwide still die of rabies every single year. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2022"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"BACKGROUND","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Luckily, rabies is a disease that most people have no experience with, other than the vaccination of their pets. It is important to realize that rabies is fatal over 99% of the time and that more than 59,000 people worldwide still die of rabies every single year. This makes it one of the deadliest and most important diseases on the planet. The following is an overview of the disease as well as a reminder that current vaccination is is strongly recommended and may be required by some veterinarians.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"EPIDEMIOLOGY","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Rabies is present worldwide and reported in over 150 countries. The only place that it has not been reported is Antarctica. All mammals can potentially carry and/or become infected with rabies. Wildlife such as bats, skunks, raccoons, and foxes are the most common hosts. Rabies is exceptionally rare in opossums due to their lower-than-normal body temperature (~94-97 degrees Fahrenheit). Birds have only been experimentally infected and are not considered a natural threat. Rabies virus is specifically adapted to its reservoir host species with several different variants existing in the United States. These include raccoon variant, bat variant, fox variant, and skunk variant. The canine variant was eliminated in the US in 2004 thanks to leash laws and a rigorous (and effective) vaccination program. Although cross-species transmission of rabies variants does occur (for example, dogs becoming infected with bat or raccoon variant), rabies virus variants are primarily transmitted within the species to which they are adapted. In other words, the raccoon variant is primarily transmitted between raccoons. With that said, it is still entirely possible for dogs to become infected and then transmit the disease to a human.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"STRUCTURE","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The rabies virus is within the family Rhabdoviridae. Each viral particle is surrounded by a thick lipid (fatty) envelope which helps protect it from attack while within an animal. This is part of what makes rabies infection so difficult to treat or cure once an animal is infected. Once outside of the animal, the envelope makes them very sensitive to drying out in the environment, and relatively easy to kill with various chemicals (ie. formalin, alcohol, phenols), soaps, and detergents. So, rabies actually has limited survival when not inside of its host animal. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"RABIES VIRUS IS A ROD- OR BULLET-SHAPED, SINGLE-STRANDED, NEGATIVE-SENSE, UNSEGMENTED, ENVELOPED RNA VIRUS. ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"INFECTION","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Rabies virus is transmitted through direct contact (ie. through broken skin or mucous membranes in the eyes, nose, or mouth) with saliva or nervous system tissue from an infected animal. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"While this occurs most readily through a bite wound from a clinically rabid animal, infected saliva can get into the body through any of the above-mentioned methods. Inhalation has been reported but is extremely rare. Blood, urine, and feces are not considered with risk of infection.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Once an animal becomes infected with the rabies virus, there is an incubation period before the virus actually ascends through the nerves to the central nervous system. This is influenced by many things including the age of the animal, the proximity of the bite to the spinal cord, and the degree of innervation of the inoculation site. The virus particles enter the peripheral nerves near the inoculation site and travel in a retrograde fashion toward the spinal cord. This travel can be as slow as 1 cm/day or as fast as 40 cm/day. Once in the spinal cord, the virus ascends towards the brain\nrapidly and bilaterally resulting in damage to the spinal cord's lower motor neurons. This can result in flaccid weakness or paralysis. Once in the brain, necrotizing encephalitis ensues resulting in marked injury and death of neurons. After this damage occurs, the virus then travels through cranial nerves and peripheral spinal cord nerves to other tissues. This includes the acinar cells of the salivary glands. Presence of virus in saliva indicates brain involvement has already occurred.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"CLINICAL SIGNS","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The clinical course associated with rabies infection is invariably progressive and has classically been divi
