Hydrocephalus and syringomyelia in a cat

Morphometric analysis of ventricular indexes and intracranial cerebrospinal fluid spaces in the brain using magnetic resonance imaging healthy in Van cats

BACKGROUND

Ventricular indexes are defined as a numerical marker of ventricular dimensions in domestic mammals. The anatomical size of the brain ventricles has been the subject of many studies so far and has been accepted as a potential indicator of many brain disorders in the clinical field. Currently, the number of studies describing the morphometry of the brain ventricular system in cats is limited. Furthermore, no studies have been conducted specifically on indexes characterizing the numerical compatibility of the brain and brain ventricles in cats. The aim of this study was to reveal the morphometric status of intracranial cerebrospinal fluid spaces and ventricular indexes in healthy Van cats by magnetic resonance imaging method.

RESULTS

For this retrospective study, T2-weighted magnetic resonance imaging (MRI) scans were performed at 1.5 T on 20 (10 male and 10 female) Van cats, under general anaesthesia. The animals were at the age of mean 4 (3-5 age). All Van cats were selected from individuals who had not undergone any surgical procedures, were not neutered, and had no visible anomalies. The statistical analysis of first, descriptive statistics such as mean and standard deviation were calculated. In line with the mean results obtained, the difference between sex was examined statistically. 'A Mann-Whitney U test' was applied to detect sex differences in measurement parameters in the study. The results are as follows (mean ± standard deviation): İntracranial cerebrospinal fluid spaces measurements: R-fss: 1.02 ± 0.19 mm, L-fss: 1.03 ± 0.18 mm, A-if: 1.06 ± 0.26 mm, R-sf: 1.38 ± 0.32 mm, L-sf: 1.37 ± 0.27, V1: 4.26 ± 0.53 mm. Indexes: Fourth ventricle: 15.95 ± 1.73%, Bifrontal: 17.45 ± 1.78%, Bioccipital: 47.53 ± 9.36%, Evans: 13.76 ± 2.93%, Lateral ventricle: 35.41 ± 2.50%, Callosal angle: 85.06°±4.42°.

CONCLUSIONS

The present study provides baseline values of intracranial cerebrospinal fluid spaces and linear indexes of the ventricles in the Van cats. The acquisition of these data contributes to filling the knowledge void on important anatomical and morphological features of the Van cats brain.

Spontaneous hemispheric ventricular collapse and subarachnoid haemorrhages in a dog with congenital hydrocephalus internus

Background

Overdrainage and collapse of the hemispheres is a potential severe complication after surgical treatment of internal hydrocephalus using ventriculoperitoneal shunts. Here we describe a case of a spontaneous hemispheric ventricular collapse in an untreated dog with congenital hydrocephalus internus.

Case presentation

A twelve-week-old, male, intact Golden Retriever was presented with a history of peracute obtundation, impaired vision, and progressive gait abnormalities of all limbs for three days. Neurological examination revealed a dome shaped skull, a broad-based stance and a moderate cerebellar ataxia. The postural responses were markedly delayed in all limbs. Moderate ventro-lateral strabismus, vertical nystagmus and absent menace response were observed bilaterally. Clinical signs indicated multifocal localisation (forebrain, cerebellum). Magnetic resonance imaging (MRI) showed dilation of all cerebral ventricles, irregular thinning of the periventricular white and grey matter, consistent with internal hydrocephalus. In addition, the hemispheres were collapsed at the right temporal and left frontal lobe with haemorrhage filling the adjacent subarachnoid space. The dog underwent left frontal and right temporal craniotomy for removal of the haemorrhage. The dog improved on all neurological signs and was discharged after seven days. A repeat MRI three months postsurgical intervention showed reexpansion of the cerebral hemispheres. Subarachnoid haemorrhages were markedly reduced.

Conclusions

Collapse of the hemispheres can occur spontaneously in dogs with hydrocephalus internus. Removal of the haemorrhage can improve clinical signs.

Complications associated with ventriculoperitoneal shunts in dogs and cats with idiopathic hydrocephalus: A systematic review

BACKGROUND

Several case series and case reports have been published about idiopathic hydrocephalus treatment in dogs and cats using ventriculoperitoneal shunts (VPS).

OBJECTIVES

To determine the risk and type of complications in dogs and cats after VPS placement.

