Vets on the Balkans - an online journal for veterinarians from the Balkans

Glioblastoma in cerebellum of the dog

August 5, 2020

Dr Dimitar Ivanov

Veterinary Clinics Dobro Hrumvane

Sofia, Bulgaria

Glioblastoma is a malignant tumor of the nervous tissue. This is the fourth degree of astrocytoma. It is more common in the frontal and temporal lobes. Good contrast enhancement in magnetic resonance imaging, edema of the surrounding tissue is often observed. Macroscopically, it has well-defined borders.

Male dog, named Jazz, 9 years old, husky, brought to the clinic on 01.07.2020

There is worsening of the condition since the day before, the animal was no longer interested in food or water, there was lack of coordination. The clinical examination reveals that the animal was obtunded, but still responsive and it was responding to commands, given by the owners, it was also consciously resisting some tests, during the examination, which it doesn’t seem to like. No evidence of seizures. Posture – head turn to the left and tilt to the right. Gait – vestibular ataxia. Cranial nerves – absent menace reaction on the left. Postural reactions – decreased proprioception of the left pelvic limb, decreased hopping reaction of the right thoracic limb. Spinal reflexes – normal. Localization – the decreased proprioception only on the left pelvic limbs cannot definitively determine the localization. Due to the left head turn, the localization is determined in the left forebrain or peripheral vestibular syndrome. Differential diagnoses: ischemia, metabolic disease, neoplasia. MRI is recommended.

On 02.07.2020 blood was taken for CBC – nothing remarkable, Biochemistry – a slight increase in glucose and AST, ALP – 455.99 (10.6-109 U / L). FT4 and TSH are normal.

On 03.07.2020, an MRI was performed. The imagining showed a mass in the left cerebellum, with mass effect on the brainstem and cerebellum, obstruction of the normal outflow of cerebrospinal fluid and for that causing hydrocephalus. Also edema in the surrounding tissue.

Preoperative preparation was started with Mannitol 1.5 g/kg/12h i.v., Methylprednisolon 15.78 mg/12h i.v. Antibiotic therapy – Ceftriaxone – 1 g/12h i.v.

On July 4, 2020, a left suboccipital craniectomy was performed for removing the mass, part of which was sent for histopathology to Laboklin, Germany. Part of the capsule of the tumor has not been removed due to adhesions with the brainstem and the risk of injury during the process of removing it. An artificial dura was placed on the defect to prevent the leakage of cerebrospinal fluid.

After the surgery Jazz was recovering very well. There was a manifestation of vertical nystagmus, which disappeared quickly by itself. Antibiotic therapy was continued, as well as mannitol and methylprednisolone therapy 24 hours after the surgery. Meloxicam was included for pain management 12 hours after the steroids were stopped

The first day after the surgery Jazz was still slightly uncoordinated and his head was still with negligible turn, but he was able to get up and walk on his own.

On July 6, 2020, 48 hours after the surgery, Jazz was more stable, progressively getting better and eating and drinking water.

On July 9, 2020, in the middle of the day Jazz’s condition got worse. He started to turn his head to the left again. On the same day, the histology result was received:

Glioblastoma with high degree of malignancy.

On 10.07.2020, steroid therapy was started, which led to a fast improvement. On the next day Jazz was sent home with home therapy of prednisolone 0.5mg/kg/12h.

Consultation with oncology department for chemotherapy was recommended

On 17.07.20 the sutures were removed from the skin incision, Jazz’s therapy with prednisolone (0.5 mg/kg /12h) was continued. There was a slight incoordination and tilt of the head.

Trigeminal nerve sheath tumor

July 13, 2020

Dr Svetoslav Penchev

United Veterinary Clinic

Varna, Bulgaria

The nerve sheath is a layer of myelin and connective tissue that surrounds and insulates fibers in the peripheral nerves. A nerve sheath tumor is an abnormal growth within the cells of this covering. Nerve sheath tumors include schwannomas, neurilemmomas, and neurofibromas. The trigeminal nerve is the most frequently affected cranial nerve. This results in unilateral atrophy of the temporalis and masseter muscles and facial dysesthesia or anesthesia. Eventually, brain-stem compression can develop.