1007ded into a furious (or \"psychotic\") form and a paralytic (or \"dumb\") form. It should be noted that clinical signs in rabid animals can be highly variable and that not all cases adhere to these specific signs.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The furious type of disease can last from 1-7 days and is marked by increasing levels of anxiety, restlessness, hyperesthesia, and photophobia. As they progress through this form of the disease, they become increasingly aggressive to people, objects, or their enclosure (cage). Ataxia and seizures can also occur. Cats typically show wild and\nerratic behavior, muscle tremors, and continuous running.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The paralytic form of the disease is characterized by ascending paralysis until the entire central nervous system is affected. This form is most commonly seen in dogs; however, when seen in cats, it typically follows the furious form. Dogs will often show the characteristic change in bark, dropped jaw, difficulty swallowing, and hypersalivation (\"foaming at the mouth\") due to the brainstem and cranial nerves being affected. Since it was often mistaken\nfor choking, people may be exposed when exploring or trying to clear the mouth.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DIAGNOSIS \u0026 PATHOLOGIC FINDINGS","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Rabies is most often strongly suspected based on clinical signs and history; however, due to the large variation in presentation, it should be suspected in any animal displaying a profou
1007nd change in attitude or behavior. Definitive diagnosis is only made postmortem by finding rabies virus antigen in suitable brain tissue samples. Similar testing on skin samples, saliva, and blood have been described, but lack the sensitivity and specificity required for such an important disease.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"POST-EXPOSURE MANAGEMENT","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Whenever there is concern that an animal may have been exposed to the rabies virus, care needs to be taken to minimize the possibility of exposure to humans until the vaccination status of the animals involved is known. We recommend checking with your state's public health department for specific policies. For example, our BVNS locations in Virginia adhere to the Virginia Department of Health Guidelines for Rabies Prevention and Control. This can be found at ","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"https://www.vdh.virginia.gov/animal-contact-human-health/rabies-control/virginia-guidelines-for-rabies-prevention-and-control/"},"content":[{"nodeType":"text","value":"https://www.vdh.virginia.gov/","marks":[],"data":{}}]},{"nodeType":"text","value":"","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"https://www.vdh.virginia.gov/animal-contact-human-health/rabies-control/virginia-guidelines-for-rabies-prevention-and-control/"},"content":[{"nodeType":"text","value":"animal-contact-human-health/rabies-control/","marks":[],"data":{}}]},{"nodeType":"text","value":"","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"https://www.vdh.virginia.gov/animal-contact-human-health/rabies-control/virginia-guidelines-for-rabies-prevention-and-control/"},"content":[{"nodeType":"text","value":"virginia-guidelines-for-rabies-prevention","marks":[],"data":{}}]},{"nodeType":"text","value":"","marks":[],"data":{}},{"nodeType":"hyperlink","data":{"uri":"https://www.vdh.virginia.gov/animal-contact-human-health/rabies-control/virginia-guidelines-for-rabies-prevention-and-control/"},"content":[{"nodeType":"text","value":"-and-control/","marks":[],"data":{}}]},{"nodeType":"text","value":"","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"PREVENTION","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Vaccination of dog and cat pets is the best and most effective strategy for preventing rabies. Elimination of stray or feral unvaccinated dog and cat populations is expensive, controversial, and ineffective. Control of wildlife populations is also not effective or practical.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"While modified live vaccines generally provide better immunity to disease, rarely reported vaccine-induced rabies has prevented their use. Currently, rabies vaccines utilize inactivated (killed) virus and provide good immunity. Recombinant or DNA vaccines have been developed and may prove to be a better alternative in the future.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In Virginia, the law (*see reference above) requires every dog and cat receive a rabies vaccination before 4 months of age (whenever possible). The second vaccination (ie. booster) should be administered within 12 months of the first. Subsequent vaccinations should be administered based on the formulation of the previous vaccine given (ie. 1-year vs 3-year). Proper vaccination is essential for the protection of your pet and for the protection of veterinarians and their staff. If your pet has clinical signs compatible with rabies and no history of rabies vaccination, your pet will not be seen or examined by our staff. Examination of pets with outdated vaccine status depends on several factors but is typically handled on a case-by-case basis.\n","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"SUMMARY ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Rabies is a very rare disease in our domesticated pets; however, the risk of contracting the disease is\nvery real. Because rabies can present with subtle or variable clinical signs, care should be taken with any animal displaying abrupt neurologic dysfunction. Knowing that it is invariably fatal once neurologic signs develop, we feel strongly that every animal needs to be properly vaccinated.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}}
