Dr Svetoslav Penchev
United Veterinary Clinic
Stroke or cerebrovascular accident (CVA) is the most common clinical manifestation of cerebrovascular disease, and can be broadly divided into ischemic stroke and hemorrhagic stroke. CVA are characterized clinically by a per acute or acute onset of focal, asymmetrical and non-progressive brain dysfunction. Next cases show the both type of CVA in dogs.
1st case is about 9 years old female boxer. The dog was referring to the clinic with acute onset of seizures. The results of CBC and Biochemistry were normal and MRI was performed.
MRI findings: Intra-axial right piriform lobe and hippocampus lesion with impression of moderate swelling of these portions is present. The cerebral falx is only mildly displaced to the left. There is corresponding low T1 signal intensity in these sections of the brain suggesting edema. There is no enhancement of the lesion after contrast administration. The findings suggest that there is a non-hemorrhagic cerebrovascular accident in right forebrain of the dog.
The 2nd case is about a 8 years old male Cane corso. The dog was present in the clinic with unilateral fore brain deficits and history of epileptic seizures. Biochemistry and CBC were normal and MRI was performed.
MRI findings : There is a well‐delineated T1 iso- to hypointense and T2 hypointense mass lesion with surrounding brain edema in right piriform lobe with a thin peripheral rim of contrast enhancement. There is a mass effect, displacement of the right lateral ventricle and midline shift to the left. This imaging feature is consistent with an acute to subacute intracranial hemorrhage.
MRI features of Hemorrhagic infarction in dogs may not be distinguishable from hematoma caused by vascular disruption. Imaging characteristics will vary depending on the size, location, and chronicity ofthe hematoma.
Hyperacute – 24 hours T1 isointense ; T2 hyperintense
Acute 1-3 days T1 iso- to hypointense ; T2 hyperintense
Early subacute >3 days T1 hyperintense ; T2 hypointense
Late subacute >7 days T1 hyperintense ; T2 hyperintense
Chronic > 14 days T1 hypointense ; T2 hypointense
Secondary features : mass effect, surrounding edema, midline shift , ventricular displacement and compression .
MRI features of Nonhemorrhagic Infarction in dogs include mildly T1 hypointense and T2 hyperintense lesion with minimal mass effect involving both gray and white matter on unenhanced MR images. These changes seen in ischemic parenchyma rely on an increase in tissue water content. Gradually, during the acute stage, the T2-weighted image becomes more hyperintense in the ischemic region, particularly over the first 24 hours. These signal changes seen in the first 24-hours are best appreciated in grey matter and are well visualized in deep grey matter structures such as the thalamus or basal ganglia, in addition to cortical grey matter. Gadolinium enhances infarcts because of vascular rupture but does not enhance ischemia or edema.
Dr Svetoslav Penchev
Unites Veterinary Clinic
3 years old male, not castrated British shorthair cat with history of tetraparesis was referred to the clinic for Computed Tomography. Mineral-attenuating endobronchial lesions were detected in Thorax as accidental finings in spinal CT. The finding is specific for broncholitiasis.
CT features: Multifocal mineral-attenuating endobronchial lesions in cranial and middle right and cranial left lung lobe are present. There is mild generalized thickening of the bronchial walls and consolidation of right middle lung lob with regional bronchiectasis
X-ray features: Multiple mineral opacity nodules with irregular margins are present within left and right cranial and right middle lung lobe. The largest of which lies within the right middle lung lobe and interstitial patter in this region is present.
Broncholithiasis is very rare condition in cats and is defined as the presence of calcified or ossified material within the bronchial lumen. Only four cases of broncholithiasis in cats have been reported in the veterinary literature. Normal this condition is associated with lower airway inflammation, but in this case the owner does not report for respiratory problems. Broncholithiasis is an uncommon condition, which should be considered as a differential diagnosis for cats with chronic respiratory disease. Affected cats may develop broncholithiasis secondary to a diffuse inflammatory lower airway disease with mineralisation of secretions in the airways.