Signalmen: 12 years old, female, castrated Labrador retriever

History: The owner noticed that dog`s head has not normal shape.

Case presenting signs: Chronic right trigeminal nerve deficit with atrophy of the temporalis and masseter muscles. Reduced facial sensation, absent palpebral reflex with normal menace response reaction and reduced right corneal sensation and enophtalmus.

Clinical examination: The overall condition of the dog was normal with normal appetite, good muscle and body condition except the right temporalis and masseter muscles. Internal body temperature 38,8 ; Normal respiratory and heart rate; Color of mucous membranes – pink; CRT – 1,5 sec.

Neurological examination:

Mentation and behavior- Normal

Posture- Normal

Gait – Normal

Cranial nerves – right trigeminal nerve deficit

There was no change in conscious proprioception and bladder function was normal.

Spinal reflexes were normal.

Neuroanatomic localization: R Trigeminal nerve

Differential diagnosis:

Idiopatic/Inflammatory/Trauma/Metabolic/Neoplastic

Case work-up: CBC – without changes; Biochemistry – Elevation of Liver enzymes (ASAT 69 IU/L; ALAT 90 IU/L)

Contrast MRI study of the head was performed with GE MRI 1.5 Tesla.

MRI findings:

There is a large extra-axial T1 hypointense, T2 hyperintense tubular mass that arises at the origin of the right trigeminal nerve and extends rostrally through the trigeminal canal of the temporal bone. The right oval foramen is enlarged because of involving the mandibular branch. Atrophy and denervation of the masticatory muscles (temporalis, masseter and pterygoid muscles) is present with T1-, T2-hyperintesity, reduction of the muscle mass and replacement by fatty tissue. Post contrast images shows marked contrast enhancement of the right trigeminal nerve compared with the left (mild enhancement of the left trigeminal nerve is physiologic).

Diagnosis:

Right Trigeminal nerve sheath tumor

Intracranial peripheral nerve sheath tumors are relatively uncommon tumors in dogs. Clinically, dogs with intracranial PNST have one or more of the following clinical signs: ipsilateral masticatory muscle atrophy, loss of facial sensation, and Horner’s syndrome. Signs from intracranial brainstem compression can also occur. Radiation therapy is a commonly used modality in the treatment of intracranial PNST. Stereotactic radiation therapy (SRT) is one method used to deliver a curative dose of external beam radiation therapy. This precise and conformal treatment directly targets the radiation at the tumor with rapid dose drop-off, which allows for very high doses of radiation to be administered without increasing toxicity to adjacent normal tissues.

Mycoplasma in canine reproduction

May 26, 2020

Dr. Miroslav Genov, DVM, PhD student

EVSSAR member

“Multidisciplinary Veterinary Clinic BULGARIA”

Sofia, Bulgaria

Mirela Marinova ,Vet student

“Multidisciplinary Veterinary Clinic BULGARIA”

Sofia, Bulgaria

Mycoplasmas are bacterial organisms that have been placed in a separate class because of their small size. The lack of a rigid, protective cell wall makes them fragile outside the host but confers resistance to antibacterials that act by invoking cell wall damage.

They live on urogenital and respiratory mucosal surfaces in their hosts because they need a nutrient-rich environment. Their fastidious growth requirements and sensitivity to adverse environmental conditions, such as dryness and heat, complicate their diagnosis. They are difficult to culture without special media.

Several mycoplasma species have been found to be normal inhabitants of the upper respiratory and genital tracts of the dogs and cats and can be routinely isolated.

The diseases they cause involve inflammation of mucosal or serosal surfaces of the respiratory and urogenital tracts, joints, mammary glands and conjunctiva. Systemic spread often involves immunosuppression. Some mycoplasmas may become intracellular, resulting in chronic persistent infections.