1007,"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"1nWS2H4WqC31sRTuza2cMo"},"name":"IMAGE CONTAINER - NVA - MASTER - BLOG - OUTDOOR - Dog Lying on Grass Next to a Plant Pot Outside","title":null,"altText":"A Brown Dog Lying on Grass Next to a Plant Pot Outside","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - NVA - MASTER - BLOG - OUTDOOR - Dog Lying on Grass Next to a Plant Pot Outside","url":"https://images.ctfassets.net/rt5zmd3ipxai/5qAQpboCMLT5Ltm2BJqdGF/5c3c1a63c06c2a925b0d7dee717545a4/iStock-1330460234-1200x800.jpg","size":194391,"width":1255,"height":685,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Ziva","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Ziva","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Ziva was adopted by her family at 7-years-old. Her background medical history includes coxofemoral osteoarthritis and previous treatment for heartworms. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2022"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"ZIVA'S HISTORY","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Ziva was adopted by her family at 7-years-old. Her background medical history includes coxofemoral osteoarthritis and previous treatment for heartworms. She presented to Bush Veterinary Neurology Service in Richmond, VA due to an acute onset of seizure activity. Her guardians noted that Ziva had her first seizure in mid November, 2021. She had facial twitching and went into a tonic clonic seizure that lasted 2-3 minutes. A couple of days later, she presented to her primary care veterinarian for bloodwork which came back within normal limits. Almost a month later, Ziva had her second seizure.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"BRAIN TUMOR","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Brain tumors are not always the âend of the roadâ for pets and are usually treatable in some way, shape or form.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"SEIZURES","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Seizures originate in the forebrain (cerebrum/thalamus). The differentials for this localization are late onset genetic-based, immune disease, vascular disease, neoplasia or others.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"AT HOME CARE","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Managing a pet with seizures or a brain tumor will most frequently require medical management, monitoring any\nchanges in behavior or routine, and regular follow-ups with your local neurologist. There will always be options available for treatment depending on each case.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MRI","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Dr. Martin Young at Bush Veterinary Neurology Service recommended and performed diagnostics including MRI of\nthe brain. T1 post contrast sequences show an increased signal mass lesion within the left parietal lobe. The mass\nmeasured 0.8cm X 1cm. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Summary: these findings are consistent with a small left forebrain meningioma.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"PROGNOSIS \u0026 TREATMENT","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Based on the diagnostics, the prognosis for Ziva is fair to good depen
1007ding on the treatment course. With medical management of steroids and an anticonvulsant medication, there would be an anticipated survival up to 6 months, with the addition of chemotherapy, about 8-10 months, and with radiation therapy, there would be an expected survival of 14-18 months. If decompressive surgery is considered, survival rate of over 18 months is expected. A combination of therapy would anticipate a longer survival which has been reported out to 3 years. After the MRI diagnosis, Ziva started a steroid medication to reduce edema and inflammation and an anti-convulsant medication to manage seizures prior to decompressive craniotomy.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"SURGICAL INTERVENTION","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Ziva continued to have some seizure activity at home, including facial twitching. It was decided that Ziva should undergo a left lateral rostrotentorial craniotomy performed by Dr. Young. During this procedure, an injection of Fluorescein was administered IV to highlight the tumor.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Fluorescein is absorbed by tumor cells, making abnormal tissue light up neon green while the remaining normal brain\ntissue glows blue when using a 497 nm wavelength light source. In this case, the Myriad (a surgical aspirator) with light source highlighted the tumor which was aspirated providing complete excision of the mass. The light source revealed that no contrast enhancing tumor remained in the field after aspiration was complete.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"All samples were submitted to Virginia Tech College of Veterinary Medicine diagnostics lab. Results noted benign meningioma that is likely not to recur.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{}