ANIMALS

Sixteen papers were included. Sixty dogs and 13 cats with idiopathic hydrocephalus treated by VPS placement were identified.

METHODS

The databases CAB, Scopus, and Medline were used. Idiopathic/congenital hydrocephalus, feline/canine patients, ventriculoperitoneal shunting, complications, and outcomes were inclusion criteria. The focus was on complication type and time frame within which they arose.

RESULTS

Complications in dogs (n = 60) were shunt obstruction (6/60; 10%), pain (4/60; 5.5%), shunt infection (3/60; 4.1%), disconnection (3/60; 4.1%), excessive shunting (2/60; 2.7%), and kinking (1/60; 1.6%). Complications in cats (n = 13) were coiling of the shunt in the SC tissue (2/13; 15.4%); kinking (1/13; 7.7%); and shunt obstruction (1/13; 7.7%). Complications were most likely during the first 6 months after shunt placement.

CONCLUSION AND CLINICAL IMPORTANCE

Ventriculoperitoneal shunting is considered a viable treatment option for patients with hydrocephalus. Potential complications should be discussed with the owner. Early diagnosis of complications is essential.

Syringomyelia in an Adult American Paint Horse

Syringomyelia is a form of myelodysplasia defined by the formation of one or more fluid-filled cavities within the spinal cord that do not communicate with the central canal. The defect may be congenital or acquired. Clinical signs correlate to the segment of spinal cord affected and include pain, paresis, proprioceptive deficits, alterations in sensation, scoliosis, and autonomic dysfunction. This report describes the clinical and pathologic changes in a case of acquired syringomyelia in a 10-year-old American Paint Horse mare. The horse had a six-week history of progressive proprioceptive deficits in all four limbs, bilateral pelvic limb ataxia, and muscle fasciculations that were unresponsive to treatment with stall rest, phenylbutazone, and dexamethasone. Syringomyelia was diagnosed postmortem within cervical, thoracic, and lumbar spinal cord segments. Acquired syringomyelia should be considered among differential diagnoses in adult horses displaying progressive neurologic deficits.

Shape of the feline cerebellum and occipital bone related to breed on MRI of 200 cats

Objectives The MRI features of the feline cerebellum and occipital bone have not previously been described in the literature. The aims of this study were three-fold. Firstly, to document variations in cerebellar shape on MRI in neurologically normal cats to support our hypothesis that crowding of the contents of the caudal fossa or herniation of the cerebellar vermis through the foramen magnum occurs frequently as an anatomical variant. Secondly, to document variations in the morphology of the occipital bone. Thirdly, to see whether these variations in shape of the feline cerebellum and occipital bone could be associated with head conformation, such as brachycephaly. Methods The imaging records of the small animal clinic at the Animal Health Trust between 2000 and 2013 were searched retrospectively to identify adult cats that had undergone high-field (1.5 T) MRI investigation which included the brain. Exclusion criteria included evidence of intracranial disease or the presence of cervical syringomyelia. Midline sagittal T2-weighted and transverse images were used to assess the occipital bone morphology and cerebellar shape, and to measure the width to length ratio of the cranial cavity. Results Fourteen different breeds were represented. A cerebellar shape consistent with crowding of the contents of the caudal fossa, or herniation through the foramen magnum was present in 40% of the entire population. Persians (recognised as a brachycephalic breed) had a higher proportion of cerebellar crowding or herniation than all other breeds. There was no significant difference in the distribution of occipital bone morphology between these breed groups. Conclusions and relevance It is important to recognise morphological variations of the feline cerebellum and occipital bone in order to avoid false-positive diagnoses of raised intracranial pressure and pathological herniation on MRI.