Same species of mycoplasmas have been isolated from the upper and lower respiratory tracts of healthy dogs, lower respiratory tract of pneumonic dogs, from the genital tracts and urine of the dog: M. bovigenitalium, M. canis, M. cynos, M. edwardii, M. arginini, M. spumans, M. molare, M. maculosum, M. opalescens.

Mycoplasma and genitourinary infections in the dog

Isolating mycoplasmas in large numbers from the urine of dogs with urinary tract infection is not uncommon – most times mixed with bacteria, but also occasionally isolated in pure culture.

Mycoplasmas of the reproductive tract are considered to be opportunistic- they have been implicated in causing reproductive disease in the bitch, although they are also frequently isolated on clinically normal animals with no evidence of reproductive tract disease. The establishment of mycoplasma from vaginal swab or semen does not always correlate to reproductive disease. Clinical manifestation often results when an animal is under stress or exposed to high numbers of organisms. Clinical findings often are diversified and nonspecific. Mycoplasma spp. Infections should be considered a potential differential diagnosis for dogs presented for evaluation of coughing, dyspnea, fever, pollakiuria, hematuria, azotemia, lameness, mucopurulent vaginal discharge or infertility.

There are two ways of transmission for mycoplasma- aerosol, since they live in the respiratory tract, and venereal transmission.

Mycoplasma colonization of the vagina has been demonstrated following prolonged treatment of bitches with oral ampicillin and sulfonamides- this suggests that the wide-spread use of antimicrobial agents in healthy bitches should be avoided.

Samples in bitches must be obtained from the vaginal area close to the cervix and semen from stud dogs must be collected using a sterile technique, avoiding urethral contaminants. The samples should be sent to competent laboratories since mycoplasmas require special techniques for successful growth in cultures. PCR assays are also available for amplification of mycoplasmal DNA. Interpretation of positive culture results in sick animals is difficult.

Mycoplasmas are generally susceptible to the macrolides, pleuromutilins, tretacycline, chloramphenicol, spyramycin, clindamycin, fluoroquinolones and aminoglycosides. Doxycycline administered orally at 5-10 mg/kg q12-24h is generally effective in animals with a competent immune system. Erythromycin administered orally at 20 mg/kg q8-12h or lincomycin administered orally at 22 mg/kg q12h should be used in pregnant animals.

Clinical cases

Case I

Patient history:

A 6-year-old female Giant Schnauzer had one normal pregnancy and parturition in the past.

The second pregnancy of the bitch was detected at day 30. A week later the dog was lethargic and had vaginal discharge. Embryo resorption was confirmed by ultrasound. No tests were done.

The dog visited the clinic for artificial insemination with fresh semen. A vaginal swab was collected and sent for PCR testing for genital mycoplasma, brucella, herpes and chlamydia. The results came back positive for Mycoplasma spp.

Doxycycline treatment was initiated 10 mg/kg once daily for three weeks.

During the next heat a retest was done and the results were negative.

Transcervical insemination was performed using fresh semen from a male Giant Schnauzer who was also positive for Mycoplasma spp. and treated with doxycycline.

Case II

Patient history:

A 2-year-old female Caucasian shepherd was diagnosed pregnant 30 days after natural mating.

On the 53 day of pregnancy the puppies were stillborn and the bitch ate them.

A complete blood cell count (CBC) revealed leucocytosis. Аbdominal ultrasonography confirmed no foetuses and excess fluid in the uterus.

PCR testing of vaginal swab was positive for Mycoplasma spp.

Doxycycline treatment was initiated 10 mg/kg once daily for three weeks.

It was recommended to the owners to do a retest during next estrous.

Case III

Patient history:

A 2-year-old female Giant Schnauzer failed to get pregnant after the first mating. The reproductive cycle after that was normal.

We recommended PCR testing for genital mycoplasma, brucella, herpes and chlamydia.

The results came back positive for Mycoplasma spp. after the dog was inseminated. The treatment of choice was enrofloxacin for 10 days. AI was unsuccessful.