1007,"content":[{"nodeType":"text","value":"BENEFITS OF TECHNOLOGY","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The canine and the human brain are very closely correlated when it comes to structure and tumor types. Therefore, we can use the canine brain as a base model to help improve technology and advancements in both veterinary medicine and human medicine. Having the best and most innovative tools at the surgeons fingertips can help on many levels:","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Improved diagnostic potential and surgical performance","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Reduce error, labor time, and anesthesia time","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Boost productivity","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Enhance quality of patient care","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Revolutionize the way doctors diagnose and treat patients","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"In Zivaâs case, Dr. Young has used the NICO Myriad device with light source for maximal safe tumor removal.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"CONCLUSION","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Ziva continues to do well at home. She enjoys going on walks and playing frisbee! Dr. Young and Bush Veterinary Neurology Service look forward to continuing her care and aiding in her recovery.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"*All photographs included are from Zivaâs case with permission.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"*Special thank you to Ziva and her family","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"ANVVoYMVcZQqEMT7UWXN5"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Ziva","title":null,"altText":"A brown dog laying on the floor with stitches in her head","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Ziva","url":"https://images.ctfassets.net/rt5zmd3ipxai/5VIvJOwmYZwQZPFHXwJ3Bw/6ebd27a9bb31e8ef4c4e8fb415cd60a0/ziva.png","size":395850,"width":1255,"height":685,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Henrietta","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Henrietta","blogAuthor":null,"blogDate":null,"url":"henrietta","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Henrietta is a four-year-old spayed female cat whom presented with a sudden onset of abnormal head movements. ","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2023"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MEET HENRIETTA ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Henrietta is a four-year-old spayed female cat whom presented with a sudden onset of abnormal head movements. When a patient presents for abnormal head movements â what would you do? The best approach is to localize the lesion and create an accurate list of possible causes for the symptoms. What do you think? Our thoughts are below.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"BACKGROUND ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Four-years-old Spayed Female Domestic Shorthair Cat ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"PRESENTING COMPLAINT ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Sudden onset of abnormal head movements, spacey ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"BEST APPROACH ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Localize the lesion and create an accurate list of possible causes for the symptoms ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"EXAM FINDINGS ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DMentation: Quiet, alert ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Posture: Persistent figure 8 or side to side wide head excursions ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Gait: Unwilling to walk, when prompted takes a few steps without ataxia ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Postural Reactions: Normal tactile placing, hopping and paw flip test ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cranial Nerve Exam: Mild right positional strabismus and right head tilt, miosis on right ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Occular / Retinal Exam: Normal ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hyperaesthesia: Normal ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"LOCALIZATION ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Bilateral vestibular (head excursions) with sympathetic tract (miosis) and vestibular nerve (strabismus, head tilt) involvement on the right. Peripheral disease most likely (normal mentation, postural reactions) with potential middle ear invovement on the right (head tilt, miosis). ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DIFFERENTIALS ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Bilateral otitis media / interna (worse on right) vs idiopathic more likely than metabolic (thiamine), neoplasia (carcinoma, lymphoma) more likely than central causes infection (FIP, toxoplasmosis, cryptococcous), noninfectious inflammation, neoplasia, infarct(s), others ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"RECOMMENDATIONS ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"CBC and Chemistry were already normal and Henrietta eats a normal diet without exposure to raw fish (low thiamine very improbable). MRI recommended to assess head / middle ear / brainstem. If testing avoided, then consider 6 week trial with clindamycin for potential bacterial ear infection. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"TESTING ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MRI of the head is normal - further testing for central causes not pursued given examination findings ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"OUTCOME ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Head excursions improved, then resolved over 14 days. Recheck at 3 weeks demonstrated an improved but subtle right head tilt and transient (subtle) right positional strabismus. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"DIAGNOSIS","marks":[{"type":"bold"}],"data":{}},{"nodeType":"text","value":" ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Idiopathic bilateral vestibular disease ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"The goal of this case report was to improve your recognition of bilateral vestibular disease and describe diagnostic / therapeutic approach. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"IMPORTANT POINTS ","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cats with wide head excursions localize to bilateral vestibular system AND these cats have similar differentials and prognosis as cats presenting with unilateral vestibular signs ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"About 1/3 bilateral vestibular cases will have a central (brainstem) localization â these cats typically have a dull mentation and delayed postural reactions. Differential causes include infection, immune-mediated diseases, neoplasia and low thiamine. Generally, the prognosis is worse for central disease compared to peripheral disease. ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"2/3 cats with bilateral vestibular signs have peripheral disease (curiously some of these will have postural deficits). Otitis media / interna is slightly more prevalent than idiopathic / unknown cases. Typically, all otitis will improve with treatment and most (but not all) idiopathic cases will resolve. ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MRI is recommended to rule-out central causes (some central cases will not demonstrate a dull mentation or postural deficit) AND for peripheral cases, determine the necessity of treatment with antibiotics. ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"References ","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"LeCouteur RA, Vernau KM. Feline vestibular disorders. Part I : anatomy and clinical signs. Journal of Feline Medicine and Surgery 1999 ;1: 71-80 ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Vernau KM, LeCouteur RA. Feline vestibular disorders. Part II : diagnostic approach and differential diagnosis. Journal of Feline Medicine and Surgery 1999; 1 :81-88 ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"LeCouteur RA. Feline vestibular diseases - new developments. Journ
1007al of Feline Medicine and Surgery 2003 ; 5 : 101-108 ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Negrin A, Cherubini GB, Lamb C, et al. Clinical signs, magnetic resonance imaging findings and outcomes in 77 cats with vestibular disease : a retrospective study. Journal of Feline Medicine and Surgery 2010 ; 12 : 291-2995. ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Lorenz MD, Coates JR, Kent M. Ataxia of the Head and the Limbs. In : Handbook of Veterinary Neurology. 5th ed. Missouri : Elsevier Saunders Co, 2011 ; 250-281 ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Delahunta A et al. Veterinary Neuroanatomy and Clinical neurology. 5th ed. Philadelphia, Elsevier 2021 ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Lamy C, et al. Bilateral Peripheral Disease in Cats; A retrospective of 35 cases. Presented at SEVEN veterinary conference, 2020 ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"mFZIYvxZBeQVels9mdZXh"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Henrietta","title":null,"altText":"Calico cat on yellow blanket ","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Henrietta","url":"https://images.ctfassets.net/rt5zmd3ipxai/1mhGkOUo9JEJbuLXt6p9vS/906b93212f6bfddfc917955cb459dba7/Henrietta.png","size":122327,"width":300,"height":211,"contentType":"image/png"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Mya","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Mya","blogAuthor":null,"blogDate":null,"url":"mya","blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Mya is a seven-year-old rescued Doberman. 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","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"General exam is normal with exception of firm bony protrusion from the left frontal bone (over frontal sinus) ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"PRESENTING COMPLAINT ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Right thoracic limb sliding out to the side and occasional stumbling and knuckling on RTL ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Droopy right eye ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Possible leaning to the left and less energy than her sister ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"MENTATION ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"(level of awareness, presence of confusion) ","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Quiet, but seemingly normal. She kept raising her paw for attention ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"GAIT - NORMAL ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"POSTURE ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"(body position, things noted by just looking at patient) ","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Occasional / possible left head tilt ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Occasionally holds right thoracic more than right pelvic limbs abducted (away from midline) ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Bump over her left frontal sinus ","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Ptosis on right eye ","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"POSTURAL REACTIONS ","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"(ability to correct position of a limb) ","marks":[],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{}
