Meningocele and meningoencephalocele in a dog

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Dr Svetoslav Penchev

United Veterinary Clinic

Varna, Bulgaria

 

8 mounts ,female dog with congenital meningocele and hydrocephalus . The dog is with normal behavior and without neurological deficits.1113

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.111 1122

Craniomandibular osteopathy in a young dog

421347_10151629937179640_1038846606_nDr Miroslav Todorov

Blue Cross Veterinary Hospital

Sofia, Bulgaria

Case report

40542605_382709382264902_1711454165768601600_nCraniomandibular osteopathy in a young Labrador retriever.

A 4 months old Labrador retriever was presented at the BlueCross Veterinary Hospital in Sofia, Bulgaria, with the owner complaining about painful episodes after touching the head of the animal.

Clinical examination: the dog is in a good clinical stage, no pathological heart or lung sounds.

The temperature was 39,5 C. No abdominal pain or other abnormalities.

The palpation of the skull was painful for the dog, there was slight dome shape of the cranium. The masseter muscles were atrophied. After palpation of the mandibula it was noted that the lower jaw of this dog looked enlarged. Pic 1

Considering the age, breed and the affection of the specific bones, the following list of differential diagnosis was made:

  1. Craniomandibular osteopathy
  2. Osteomyelitis
  3. Calvarial Hyperosthosis
  4. Neoplasia

We took a blood sample for CBC and biochemistry analysis.

On the CBC there was a slight decrease of the RBC – 5,36 (5.5- 8.5 x10/12/L) but this could be normal for younger animals.

On the biochemistry there was a slight decrease of the Total protein – 49 (51- 78) g/L and Albumin – 20(26- 41) g/L. Everything else was WNL.

The patient was sent for CT of the head to search for additional characteristics of the bones of the head and confirm my suspicion about the disease. We put an injection of NSAID for the pain until the test was done.

On the CT we discovered symmetrical bone proliferation of the rami of the mandubule and bone thickening of the calvarium of the animal. No underlying bone lysis was noted. Fortunately, till this moment affection of the temporomandibular joints was not discovered, but it is possible that this could happen during the next months.40574303_322560345178752_5208200230733873152_n 40589358_286835962116167_5128061020073361408_n 40589364_655681474803526_9092529697882898432_n 40623237_513632389060326_2736220804109828096_n 40764141_2203859333191397_5014338687031312384_n

There were not clear signs of neoplastic process or osteomyelitis. As a result, considering the information that we had, a diagnosis of craniomandibular osteopathy was made.

Craniomandibular osteopathy is a non neoplastic proliferative bone disease affecting immature dogs.

Usually the clinical signs start between 3 and 8 months of age. Common clinical presentation is pain episodes, fever, trouble chewing food, drooling and in more advanced cases – inability to open the mouth and eat. The etiology of this disease is unknown.40530022_1906226039680267_8977683290295107584_n

The first written description of CMO appeared in 1958.(9) It was described in five West Highland white terriers affected within a 2-year period. The most common breeds that are affected are West Highland white Terrier, Scottish Terrier, Cairn Terrier. The disease is described in other breeds – in Labradors, Boxers, Great Dane and a few more.

It is believed that this could be an inherited disease (autosomal recessive inheritance pattern) and as such it is advised for such animals to be neutered.

Commonly the affected dogs have bilaterally symmetrical enlarged mandibles and tympanic bulles, and affection of other bones of the calvarium. In severe cases those structures could fuse and this will lead to decreased range of motion of the temporomandibular joint. On examination, the temporal and masseter muscles may be atrophied.

In advanced cases, the diagnosis of craniomandibular osteopathy can be done with good positioned x-rays of the head of the animal. The advance imaging techniques, such as CT or MRI, improve the visualization and confirm the extension of the process.

On x- ray or CT increased irregular bone density is commonly observed –  symmetrical periosteal proliferation, in most of the cases primary affection of the mandibules- 84%; tymplanic bulles – 51% and in some of the cases bones of the calvarium -13%.

The treatment plan is symptomatic with painkillers and anti-inflammatory drugs – commonly used drugs are NSAID and Steoids. Such drugs are needed during pain episodes and fever. Placement of an esophagostomy or gastrostomy feeding tube may be considered in patients that have difficulty eating and their nutritional requirements are not being met. Soft or liquefied food may be easier for some patients to eat. A high protein, high caloric food should be offered in order to meet nutritional needs.

Surgery of the bone proliferated tissues is not helpful in those cases.

The prognosis for these patients depends of the extent of progression of the disease. In those cases where a severe bone proliferation develops, the result is fusion of the temporomandibular joint and the prognosis is poor. Most of those dogs are euthanized because of the extent of the disease. It has been a common observation that when the affected dog is approximately 11 to 13 months of age, the disease may become self-limiting. The growth of abnormal bone slows, often regresses, and sometimes recedes completely. This period of self-limitation coincides with the time of completion of regular endochondral bone growth and ossification.

Our patient felt great after one injection of meloxicam. He is feeling active and has no signs of pain and temperature. Unfortunately, we cannot say whether his condition will progress to the extent to affect the temporomandibular joints and lead to inability to open its mouth.

The owner will return the dog to the breeder. It was advised to watch the dog for any additional signs and painkillers were prescribed.

C2 FRACTURE AND CENTRAL CORD SYNDROME

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Dr Svetoslav Penchev

United Veterinary Clinic 

Varna, Bulgaria

 

 

 

 

Case is about a 6 months , male  cocker spaniel named  Michael.Michael was brought in the clinic from another city in very bad candition.The owners report for a trauma in cervical region.Radiography and neurological examinations were made. Results revealed –Tetraplegie and atalnto-axial instability.It was made a CBCT on cervical region.The image show C2-Fracture .3

 

 

 

 

 

 

 

 

Michael C2 fr et CCS 9Michael C2 fr et CCS 5Michael C2 fr et CCS 6Michael C2 fr et CCS 4Michael C2 fr et CCS 2It was maked a surgary to stabilize  cervical spine. Ten days after surgery Michael starts moving the pelvic limbs first and tries to stand on them. Twenty one days after surgary Micheal start to moving and thoracic limb  , but  have ataxia and destroys proprioception on his  four leg. Michael`s  recovery begin first with the hind limbs and then with the thoracic limbs .In human literature, the symptom in which the thoracic limb is in a dysfunctional state with minimal to no deficit in the pelvic limbs has been referred to as CCS (Central Cord Syndrome ). The spinal cords that travel to the pelvic limbs are minimally affected because the lesion is centralized in the cervical region, which only affects the thoracic limbs. In general, CCS has a good prognosis for functional recovery and its common etiology is traumatic disease in human medicine. CCS treatments with nonsurgical management include cervical spine restriction with a neck collar, rehabilitation followed by physical therapy and occupational therapy. Surgical management is provided for patients who cannot be treated by conservative management alone.

 

Michael C2 fr et CCS 10Michael C2 fr et CCS 8Michael C2 fr et CCS 11Michael C2 fr et CCS 12Michael C2 fr et CCS 13