The male that had direct sexual contact with the Schnauzer was also positive for Mycoplasma spp.- after administration of doxycycline 10 mg/kg once daily for three weeks his second test was negative.

Case IV

Patient history:

A Cane Corso in heat was admitted for monitoring of estrous.

She was bred by artificial insemination at her last season but failed to conceive.

The owners shared they had other bitches that mated, but did not get pregnant. The PCR test was positive for Mycoplasma spp..

Therapy with marbofloxacin for 21 days was recommended and also PCR test for the other dogs, isolation and antibiogram.

Summary

When a bitch’s past medical history includes failure to conceive and resorption of fetuses, especially when the estrous cycle was normal, a test for sexually transmitted diseases should be done. It’s recommended to identify the microorganism and do a sensitivity test.

Mycoplasma spp. Is just one of the many factors that affect canine reproduction.

Uterine prolapse in cats – tips & tricks

May 8, 2020

Yavor Stoyanov, DVM

Yordan Yordanov, DVM

Bomed Veterinary Clinic – Sofia

Uterine prolapse is a relatively uncommon complication of parturition, occurring infrequently in cats. Ekstrand and Linde-Forsberg reported it as accounting for 0.6% of the maternal causes of dystocia. The etiology of uterine prolapse is unknown in queens. The prolapse can be complete, with both horns protruding from the vulva, or limited to the uterine body and one horn. Uterine prolapse requires immediate attention. It is an obstetric emergency.

A 1-year-old female European Shorthair outdoor cat weighing 2.5 kg was presented to our clinic with 96h after parturition. Two days before presentation his caretaker saw “something like placenta to hanging behind the cat”.

On physical examination, the animal was alert, 38.3 °C and slightly dehydrated. The pulse and respiratory rate were both within normal ranges. The prolapse of the uterus was complete, with both horns protruding from the vulva. The exposed tissue was congested and slightly edematous with a few small areas of necrosis, and was covered with debris.

The exposed uterus was palpated to rule out the possible presence within it of any abdominal organs such as the urinary bladder.

Tips & Tricks. Ultrasound examination of the abdomen and the uterine prolapse can be performed to reveal the position of the urinary bladder and the intestine.

Tips & Tricks. Topical application of Manitol 10% can be performed to reduce the oedema in prolapsed tissue.

CBC and biochemical analysis were performed. CBC showed WBC 38.8 x109/l, HGB 89 g/l, HCT 0.265 l/l. Other parameters of the biochemical analysis and packed cell volume were all normal in range.

After premedication with domitor/buprenorphine/ketamine, anesthesia was induced with propofol after preoxygenation. An endotracheal tube was inserted and anesthesia was maintained with isoflurane. Preoperative antibiotics: Cefazoline i.v. and enrofloxacine s.c.

The surgery was performed in two steps: first the replacement of the prolapsed horns and uterus and then ovariohysterectomy.

Tips & Tricks. If the prolapsed organ is in very good condition and the cat is a valuable breeding animal you can try conservative treatment. Replacement, following by medical treatment Oxitocin (0.5-1.0 UI) and antibiotics. Complications may develop from minor laceration of the uterus to septicemia or uterine rupture.

Tips & Tricks. Do OHE! It is the safest option in this situation.

Tips & Tricks. OHE can be performed before reduction if the uterus is too contaminated or necrotic or ruptured.

In this reported case the uterus looked in good condition.

Gross debris was removed gently from the prolapsed organ by irrigation with hypertonic solution.

Then the uterus was reponeted carefully, starting from tip of the horns, one by one.

Tips & Tricks. Use some type of lubricant, like Vaseline.

Tips & Tricks. Oxytocin 0.5 IU can be administered directly in prolapsed tissue to facilitate uterine involution prior to replacement. Attention! Oxitocin make uterine tissue fragile.

Tips & Tricks. An episiotomy may be performed to assist uterine replacement.