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Her signs gradually resolved over 2-3 weeks.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Tetanus Disease Summary","nodeType":"text"}],"nodeType":"heading-3"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Clinical Signs","nodeType":"text"},{"data":{},"marks":[],"value":"\nSigns start 5-10 days after exposure and may persist for up to 3 weeks. Affected animals commonly have rigidity of the limbs, extension of the neck, clenching of the jaw (trismus), a characteristic facial expression (risus sardonicus) and less commonly cardiac arrythmia and seizure.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Pathophysiology","nodeType":"text"},{"data":{},"marks":[],"value":"\nThe signs of tetanus are caused by a neurotoxin produced by Clostridium tetani, an obligate anaerobic spore forming Gram-positive bacteria. Spores found in the environment will germinate in response to anaerobic conditions (such as in a deep penetrating wound, or in teething animals) and produce various toxins. The toxins invade peripheral nerves at the axonal terminals and ascend to the spinal cord. The most significant of these toxins (ie. tetanospasmin) blocks inhibitory neurotransmitter release at interneurons in the spinal cord and brain. This results in the inability for muscles to relax.\n","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Diagnosis","nodeType":"text"},{"data":{},"marks":[],"value":"\nA diagnosis of tetanus is usually based on solely on clinical signs. Blood samples for complete blood count (CBC) and biochemistry will often be unhelpful although an elevation in creatine kinase may be noted. A wound may be detected; however, in the majority of cases, one is never found. Isolation (culture) of C. tetani can be attempted but this requires anaerobic conditions and special culture media. Growth is slow and will often take longer than 12 days.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Treatment","nodeType":"text"},{"data":{},"marks":[],"value":"\nTreatment of tetanus may include wound debridement, intravenous antitoxin, sedation/muscle relaxation, antibiotics, and intense nursing care (feeding, maintaining hydration, preventing soiling, etc). Untreated cases are often fatal due to respiratory complications.\n","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Wound debridement followed by topical antiseptics is important to remove any necrotic tissue found and inhibit further bacterial growth.\n","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Antitoxin neutralizes any free or unbound toxin and (if used) should be given as soon as possible after the onset of clinical signs. Unfortunately, intravenous administration of antitoxin is associated with a high prevalence of anaphylaxis.\n","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Muscle relaxants and sedatives are indicated in cases with marked muscle rigidity and hyperexcitability. Diazepam or clorazepate can be used for muscle relaxation and/or seizure activity. Phenothiazine derivatives (e.g., acepromazine) have a sedative effect and a weak anticholinergic action.\n","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Antibiotic therapy is indicated to eliminate vegetative C. tetani organisms and prevent further toxin formation. It is important to realize antibiotics have no effect on toxin that has already bound to the nerves. Penicillin has long been thought to be the drug of choice but a 1985 study found metronidazole to be more effective than penicillins. It suggested dogs receiving metronidazole had an improved response, with a significantly lower mortality rate and a shorter stay in the hospital.\n","no
1007deType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Intense nursing care is important since patients are often hyperthermic, dysphagic, hyperexcitable and prone to dermatitis from urine/fecal soiling. Some cases will require tube feeding if dysphagia is severe. Tracheostomy if laryngeal spasms develop. Physiotherapy is important to improve blood supply to and lymphatic drainage from the rigid muscles. It also helps relax spastic muscles and improve comfort.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[{"type":"bold"}],"value":"Case Outcome","nodeType":"text"},{"data":{},"marks":[],"value":"\nStella did very well in that the condition was recognized and treatment (with metronidazole) was started prior to an overwhelming and widespread contraction of all of her muscles. Her signs gradually resolved over 2-3 weeks. In more severe or fulminant cases of tetanus, patients commonly experience malnutrition from the inability to eat, aspiration pneumonia, hyperthermia, and respiratory distress/fatigue due to the inability to effectively use the diaphragm and intercostal muscles.