Quantification of cerebral lateral ventricular volume in cats by low- and high-field MRI

Objectives The aim of this study was to evaluate variations in lateral ventricles in the examined feline population with the use of quantitative analysis methods to determine whether sex or body weight influenced the size of the ventricles, and to identify any significant differences in the results of low- and high-field MRI. Methods Twenty healthy European Shorthair cats, aged 1-3 years, with body weights ranging from 2.85-4.35 kg, were studied. MRI of brain structures was performed in a low- and a high-field MRI system. The height of the brain and lateral ventricles at the level of the interthalamic adhesion, and volume of the lateral ventricles were determined in T2-weighted images in the transverse plane. The degree of symmetry of lateral ventricles was analysed based on the ratio of right to left ventricular volume. The measured parameters were processed statistically to determine whether sex and body weight were significantly correlated with variations in ventricular anatomy. The results of low- and high-field MRI were analysed to evaluate for any significant differences. Results The average brain height was determined to be 27.79 mm, and the average height of the left and right ventricles were 2.98 mm and 2.89 mm, respectively. The average ventricle/brain height ratio was 10.61%. The average volume of the left ventricle was 134.12 mm3 and the right ventricle was 130.49 mm3. Moderately enlarged ventricles were observed in two cats. Moderate ventricular asymmetry was described in four cats. Sex and body weight had no significant effect on the evaluated parameters. The differences in the results of low- and high-field MRI were not statistically significant. Conclusions and relevance This study has determined reference intervals for ventricular volume in a population of European Shorthair cats without brain disease, which will facilitate the interpretation of MRI images and the characterisation of brain abnormalities in cats with neurological disease. Further research involving larger animal populations, including other breeds, is required to compare the measured parameters between breeds and to determine reference values for other breeds.

Clinicopathologic Features and Magnetic Resonance Imaging Findings in 24 Cats With Histopathologically Confirmed Neurologic Feline Infectious Peritonitis

BACKGROUND

Feline infectious peritonitis (FIP) is the most common infectious central nervous system (CNS) disease in the cat and is invariably fatal. Improved means of antemortem diagnosis is required to facilitate clinical decision making. Information regarding the magnetic resonance imaging (MRI) findings of neurologic FIP currently is limited, resulting in the need for better descriptions to optimize its use as a diagnostic tool.

OBJECTIVE

To describe the clinicopathologic features and MRI findings in cases of confirmed neurologic FIP.

ANIMALS

Twenty-four client-owned cats with histopathologic confirmation of neurologic FIP.

METHODS

Archived records from 5 institutions were retrospectively reviewed to identify cases with confirmed neurologic FIP that had undergone antemortem MRI of the CNS. Signalment, clinicopathologic, MRI, and histopathologic findings were evaluated.

RESULTS

Three distinct clinical syndromes were identified: T3-L3 myelopathy (3), central vestibular syndrome (7), and multifocal CNS disease (14). Magnetic resonance imaging abnormalities were detected in all cases, including meningeal contrast enhancement (22), ependymal contrast enhancement (20), ventriculomegaly (20), syringomyelia (17), and foramen magnum herniation (14). Cerebrospinal fluid was analysed in 11 cases; all demonstrated a marked increase in total protein concentration and total nucleated cell count. All 24 cats were euthanized with a median survival time of 14 days (range, 2-115) from onset of clinical signs. Histopathologic analysis identified perivascular pyogranulomatous infiltrates, lymphoplasmacytic infiltrates, or both affecting the leptomeninges (16), choroid plexuses (16), and periventricular parenchyma (13).

CONCLUSIONS AND CLINICAL IMPORTANCE

Magnetic resonance imaging is a sensitive means of detecting neurologic FIP, particularly in combination with a compatible signalment, clinical presentation, and CSF analysis.

Retrograde migration and subcutaneous coiling of the peritoneal catheter of a ventriculoperitoneal shunt in a cat

Case summary Ventriculoperitoneal shunt placement is the most commonly utilised surgical treatment for hydrocephalus in human and veterinary patients. Migration of the peritoneal catheter is an uncommon but well-documented complication in people, usually occurring within the first 3 months postoperatively, although only a single feline case report exists. A ventriculoperitoneal shunt was placed in a domestic shorthair cat, aged 4 years and 10 months, following a diagnosis, with MRI, of unilateral, non-communicating hydrocephalus. Diarrhoea, increased vocalisation and pruritus were reported within the first 3 months postoperatively. A shunt-associated seroma developed, which was aspirated under ultrasound guidance. Within 3 days, the entire peritoneal catheter was subcutaneously coiled at the level of the seroma. The peritoneal catheter was replaced within the abdomen via a new subcutaneous tunnel. No further complications had occurred 24 months following revision surgery.