Tips & Tricks. Cystocentesis may be performed before attempting to reposition the uterus.

Tips & Tricks. Use monofilament suture material, like PDS 2-0 for cervix ligatures. Polyfilament suture can cut the weakened uterine tissues like saw.

Apposition of vulvar lips was performed with a horizontal mattress pattern without tightening to allow vulvar discharge and normal urination.

This suture was removed after 24 h.

The queen recovered well. Postoperative treatment included the use of an Elizabethan collar and intravenous fluid therapy.

The day after surgery, the cat was alert, urinated normally and there was mild discharge from the vulva.

Antibiotic treatment for 5d amoxicillin/clavulanic acid -Synulox and Enrofloxacin.

Tips & Tricks. Postoperatively, urination should be monitored as swelling and pain can lead to urethral obstruction.

Conclusions

Although rare, uterine prolapse should be managed as an emergency. The treatment for uterine prolapse depends upon the severity of damage to the uterus. The prognosis following treatment for a uterine prolapse is guarded to good, depending on the timing of veterinary intervention.

Panda mouse- case presentation

April 28, 2020

Dr Spas Spasov

Veterinary Center Dr Antonov

Varna, Bulgaria

Case presentation

Whole family of Panda mice (two adults and 12 babies) were presented at the clinic with acute and severe Pruritus and progressive history of hair loss for the past two weeks.

Clinical signs:

Severe Pruritus, Hypotrichosis, Seborrhea and secondary scratch wounds.

These symptoms are presented in all of the 14 mice.

Diagnostics:

Scotch tape samples from two of the babies and both adults.

All samples were positive for the parasite Myocoptes musculinus (dozens – male, female and eggs).

Coproparazitologic sample

Coproparazitologic sample

Fecal samples (native and flotation) were done – both were negative for endoparasites and positive for mites (adults and eggs).

Treatment:

Once a week – Ivermectine spot on and disinfection of the enclosure.

Data:

Myocoptes musculinus is the most common parasite in mice.

Typical affected areas are the neck, the head and the shoulders.

Oral Ivermectin doesn’t seem to be very effective. Environmental sanitation is vital.

There’s no data of zoonotic aspect .

REFERENCES:

Small Animal Dermatology 7th edition

“We are all together”- such a beautiful initiative and wonderful vets from 12 countries share their love, because sharing is carying

April 24, 2020

Veterinarians from 12 countries have shown their concern for the veterinary world in time of Pandemic and social isolation.

We would like to express our gratitude to all of them:

Romania: Dr Robert Popa, Dr Constantin Ifteme, Dr Florin Delureanu, Dr Raluca Zvorasteanu, Dr Lucian Fodor, Dr Diana Soare, Dr Giulia Nadasan, Dr Alexandra Curac, Dr Alexandru Vitalaru, Vet student Ilinca Zarinschi

Bulgaria: Dr Yovko Haralanov, Dr Spas Spasov. Dr Luba Gancheva, Dr Todor Kalinov, Dr Sofia Sinadinova, Dr Yavor Stoyanov

Serbia: Dr Andrija Dakovic, Dr Zoran Loncar, Dr Nikola Katic, Dr Goran Cvetkovic, Dr Ivana Jovandine

Slovenia: Dr Ana Nemec

Croatia: Dr Lea Kreszinger

North Macedonia: Dr Svetla Drakulovska

Turkey: Dr Murat Saroglu

Italy: Dr Luca Formaggini

UK: Dr Luca Ferasin

Belgium: Dr Ann Criel

Switzerland: Dr Katharina Brunner

Portugal: Dr Dr Goncalo Da Garca Periera

Here you can watch all of them here in our channel: https://www.youtube.com/channel/UCj3rBMaB1sD1hXHWIhcrkmw/videos

The power of local therapy in superficial bacterial infections- part 2

March 9, 2020

Dr Spas Spasov

Veterinary Center Dr Antonov

Varna, Bulgaria

Sandra is a French bulldog whose case I have been following for 2 years.