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"},"links":{"__typename":"BlogBlogContentLinks","entries":{"__typename":"BlogBlogContentEntries","inline":[],"block":[]},"assets":{"__typename":"BlogBlogContentAssets","block":[]}}},"blogImage":{"__typename":"Image","sys":{"__typename":"Sys","id":"2abD9THsERZTe2xZkU5Q9E"},"name":"IMAGE CONTAINER - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Stella","title":null,"altText":"Stella the golden lab.","imageCaption":null,"attribution":null,"image":{"__typename":"Asset","title":"IMAGE - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Stella","url":"https://images.ctfassets.net/rt5zmd3ipxai/7KQKxkhd1PNl2IwOGqgWZD/aee6f889b27353ac165ea64fbf2e7e04/Stella.jpg","size":125805,"width":610,"height":813,"contentType":"image/jpeg"},"mobileImage":null},"webpageBlog":null,"shareLinks":null},{"__typename":"Blog","featured":false,"title":"Berkeley","name":"BLOG - Bush Veterinary Neurology Service (BVNS) 301402 ; 301403 ; 301404 ; 301405 - Berkeley","blogAuthor":null,"blogDate":null,"url":null,"blogShortDescription":{"__typename":"BlogBlogShortDescription","json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Berkeley is a 2-year-old FS Miniature Pinscher","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"document"}},"blogCategory":{"__typename":"BlogCategory","categoryName":"2024"},"relatedBlogs":null,"blogContent":{"__typename":"BlogBlogContent","json":{"nodeType":"document","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presenting Complaint","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Presented to BVNS for a one-month history of legarthy, abnormal behavoir, and ataxia in all four limbs. She went to her primary veterinarian where blood work was performed and was largely unremarkable, aside from a mild eosinophilia. Multiple medications were tried prior to the initial consultation gabapentin, diazepam, and meloxicam, but Berkeley continued to decline.","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Neurological Exam","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Mentation: quiet to obtunded","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cranial nerves: normal","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Gait: ambulatory with moderate proprioceptive ataxia, compulsively paced/circled around exam room and tripped over the owner multiple times","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Proprioception: absent placing response in right pelvic limb, decreased hopping on all four limbs","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Reflexes: normal","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Hyperesthesia: no spinal pain","marks":[],"data":{}}]}]}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Neurolocalization","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cerebrum","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Differentials","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Meningoencephalitis (immune-mediated vs. Infectious), less likely neoplastic. 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infectious disease testing returns","marks":[],"data":{}}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Increased to 2.5 tablets PO every 24 hours until infectious disease results (1.8mg/kg/day) ","marks":[],"data":{}}]}]}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Clindamycin 75mg capsules: 1 capsule PO every 12 hours until infectious disease testing returned ","marks":[],"data":{}}]},{"nodeType":"unordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Discontinued after negative infectious disease results","marks":[],"data":{}}]}]}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Cytosar 100mg/m2 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","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Eosinophilic Meningoencephalitis can be caused by infectious organisms or non-infectious causes. When infectious diseases have been ruled out, eosinophilic Meningoencephalitis of unknown origin is then diagnosed. It is suspected to be an immune-mediated disease process, although the exact cause remains unknown. This is considered a less common subset of the other meningoencephalitis of unknown origin (MUO). This disease is more commonly diagnosed in young, large-breed dogs, but it has been diagnosed in small breeds as well. Diagnosis is made via specific MRI findings, eosinophilic pleocytosis, and negative infectious disease testing. Many dogs diagnosed with this disease will also have a peripheral eosinophilia. Treatment is focused on reducing inflammation and immunosuppression, typically with steroids alone or a combination of steroids, cytosar, and sometimes other immunosuppressives. the prognosis and response to treatment for eosinophilic meningoencephalitis of unknown origin tends to be better compared to the other MUOs. ","marks":[],"data":{}}]},{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Take Home Points","marks":[{"type":"bold"}],"data":{}}]},{"nodeType":"blockquote","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"","marks":[{"type":"bold"}],"data":{}}]}]},{"nodeType":"ordered-list","data":{},"content":[{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Eosinophilic meningoencephalitis of unknown origin is less common than the other types of immune mediated meningoencephalitides, but prognosis may be better.","marks":[],"data":{}}]}]},{"nodeType":"list-item","data":{},"content":[{"nodeType":"paragraph","data":{},"content":[{"nodeType":"text","value":"Diagnosis is based on MRI findings, eosinophilic pleocytosis, and negative infectious disease testing. 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