DR SVETOSLAV PENCHEV
United Veterinary Clinic
CLINICAL CASE 1
Old Dogs with sudden onset of seizures
The 1st clinical case is about 13 years old, castrated Belgian shepherd with acute onset of cluster seizures. Before 5 years the dog was operated ( total mastectomy and ovariohysterectomy) , because of mammary gland tumor. Another vet made the blood analysis and there is no change in laboratory results. Contrast MRI study was performed.
There are two, oval shaped, T1 hypo- and T2 hyperintense, intraaxial mass lesion with cystic component. One is in right piriform lobe and another one is in the left olfactory bulb/ frontal lobe. The masses nonuniformly enhances following contrast administration, with more intense enhancement peripherally. Mass effect with mild brain edema surrounding the lesions is present.
Multifocal nodules with soft tissue opacity in lung parenchyma
The reason of seizures are metastatic brain tumors in the right piriform lobe and in the left olfactory bulb and there are multifocal metastatic nodules in the lungs. Although the dog was operated , the primary mammary gland tumor is the reason of this condition
There is no feedback with the owner about dog`s condition.
Next case is about a 9 years, female, not castrated Labrador retriever with acute onset of cluster seizures. The dog present proprioceptive deficit on the right fore and hind limb. There is no history of previous seizures. By abdominal palpation mammary gland mass was find.
There is no change in the blood analysis.
There is oval shaped T1, T2 mixed intensity mass in the parietal part of left cerebral hemisphere with surrounding brain edema. Mass margins are well defined on T2. Peripherally enhancing following contrast administration is present with mass effect and midline shift to the right
Thoracic x-ray show multiple oval shaped masses with soft tissue opacity
In this case we have the same condition. The metastatic lung and brain disease are due the primary mammary gland tumor.
The dog`s owner prefer to euthanized the dog, because the seizures getting longer and stronger.
CLINICAL CASE 3
The last case is about a 9 years, not castrated, female Jack Russell terrier with depressed mental status from a month and acute onset of seizures. The dog reacted with hypersensitivity in right cranial nerves, proprioceptive deficit in left fore and hind limb and proprioceptive ataxia. MRI contrast study was performed. MRI findings:
There is a one, irregularly shaped, T1 hypo and T2- mixed intensity intraaxial mass involving the right midbrain. The mass intensely, but nonuniformly, enhances following contrastadministration. There is a mass effect and surrounding brain edema.
In this case there is no history of neoplastic disease. This midbrain mass has a characteristic of primary tumor and It is the cause of the seizures. Every dog after 5 years of age, who presented with a new onset of seizures should be suspected for a brain tumor. The most common indication for brain tumor in dogs are seizures, especially seizures that began for the first time in a dog older than five years of age. Other signs suggestive for a brain tumor include abnormal behavior, vision problems, circling motions, uncoordinated movements and lethargy.
Dr Svetoslav Penchev
United Veterinary Clinic
Meningocele and meningoencephalocele of the skull are congenital deformities. These deformities, which are observed as cyst-like swellings in the median part of the skull cap, occur very rarely. The intracranial material protrudes through a spontaneous cavity, such as the anterior fontanelle , and they are classified as encephalocele, meningocele, or meningoencephalocele according to the cranial bifida.
History: presented for a large firm mass arising from the right side of the calvarium.
Findings: A dense, mineralized mass with a stippled appearance arising from the right side of the calvarium, with an approximate diameter of 6cm.
Because of the dense appearance of the mass, it’s hard to appreciate the degree of underlying osteolysis just with an Xray
Diagnostic: the radiological appearance it’s of MLTB (multilobular osteochondrosarcoma)
Discussion: MLTB is an uncommon tumour that arises almost exclusively on the flat bones of the skull, mainly on the calvarium, maxilla and mandible and tend to occur in older medium and large breed dogs, although they have been reported in younger and small breed dogs, and have also been reported in cats. It is slow-growing and locally invasive, often recurring after excision. Metastasis may occur
8months old, American bully, Female
History: pain, jaw swelling.
Findings: Periosteal new bone formation, palisading type, affecting the mandible bilateral.
The tympanic bullae and temporomandibular joints are not affected.
Diagnostic: Craniomandibular osteopathy.