Sandra is regularly vaccinated and with regular tick and flea treatmen and dewormig as well .

When we first met, Sandra was prescribed 2 mg of Prednisolone per kg in the morning and evening.

There were already 2-3 diets with hypoallergenic food with no results .

When the dog is on Prednisolone is very good, with no symptoms.

Sandra has been on immunotherapy for two years and during this time there are a total of 3-4 exacerbated periods with superficial bacterial infection.

To control these infections we tried various antibacterial shampoos and the ONLY systemic antibiotic we used was amoxicillin with clavulonic acid (at least one month ingestion)

During immunotherapy, Sandra takes 1/4 of Prednisolone at 5 mg every 36 hours (Sandra weights about 15 kg throughout the therapy).

For two years, Sandra was very good, and controlling the pyoderma was relatively easy without changing the doses of immunotherapy and without changing the dose of Prednisolone.

The last case of bacterial infection was the beginning of November 2019.

We began the scheme with Chloroxiderm and Amoxicillin with clavulonic acid.

10 days later, it had no effect, even the opposite.

Sandra’s skin was flushed with pustules, color and intense itching.

We did cytology, bacteriology and antibiogram.

The results (Staph. intermedius ) were completely resistant to 15 types of antibiotic from different groups.

The only antibiotic that worked was Rifampim, which is a strategic antibiotic in human medicine and we decided not to use.

Sandra’s improvement has been much slower and in the last few months we have changed several different regimens of local therapy.

Peptive Shampoo & Foam, Duoxo tampons & duoxo spo on (First Month Every Day)

Omega 3 and 6 fatty acids, Chloroxiderm shampoo, Duxo pyo shampoo and foam (second month every day)

Since the beginning of January, Sandra has been on Peptive again with a bath twice a week and a hermitra spray.

The itching has decreased to normal, there are no new pustules and the hair is gradually recovering.

In conclusion, every time we use an antibiotic for systemic therapy or topical therapy, we should think very carefully about all the possible options because resistance is one of the greatest problems of our future.

Diagnosis :

Atopic dermatitis

Superfitial pyodermia

The power of local therapy in superficial bacterial infections- part 1

March 1, 2020

Dr Spas Spasov

Veterinary center Dr Antonov

Varna, Bulgaria

A topic not only for dermatologists.

“Recent high-profile reports warn of the dangers of not taking action. A bleak report by economist Jim O’Neill, commissioned by the British government and released in May, estimates that 700 000 deaths globally could be attributed to AMR this year and that the annual toll would climb to 10 million deaths in the next 35 years. The report projects US$ 100 trillion in losses by 2050 if nothing is done to reverse the trend.”

Aa quote from the World Health Association website.

1.Clinical case of Azar .

*HISTORY

Azar is a 3 years old cane corso dog.

There is a regular vaccination and tick and flea teratments with tablets (isoxazolines).

Case history .

A month and a half ago, the owner has taken Azar to another clinic because of the many pustules on the dog’s chin.

Clinical symptoms include itching in the facial area, redness, and many of about 0.5 cm pustules all over the chin.
Systemic antibiotic therapy and topical once-daily chloroxidine therapy were prescribed for Azar.

Two weeks later there was no change in the condition of the dog.

Bacteriology and antibiogram were performed( Staph. Aureus ) , a second systemic antibiotic was added after the result (the first antibiotic was discontinued).

Staphyococcus aureus is extracted from the antibiogram.

Both antibiotics show the sensitivity of the causative agent.

Two weeks after the second antibiotic, there was no change in Azar’s condition.

Clinical presentation

At the initial examination, Azar was in good general condition, but there were numerous pimples throughout the chin area, which were very easily bleeding and pussing.

In addition, Azar defecates 3-5 times a day and most times the stools are not well formed.

We did cytology and deep scraping of the skin.

Cytology:
Mass neutrophils, macrophages, and cocci bacteria.

Skin scraping
No demodex or other parasites of deep skin scraping.

