Non-traumatic hemorrhagic myelopathy in dogs

Clinical Features, MRI Findings, Treatment, and Outcomes in Dogs with Haemorrhagic Myelopathy Secondary to Steroid-Responsive Meningitis-Arteritis: Nine Cases (2017-2024)

This retrospective multicentre study investigated haemorrhagic myelopathy as a rare complication of steroid-responsive meningitis-arteritis (SRMA) in nine dogs. The affected dogs exhibited varied neurological deficits, including cervical hyperesthesia, generalised stiffness, ambulatory tetraparesis, and, in the most severe cases, paraplegia without nociception. MRI findings primarily localised haemorrhagic lesions to the thoracolumbar (T3-L3) region, with intradural-extramedullary haemorrhages being the most common type. Most cases responded favourably to immunosuppressive therapy with prednisolone, either alone or in combination with cytarabine. Surgical intervention, performed in a case of compressive extradural haemorrhage, led to a successful recovery of ambulation. Two cases presented or developed paraplegia without nociception, despite immunosuppression. These findings emphasise the importance of advanced imaging and timely therapeutic interventions in addressing atypical and severe manifestations of SRMA.

Central nervous system vascular complications associated with the acute form of steroid-responsive meningitis-arteritis

This retrospective study aims to describe the vascular events in the central nervous system (CNS) associated with the acute form of steroid-responsive meningitis-arteritis (SRMA), to compare the clinical features of dogs with and without such complications and to potentially identify predisposing factors for these events. Dogs with a presumptive diagnosis of SRMA visited between 2018 and 2023 with full medical records that underwent neurological examination, blood testing, cervical computed tomography or magnetic resonance imaging and cerebrospinal fluid (CSF) analysis were included. Thirty-three dogs were included and divided in two groups. Group 1 included 7 (21,2 %) dogs with vascular complications secondary to SRMA (spinal cord ischemic and/or hemorrhagic infarcts, spinal cord subdural hematomas, intracranial subarachnoid hemorrhages), and group 2 included 26 (78,8 %) dogs with non-complicated SRMA. Age, breed, sex, presence of neurological deficits, CSF abnormalities and presence of relapses were factors evaluated for potential association with vascular complications of SRMA. Six dogs in group 1 were Golden Retrievers (85,7 %), and there was a significant association between this breed and the occurrence of vascular complications (P = 0.017). Presence of neurological deficits (P = 0.001) and xanthochromic CSF (P = 0.001) were also associated with vascular complications in dogs with SRMA. Hemorrhagic or ischemic lesions in the CNS can be a complication of the acute form of SRMA, and Golden Retrievers appear to be more affected. Dogs with vascular complications show often neurological deficits and CSF xanthochromia.

Epistaxis and Intradural-Extramedullary Haemorrhage in a Dog With Steroid Responsive Meningitis-Arteritis

A 2-year-old female entire Golden Retriever with a history of being subdued was seen. Her physical and neurological examinations were initially unremarkable, but she acutely progressed to non-ambulatory paraparesis, with absent cervical or thoracolumbar hyperaesthesia. Magnetic resonance imaging of the vertebral column was performed, showing a well-defined, intradural-extramedullary mass at the level of the caudal aspect of L2 causing right-sided ventrolateral marked cord compression. The lesion was T2W hyperintense and mildly hyperintense on T1W images. The signal intensity pattern of this lesion suggested the presence of an early stage hyperacute hemorrhagic process. Cerebrospinal fluid (CSF) was collected from the cisterna magna. CSF analysis exhibited a marked mixed pleocytosis with a slight neutrophilic predominance and elevated protein content. Due to the dog going from being ambulatory to non-ambulatory paraparetic with absent postural reactions in her pelvic limbs, surgery was performed to allow decompression of the spinal cord. A hemilaminectomy with durotomy was performed. Over the course of the dog's hospitalisation, she had two episodes of left-sided epistaxis which resolved with local application of adrenaline. Seven days post-operatively, the dog was discharged being non-ambulatory paraparetic with voluntary movement in both pelvic limbs. Three months after discharge, the dog was ambulatory with no ataxia noted in the pelvic limbs. As there is no current definitive diagnostic test for steroid responsive meningitis-arteritis (SRMA) available, the diagnosis of it in this case is supported by the dog's signalment, bloodwork, CSF analysis and response to corticosteroid therapy. This report details a rare clinical presentation, including epistaxis, intradural-extramedullary haemorrhage and absence of cervical or thoracolumbar hyperaesthesia, in a dog diagnosed with suspected SRMA.