Relevance and novel information This is the second report describing peritoneal catheter migration in a cat. Repetitive head and neck movements during self-grooming, raised intra-abdominal pressure secondary to vocalisation and tenesmus, and negative pressure exerted during seroma aspiration may have contributed to ventriculoperitoneal shunt migration. Excessive loose skin and increased activity may further increase the risk of migration in cats. Diagnostic imaging should be offered prior to and following aspiration of shunt-associated swellings, and minimal negative pressure should be exerted. Attempts to reduce the frequency of postoperative self-grooming, prevention and prompt treatment of conditions predisposing to raised intra-abdominal pressure and moderate exercise restriction, particularly within the first 3 months, may help reduce the risk of peritoneal catheter migration.

Comparison of Feline Brain Anatomy in 0.25 and 3 Tesla Magnetic Resonance Images

The intention of the comparison of both low and high field was to examine which anatomical brain structures of cats were visible on low field images, as in clinical veterinary practice, 3 Tesla (T) magnets were of limited availability. The research was performed on 20 European short-haired male and female cats, aged 1-3 years, with body weight of 2-4 kg. 0.25 T magnetic resonance images of neurocranium were acquired in all using T2-weighted fast spin echo sequences with repetition time (TR) of 4010 ms and echo time (TE) of 90 ms in dorsal and transverse plane, and T2-weighted fast spine echo sequences with TR of 4290 ms and TE of 120 ms in sagittal plane. Based on a detailed catalogue of feline brain structures visible at 3 T in previously published studies, it was examined which structures were visible on low field images. Anatomic structures were identified and compared to assess the reliability of diagnoses made based on low-field magnetic resonance imaging. In low-field scans, 92 structures were identified. Elements of auditory, visual, motor pathways, hippocampus and cerebral ventricular system were distinguished. Low-field as well as high-field magnetic resonance imaging support the identification of local tissue lesions, metastasis, focal ischaemia and haemorrhage, disorders associated with ventricular system dilation and hydrocephalus. It also produced accurate images of the hippocampus, which contributes to reliable diagnoses of various forms of epilepsy in cats. Due to technical limitations, a low-field scanner is unlikely to visualize microtraumas, local inflammations, small haematomas or metastatic tumours.

Characterization of an Inherited Neurologic Syndrome in Toyger Cats with Forebrain Commissural Malformations, Ventriculomegaly and Interhemispheric Cysts

BACKGROUND

In children, frequent congenital malformations with concomitant agenesis of the corpus callosum are diagnosed by neuroimaging in association with other cerebral malformations, including interhemispheric cysts and ventriculomegaly. Similar studies providing full characterization of brain defects by in vivo magnetic resonance imaging (MRI), and correlations with the pertinent anatomic pathologic examinations are absent in veterinary medicine.

HYPOTHESIS/OBJECTIVES

Congenital brain defects underlie the neurologic signs observed in Toyger cats selectively bred for a short ear phenotype.

ANIMALS

Using proper pedigree analysis and genetic evaluations, 20 related Oriental-derived crossbred Toyger cats were evaluated. Seven clinically healthy (carrier) cats and 13 clinically affected cats that had neurologic signs, short ear phenotype and concomitant complex brain anomalies were studied.

METHODS

Complete physical and neurologic examinations and MRI were performed in all clinically healthy and affected cats. Postmortem and histopathologic examinations were performed in 8 affected cats and 5 healthy cats.

RESULTS

Neurologic and MRI investigations confirmed 13 clinically affected cats with structural brain abnormalities. Ventriculomegaly with frequent concomitant supratentorial interhemispheric, communicating ventricular type-1b cysts and multiple midline and callosal malformations were detected in all cats displaying neurologic signs. Genetic analysis confirmed autosomal recessive mode of inheritance with no chromosomal abnormalities.

CONCLUSIONS AND CLINICAL IMPORTANCE

Neuroanatomic dissections and histopathology were helpful for evaluation of abnormalities in midline brain structures, and for the full characterization of cysts. However, MRI was more sensitive for detection of small cysts. In this feline model, MRI diagnosis had extremely good correlation with pathologic abnormalities noted in the subset of animals that were examined by both modalities.