Initial therapy:

Local therapy with daily chloroxiderm shampoo, duxo pio tampons and duxo seb spot form and Diprogenta 0.5 mg / 1 mg / g cream

betamethasone / gentamicin for 10 days.

The effect after the first 10 days is significant and more than satisfactory, so the therapy prescribed after day 10 was changed only with shampoo with peptide.

10 days later, there were almost no signs of infection.

10 days later, Azar’s therapy was limited to once daily administration of the duxo self-tampons and once a week the duxo-seb spot form, as well as a curative diet with the Analergenic diet.

There are no signs of bacterial infection now, gastrointestinal symptoms are no longer observed, and therapy is just cleansing with duxo swabs (suitable for daily use).

Diagnosis:

Chin furunculosis and suspected food allergy.

Tension pneumoperitoneum due to spontaneous gastric perforation in cat

February 19, 2020

Borislav Metodiev, DVM Yavor Stoyanov, DVM

Bomed Veternary Clinic, Sofia

Pneumoperitoneum refers to accumulation of gas within abdominal cavity, resulting from a perforated hollow viscus, penetrating wounds or bacterial peritonitis. Emergency condition of massive pneumoperitoneum compromise cardiorespiratory function, known as pneumoperitoneum, has been reported in humans. In veterinary medicine, there are also a few similar cases.

This study reports a case of a cat that developed tension pneumoperitoneum secondary to gastric perforation. The cat was treated with emergency abdominocentesis, followed by laparotomy.

A 10 years old British shorthair spayed female cat Tara (2.8 kg) was presented with a remarkable abdominal distention. Three months ago, the cat was operated because of suspected alimentary lymphoma. A part of small intestine and caecum was removed. Histology confirmed large cell lymphoma. Tara was started on chlorambucil and prednisolone protocol. Regular control examinations showed only decreased appetite and one or two times weekly vomiting. The last examination was two days before pneumoperitoneum, and ultrasonography was unremarkable.

At the time of admission, the cat was in good condition except respiratory distress, with huge ballooned, tympanic abdomen. Abdominal US showed only gas. Emergency needle abdominocentesis was performed, and about 300 ml air was aspirated. Than was performed X-ray. The abdominal radiograph showed distended by air abdominal wall, compressed viscus, displaced to thoracic cavity diaphragm. There was no evidence for free fluid in abdominal cavity. Subcutaneously was small amount of air, leaked after the needle aspiration. Second abdominocentesis was performed, and about 400 ml air was aspirated. The aspirated gas had no odor or admixtures.

On the next day, the cat was rehydrated, and a laparotomy was performed. Mild peritonitis was found with a small almond of yellowish ascites. The small intestines were empty, in the large intestines there were some faeces. The site of previously enter anastomosis was perfect. There was no evidence of leaking from the gut or any visible evidence of recurrence of lymphoma. A 6-8 mm perforation was found at the gastric fundus. The stomach, liver margin and omentum were mildly adhered. Other portions of stomach wall looked visually and palpably normal. After blunt dissection of the adhered liver and omentum, the gastric perforation was closed with interrupted sutures. Materials from stomach wall for cytology and from free fluid for microbiology were taken. Abdominal cavity was flushed with 0.9% warm saline and closed in a routine manner. Cytology did not show atypical cells, or any suspect for alimentary lymphoma. Microbiology was unremarkable.

Reported common causes for pneumoperitoneum in small animals include abdominal surgery, gastrointestinal perforation and bacterial peritonitis. In cats pneumoperitoneum also has been reported as complication after endoscopic biopsy or gastrostomy tube replacement. Most of these cases have not shown severe abdominal distention, necessitating emergency decompression.

The exact cause of gastric perforation in this cat is unknown. We suspect local weakness of gastric wall due to iatrogenic factors. Chlorambucil or prednisolone, or combination of these two medicaments may cause damage of mucosa and weakness in the walls of GI tract.