Brain MRI findings and thoracic CT findings in a dog with hemiparesis and acutely diminished Von-Willebrand factor levels through Angiostrongylus vasorum infection

A 2-year-old intact male Airedale Terrier was presented with a sudden onset of neurological signs, manifesting as hemiparesis, which were neuroanatomically localized to the brain. Initial bloodwork conducted by the local veterinarian indicated decreased levels of von Willebrand factor, and further examination showed an extended buccal mucosal bleeding time. MRI revealed a substantial hemorrhage within the right parietal lobe, while CT exhibited a mixed pulmonary pattern with unstructured interstitial, peribronchial, and alveolar components, presumably associated with larval migration and pulmonary microhemorrhages. A Baermann fecal test yielded positive results, confirming an Angiostrongylus vasorum infection. Following treatment, the patient exhibited a complete remission of all symptoms and findings.

Hemorrhagic encephalopathies and myelopathies in dogs and cats: a focus on classification

The prevalence of hemorrhagic diseases of the central nervous system of dogs and cats is low compared to other diseases such as neoplasia and inflammation. However, the clinical consequences can be devastating. Several etiological and localization-based classification systems have been reported for intracerebral and spinal cord hemorrhage or hematomyelia in humans but similar systems do not exist in veterinary medicine. The authors propose an etiologic classification system for both intraparenchymal hemorrhagic encephalopathy and myelopathy following a review of the literature detailing the presentation, diagnosis, therapy, and prognosis of these diseases. A summary of the investigative and therapeutic approach to these cases is also provided.

Surgical treatment and outcome of haematomyelia with a traumatic cause in a dog and a cat

Two surgically treated haematomyelia cases were documented. One dog and one cat were presented for acute progressive paraplegia following a fall from height incident. Neurological examinations suggested a L4-S3 myelopathy in both cases. Radiography and magnetic resonance imaging in both cases revealed no fracture or subluxation of the spine, but well-defined intramedullary mass lesions in lower lumbar regions compatible with haemorrhage and haematoma formation. Exploratory surgeries were performed over the lesions. Dark-red friable masses were removed via myelotomy. Histopathological examinations revealed organizing haematomas at the acute to subacute stage. Postoperatively, both cases improved and regained ambulation. The dog walked normally but remained urinary and faecal incontinent 9 months after the surgery. The cat was continent and ambulatory with a paraparetic gait 5 months after the surgery. In both cases, the outcomes and the patients' quality of life were considered satisfactory by the owners.

Case report: Traumatic hemorrhagic cervical myelopathy in a dog

A 1.5-year-old female entire French bulldog was referred for neurological evaluation, further diagnostic tests, and treatment 24 h after a road traffic accident. Initial emergency treatment, diagnostic tests, and stabilization had been performed by the referring veterinarian. Neurological examination revealed severe spastic non-ambulatory tetraparesis and was consistent with a C1-5 myelopathy. A magnetic resonance imaging (MRI) study revealed an irregular to elongated ovoid intramedullary lesion centered over the body of C2. The lesion showed marked signal heterogeneity with a central T2W and T2* hyperintense region, surrounded by a hypointense rim on both sequences. The lesion appeared heterogeneously T1W hypointense. The lesion was asymmetric (right-sided), affecting both white and gray matter. The C2-3 intervertebral disk appeared moderately degenerate with a Pfirrmann grade of 3. No evidence of vertebral fracture or luxation was found on radiographs or MRI of the vertebral column. Additional soft tissue abnormalities in the area of the right brachial plexus were suggestive of brachial plexus and muscle injury. A diagnosis of traumatic hemorrhagic myelopathy at the level of C2 and concurrent brachial plexus injury was formed. Conservative treatment was elected and consisted of physiotherapy, bladder care with an indwelling urinary catheter, repeated IV methadone based on pain scoring (0.2 mg/kg), oral meloxicam 0.1 mg/kg q24h, and oral gabapentin 10 mg/kg q8h. The dog was discharged after 4 days, with an indwelling urinary catheter and oral medication as described. The catheter was replaced two times by the referring veterinarian and finally removed after 10 days. Thereafter, voluntary urination was seen. During the 2 months after the road traffic accident, slow recovery of motor function was seen. The right thoracic limb recovery progressed more slowly than the left limb, also showing some lower motor neuron signs during follow-up. This was judged to be consistent with a right-sided brachial plexus injury. The dog was reported ambulatory with mild residual ataxia and residual monoparesis of the right thoracic limb at the last follow-up 3 months post-injury. This case report highlights the MRI-based diagnosis of traumatic hemorrhagic myelopathy in a dog. A fair short-term outcome was achieved with conservative treatment in this case.