Hydrocephalus in a yellow-headed Amazon parrot (Amazona ochrocephala oratrix)

A 37-year-old female yellow-headed Amazon parrot (Amazona ochrocephala oratrix) was presented after a 4-month-period behavior change and intermittent episodes of obtunded mentation. Clinical findings on physical examination included ataxia, a weak grasp, and reluctance to move. Results of magnetic resonance imaging were consistent with severe hydrocephalus without evidence of cerebrospinal fluid obstruction. The bird was treated with tapering dosages of prednisolone over a 4-month period, during which time the episodes did not occur. Discontinuation of treatment was attempted several times but resulted in relapse. After 3.5 years of maintenance treatment with prednisolone, the bird was presented subsequent to a 5-hour episode of obtunded mentation and worsening neurologic signs. Despite increasing the dose of prednisolone and providing additional supportive care, the bird's condition worsened, and euthanasia was elected. Necropsy findings included severe hydrocephalus with significant loss of right cerebral parenchyma and no evidence of cerebrospinal fluid obstruction. Histologic examination of the remaining cerebral parenchyma revealed a moderate, multifocal, cellular infiltrate; encephalomalacia; fibrosis; and hemosiderosis in tissue adjacent to the distended ventricles. Other findings included hepatic vacuolar degeneration. Diagnostic imaging and postmortem findings were consistent with a diagnosis of hydrocephalus ex vacuo. To our knowledge, this is the first report of hydrocephalus in an Amazon parrot as well as the first report of hydrocephalus in any avian species associated with long-term follow-up and prolonged corticosteroid treatment.

MRI of secondary cervical syringomyelia in four cats

This report describes the use of magnetic resonance imaging (MRI) to diagnose cervical syringomyelia in 4 cats. MRI revealed enlargement of the lateral ventricle in all the cats. Of the 4 cases, MRI revealed herniation of the cerebellum in 3 cats, an isolated fourth ventricle in 1 cat, severe hydrocephalus in 2 cats and brain masses in 1 cat. In this report, the cervical syringomyelia in these cats may have been due to formation of a secondary syrinx (enlargement of the central canal) as a result of blockage of flow in the outlet of the fourth ventricle caused by FIP encephalomyelitis or secondary cerebellar tonsillar herniation caused by increased intracranial pressure due to intracranial masses or may have been due to caudal compression of the cerebellum caused by increased intracranial pressure due to hydrocephalus.

A feline case of isolated fourth ventricle with syringomyelia suspected to be related with feline infectious peritonitis

A one-year-old female cat was unable to stand. Magnetic resonance imaging was performed, and an enlargement of the lateral, third, and fourth ventricles and syringomyelia were detected. The cat was diagnosed with an isolated fourth ventricle (IFV) with syringomyelia. The serum isoantibody test for the feline infectious peritonitis (FIP) virus was 1:3,200. After the cat died, a pathological examination revealed nonsuppurative encephalomyelitis. We suspected that the IFV, detected in the cat, was associated with FIP encephalomyelitis. To our knowledge, there has been no report on IFV in veterinary medicine.

Surgical management of combined hydrocephalus, syringohydromyelia, and ventricular cyst in a dog

Combined hydrocephalus, syringohydromyelia, and a ventricular cyst were found by magnetic resonance imaging in a 7-month-old, male miniature dachshund with gait abnormalities and altered mentation. Clinical signs did not improve with prednisone therapy. Ventriculoperitoneal shunting improved the clinical signs and anatomical abnormalities. Repeated operations were needed to replace the ventricular drainage tube at 3 and 31 months after the first surgery. The animal died suddenly with severe tonic-clonic, generalized seizures 3 weeks after the third operation. Ventriculoperitoneal shunting may be a viable treatment for syringohydromyelia associated with hydrocephalus.

Hydrocephalus with visual deficits in a cat

A 22-month-old male Japanese mongrel cat with a history of dysuria and recurrent generalised tonic-clonic seizure was examined by neuro-opthalmological testing and computed tomography (CT). Vision testing revealed narrowing of the visual field in the right eye, and complete visual deficits in the left eye. Pupillary reactions, and motor and sensory function in the eyelids and the eyes were normal. The cat was diagnosed as hydrocephalus by CT examination, because dilation of the right lateral ventricle, and compression of the right temporal and occipital cortices was shown. The etiology of the hydrocephalus was unclear. Although a unilateral lesion of the upper visual pathway was suspected, a complete homonymous hemianopsia was not shown.