Necessity of therapeutic emergency abdominocentesis due to spontaneous pneumoperitoneum in cats has been emphasized only in few previous reports.

Paradoxical Vestibular Syndrome

February 14, 2020

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Dr Svetoslav Penchev

Dr Svetoslav Penchev

United Veterinary Clinic

Varna, Bulgaria

Paradoxical Vestibular Syndrome is a condition that affects flocculonodular lobe or the caudal cerebellar peduncle of the cerebellum and causes vestibular signs. These parts of the cerebellum participate in central components of vestibular apparatus and are responsible for the maintenance of equilibrium and coordination of head and eye movements;
This syndrome is called paradoxical vestibular disease because the head tilt and circling occur contralateral to the lesion. There is usually some evidence of cerebellar disease on neurological examination, such as ipsilateral dysmetria and head tremor.

Signalment: 8 years old, male, not castrated French bulldog

History: The owner noticed that the head of his dog is not in normal position and is tilt to the left. The dog was carried to its personal doctor, and the doctor had doubts that the dog was having problem with the inner ear . The doctor refer the dog to me for computer tomography, and for approval of the diagnosis.

Case presenting signs: Left head tilt, progressive vestibular signs

Clinical examination: Internal body temperature 38,1 ; Respiratory rate: 36 breaths per minute ; Color of mucous membranes – pink; CRT – 1,5 sec.
Puls 110 bpm ; The overall condition of the dog was normal and there was no no signs of pain.

Neurological examination:
Mentation and behavior-normal; Posture – Left head tilt; Gait – Vestibular ataxia, increase muscle tone and dysmetria of right fore and hind limbs The dog react with cranial and spinal normoreflexia. Menace response reaction of right eye was a little bit reduced. There was no change in conscious proprioception and bladder function was normal. The owners report for intention tremor of the head when the dog is waiting to be fed.

Neuroanatomic localisation: Central Vestibular ; Right Cerebellar Flocculonodular lobe; Paradoxical Vestibular Syndrome

Differential diagnosis:

Neoplastic/Degenerative

Case work-up:
CBC and Biochemistry were normal. Magnetic resonance of the head was performed with GE MRI 1.5 Tesla.

Image 1

Image 2

Image 3

Image 4

Image 5

MRI images : Image 1
Image 2
Image 3 –
Image 4-
Image 5

MRI findings :
A single oval T1-hypo and T2, T2 FLAIR-hyperintensive intra-axial mass is observed, leading out of the cerebellar vermis and affecting the both cerebellar hemispheres. The mass is well circumscribed by the surrounding tissues, with extracapsular expansion and diffuse infiltration into the the gray matter. There is a significant mass effect that reveals compression of the flocculonodular lobe and reveals obstruction to the flow of cerebrospinal fluid with secondary dilatation of the quarter ventricle and central canal with subsequent syringohydromyelia.
Diagnosis: Cerebellar neoplasia
Treatment:
The clinical condition of the dog did improved after i.v
infusion with Mannitol (0.25g/kg bolus 3 times over 20 minutes) , Harmann`s solution 20ml/kg and Prednisolone p.o 0.5mg/kg – 2 times daily – for 3 days . Next 10 days the dog take Prednisolone 0.5 mg/kg 2 times daily at home.
Control visiting on the 14th day -https://www.youtube.com/watch?v=XRyp9sgqCjE

All of previous clinical signs were more severe present. There was no more improvement with this therapy and the owners chose to euthanize the dog.
With both central and peripheral Vestibular syndorme, the head tilt, circling and nystagmus typically occur ipsilateral to the side of the lesion. Less frequently, lesions affecting the caudal cerebellar peduncle, the fastigial nucleus, or the flocculonodular lobes of the cerebellum can cause central Vestibular disease with a resulting paradoxical head tilt. Bilateral Vestibular disease is characterized by head sway from side to side, loss of balance on both sides and symmetrical ataxia with a wide-based stance. A physiological nystagmus usually cannot be elicited and a head tilt is not observed.