Ordeal A case of neurological disease in a dog Kate Davis Class of 2015 May 16 2014 Meet Odie 11yearold male intact Boston Terrier Presented on April 30 2014 to the Neurology Service for a twoweek history of ataxia toe dragging on the right side and generally seeming offbala ID: 616613
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Slide1
Odie’s Ordeal
A case of neurological disease in a dog
Kate Davis, Class of 2015
May 16, 2014Slide2
Meet Odie
11-year-old male, intact Boston TerrierPresented on April 30, 2014 to the Neurology Service for a two-week history of ataxia, toe dragging on the right side, and generally seeming off-balanceSlide3
Physical Exam
Pulses were strong and synchronous and no murmurs or arrhythmias were ausculted Normal bronchovesicular sounds in the lungsAbdominal palpation was unremarkable
Mild amount of waxy debris in both ears
Stenotic
nares
Gingival hyperplasia and mild dental tartar
I
ridociliary
cysts OD, as well as iris atrophy and incipient cataracts
OUSlide4
Minimum Database
Lab work was within normal limits:CBC, chemistry, urinalysis, total T4, and heartworm antigen testUp-to-date on vaccinesCurrently on heartworm preventive
terrierpuppiespict.blogspot.comSlide5
Neurological Exam
Sensorium: mildly disoriented, periods of mental dullnessGait: dragging of right pelvic limb, leaning to the right, hypermetria in all four limbsSlide6
Neurological Exam Cont’d
Postural reactions: Spontaneous knuckling of the right thoracic and pelvic limbsRight-sided hemiparesis and spasticity
Spinal
reflexes:
Normal patellar and withdrawal reflexes bilaterally, as well as normal
panniculus
and perineal reflexesSlide7
Neurological Exam Cont’d
Mid-cervical painGeneralized head painSeizure-like episode
www.artpaw.comSlide8
Cranial Nerve Exam
Abnormal menace response ODDecreased sensation of the maxillary & mandibular branches of the trigeminal nerve on the rightSlide9
Lesion Localization
Diagram courtesy of Dr. Elaine ColemanSlide10
Lesion Localization
Deficits
Lesion Localization
Right-sided hemiparesis
Left cerebral cortex,
Right brainstem
Possible seizure-like
episode
Thalamocortex
Inconsistent menace OD
Left cerebral cortex, Right cerebellum
Decreased sensation in the maxillary and mandibular branches of the
trigeminal nerve on the right
Right
b
rainstem, peripheral
branches of the trigeminal nerve on the rightSlide11
Differential Diagnoses
Intra-axial tumorImmune-mediated/infectious disease Traumatic brain injuryStrokeHydrocephalus Intracranial arachnoid cystsTrigeminal nerve sheath tumor
Trigeminal neuritisSlide12
RadiographsSlide13
RadiographsSlide14
Abdominal UltrasoundSlide15
Magnetic Resonance ImagingSlide16
Narrowed Differentials
Intra-axial tumorImmune-mediated/infectious diseaseTraumatic brain injuryStrokeHydrocephalus Intracranial arachnoid cysts
Trigeminal
nerve sheath tumor
Trigeminal neuritisSlide17
Cerebrospinal Fluid Tap
From the lumbar regionResult: Clear, colorless WBC – 1 per uLRBC – 1 per uL
Protein - 48.8mg/dlSlide18
Narrowed Differentials
Intra-axial tumorImmune-mediated/infectious diseaseTraumatic brain injuryStrokeHydrocephalus
Intracranial arachnoid cysts
Trigeminal
nerve sheath tumor
Trigeminal neuritisSlide19
Problem List
1. Intra-axial tumor of the left cerebral cortex2. Sensory loss of the trigeminal nerve on the right side3. Fluid-filled tympanic bulla on the rightSlide20
Glioma
Common in brachycephalic breeds (Boxers, Boston Terriers, Bull dogs)Second most common canine brain tumorsMost occur in dogs >6 years oldArise from the supporting cells of the brainCan be low or high gradeMainstay therapyMean survival
timeSlide21
Treatment Recommendations
Excisional biopsyRadiation therapySymptomatic therapy
www.flickr.comSlide22
Symptomatic Therapy
Mannitol CRI (1g/kg) – 25% injection given IV over 40 minutes in the hospitalPrednisone (1mg/kg/day)Famotidine (0.5mg/kg) Furosemide (1mg/kg)
Levetiracetam
(25mg/kg
)
Fenbendazole
(50mg/kg)Slide23
Follow-up
Update on May 13, 2014:Odie is doing very wellMeds seem to be helpingLess leaningSlide24
Take Home Points…
Inform client of all options to treatSupport them in their decisionQuality of life is keySlide25
References
Bai, R.-Y., V. Staedtke, C. M. Aprhys, G. L. Gallia, and G. J. Riggins. "Antiparasitic
Mebendazole
Shows Survival
Benefit
in 2 Preclinical Models of
Glioblastoma
Multiforme
." Neuro-Oncology 13.9 (2011): 974-82. Print.“Brain Tumors.”
UC
Davis Veterinary Medicine. Department of Neurology/Neurosurgery. <http
://
www.vetmed.ucdavis.edu/
vsr
/Neurology/Disorders/Brain%20Tumor%20Info.html>.
“Brain Tumors in dogs and cats.” NC State University College of Veterinary Medicine. <http
://
www.cvm.ncsu.edu/vhc/tc/
clinical_services
/
neuro
/brain_tumor.html>.
“
Neoplasia of the Nervous System.” International Veterinary Information Service. <http://www.ivis.org/advances/Vite/
braund26/
chapter.asp?LA
=1#Glioblastoma>.
“Types of Brain Tumors.” Veterinary Society of Surgical Oncology. <http
://www.vsso.org/Brain_Tumors_-_
Canine.html>.Slide26
Acknowledgements
God
My family
My friends
Dr. Lai
Dr.
Sorjonen
Caitlin Trebelhorn
CLASS OF 2015!Slide27
QUESTIONS?