Discussion: Craniomandibular osteopathy is a non-neoplastic, proliferative bone disease that affects primarily the mandible, tympanic bullae, frontal bone and occasionally long bones in dogs of about three to eight months.
The proliferation of new bone of the head and jaws decreases as the endochondral ossification of the long bones slows after 7 to 8 months of age.
What is a nasopharyngeal polyp?
Inflammatory polyps that develop at the level of the nasopharynx and the middle ear are non-neoplastic masses which are thought to originate in the epithelial layer of the timpanic bulla or the Eustachian tube. Polyps can also emerge from the epithelium lining the external ear canal in association with otitis.
The etiology of nasopharyngeal polyps is not very clear and congenital pathologies as well as underlining inflammatory diseaseses such as bacterial or viral infections and cronical inflammations are discussed.
Most affected are the cats younger than 3 years of age, but some studies found the average age of the patients to be arround 6-7 years and up to 17,5 years in some cases. The studies citing such advnaced ages implied that polyps developed at a younger age, but remained undiagnosed for a long period.
How to diagnose a nasopharyngeal polyp?
The diagnosis is made based on patient history and clinical examination and confirmed through diagnostic imaging, endoscopy and histopathology.
The clasical clinical signs associated with nasopharyngeal polyps include sneezing andheavy breathing. When a nasopharyngeal polyp reaches a large size (and is located in the nasopharynx) or there are bilateral polyps (extending into the nasal cavities) they cause reduction of the upper airways and are associated with loud breathing noises, nasal discharge, snorring and even vestibular disorders (head tilt, balance disorders). Sometimes nasopharyngeal polyps can be associated with Horner syndrome. Large polyps can lead to difficulties in the act of swallowing and anorexia. Direct or indirect examination (endoscopy and sample retrieval) can be of great help to the clinician in diagnosing this type of pathology (depending on the size and localisation of the polyp). Radiograps (RX), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are very good diagnostic tools , providing information about the localisation and size of the polyp and have also a high specificity. Diagnostic imaging can also help differentiate between nasopharyngeal polyps and other pathologies that sometimes similar clinical appearance, such as obstructed or stenotic airways, foreign bodies, neoplasia, thickening or osteolysis of the bullae due to infection. Another advantage when using diagnostic imaging is the ability to assess the regional lymphnodes in order to give a more precise prognosis.
9 years old mix breed dog, F
History: not urinating for 24hours, apathy, lethargy
Findings: Loss of serosal detail especially in the ventral abdomen.
There are multiple radiopaque mineral foreign bodies of varying sizes in the ventral abdomen not included in the digestive tract.
Conclusion: ruptured urinary bladder with radiopaque calculi free in the peritoneal cavity.
1 year old, Samoyed, F
History: vomiting, lack of appetite
Findings: On plain radiographs there is a plicated appearance of some of the small intestinal loops on the middle side of the abdomen. The content of this intestinal loops it’s mixt gas-fluid, with variably sized and shaped gas bubbles.
Fallowing contrast medium administration: Delayed gastric emptying time. The bunched and plicated pattern it’s highlighted affectind the duodenum and the jejunum.
Conclusion: Gastrointestinal linear foreign body
Ranko Georgiev1, DVM, Central Veterinary Clinic, Sofia, Bulgaria
Akira is a German shepherd dog, first presented with an ascites and exercise intolerance 4 years ago. A diagnosis of a tricuspid valve dysplasia (TVD) was made after X-rays and echocardiography. Standard therapy for a patient with a TVD and CHF was initiated and kept since. The prognosis given in 2012 was ‘guarded to poor’ concerning the severe generalized cardiomegaly, but four years later the patient is still alive and doing great with a full therapy (attached). The size of the heart is bigger at any of the control X-rays done annually; the size of the right atrium contributing with 75% to the whole heart volume!
Akira, FI GSD, 5yoa, 30kg, TVD – therapy (the patient is with an atrial fibrillation as well)
Furosemide 60mg BID
Spironolacton 25mg SID
Hydrochlorthiazide 25mg SID
Enalapril 10mg BID
Pimobendan 10mg BID
Digoxin 0.2mg BID
Cardiovet 1tabl BID (Taurin, L-Carnitin, Vit. E, Coenzim Q)
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