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Dutil GF, Guevar J, Schweizer D, Roosje P, Kajin F, Volk HA, Grapes NJ, De Decker S, Gutierrez-Quintana R, Abouzeid J, Freeman P, Faller KME, Stein VM, Maiolini A. Otitis media and interna with or without polyps in cats: association between meningeal enhancement on postcontrast MRI, cerebrospinal fluid abnormalities, and clinician treatment choice and outcome. J Feline Med Surg 2022; 24:e481-e489. [PMID: 36409551 PMCID: PMC10812352 DOI: 10.1177/1098612x221125573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the association between meningeal enhancement (MgE) and cerebrospinal fluid (CSF) analysis results, their individual association with bacteriology results from affected ear samples and whether these test results influenced clinicians' therapeutic choice in cats with otitis media and interna (OMI). METHODS This was a multicentre retrospective study carried out over an 8-year period. Cats diagnosed with OMI, with or without a nasopharyngeal polyp, leading to peripheral vestibular signs were included. Only cats for which MRI with postcontrast T1-weighted sequences and CSF analyses available were included. Cats with intra-axial MRI lesions or empyema were excluded. RESULTS Fifty-eight cats met the inclusion criteria. MgE was reported in 26/58 cases, of which nine had an abnormal CSF result (increased total nucleated cell count [TNCC] or total protein); 32/58 cases had no MgE, of which 10 showed abnormal CSF results. There was no association between bacteriology results (external ear canal or bulla) and MgE or abnormal CSF results. CSF abnormalities were statistically significantly more common in acute cases (n = 16/37) than in chronic cases (n = 3/21; Fischer's test P = 0.04). Prednisolone was prescribed in 10/16 cases with increased TNCC. Among the 42 cases with normal TNCC, 15 received prednisolone and 13 received non-steroidal anti-inflammatory drugs. Various antimicrobial drugs were prescribed in 53/58 cats. Duration of antimicrobial treatment was similar, regardless of positive bacterial culture (5.58 vs 4.22 weeks), abnormal CSF (5.83 vs 4.76 weeks) or MgE (5.33 vs 4.90 weeks). CONCLUSIONS AND RELEVANCE No association was found between the CSF and MgE results. Furthermore, no association was found between MgE, CSF or bacteriology findings. In addition, abnormal CSF results might lead the clinician to treat with corticosteroids, but they did not have any impact on duration of antimicrobial treatment. CSF abnormalities were seen significantly less frequently in chronic cases. The outcome tended to be poorer when MgE was detected on MRI.
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Affiliation(s)
- Guillaume F Dutil
- Division of Clinical Neurology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Julien Guevar
- Division of Small Animal Surgery, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Daniela Schweizer
- Division of Radiology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Petra Roosje
- Division of Dermatology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Filip Kajin
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany
| | - Holger A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany
| | - Nick J Grapes
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | | | - Jad Abouzeid
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Paul Freeman
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Kiterie ME Faller
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, UK
| | - Veronika M Stein
- Division of Clinical Neurology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Arianna Maiolini
- Division of Clinical Neurology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Hecht S, Cushing AC, Williams-Hagler DA, Craig LE, Thomas WB, Anderson KM, Ramsay EC, Conklin GA. Magnetic Resonance Imaging in 50 Captive Non-domestic Felids - Technique and Imaging Diagnoses. Front Vet Sci 2022; 9:827870. [PMID: 35211543 PMCID: PMC8861525 DOI: 10.3389/fvets.2022.827870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/04/2022] [Indexed: 02/01/2023] Open
Abstract
Magnetic resonance imaging (MRI) is the recognized gold standard for diagnostic imaging of the central nervous system in human and veterinary patients. Information on the use of this modality and possible imaging abnormalities in captive non-domestic felids is currently limited to individual case reports or small case series. This retrospective study provides information on technique and imaging findings in a cohort of cases undergoing MRI at an academic Veterinary Medical Center. The University of Tennessee College of Veterinary Medicine MRI database was searched for non-domestic felids undergoing MRI of the brain or spine from 2008 to 2021. Medical record data were recorded, and MRI studies were reviewed. Fifty animals met the inclusion criteria. The most common brain diseases were Chiari-like malformation (n = 8) and inflammatory conditions (n = 8). Other abnormalities included pituitary lesions (n = 5), brain atrophy (n = 2), and one each of metabolic and traumatic conditions. Fourteen animals had a normal brain MRI study. The most common spinal abnormality was intervertebral disc disease (n = 7). Other disorders included vertebral dysplasia (n = 2), presumptive ischemic myelopathy (n = 1), subdural ossification causing spinal cord compression (n = 1), and multiple myeloma (n = 1). Spinal cord swelling of undetermined cause was suspected in two animals, and seven patients had a normal MRI study of the spine. MRI is a valuable tool in the diagnostic workup of non-domestic felids with presumptive neurologic disease.
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Affiliation(s)
- Silke Hecht
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, United States
- *Correspondence: Silke Hecht
| | - Andrew C. Cushing
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, United States
| | | | - Linden E. Craig
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, TN, United States
| | - William B. Thomas
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, United States
| | - Kimberly M. Anderson
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, United States
| | - Edward C. Ramsay
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, United States
| | - Gordon A. Conklin
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, United States
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Galley AP, Beltran E, Tetas Pont R. Neurogenic keratoconjunctivitis sicca in 34 dogs: A case series. Vet Ophthalmol 2021; 25:140-152. [PMID: 34870366 DOI: 10.1111/vop.12949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 10/03/2021] [Accepted: 10/17/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the clinical findings, imaging features, underlying conditions, treatment, and progression of dogs presented between 2010 and 2019 with neurogenic keratoconjunctivitis sicca (NKCS). METHODS Dogs diagnosed with NKCS were searched in the clinical database. Inclusion criteria were STT-1 readings <15 mm/min, clinical signs of KCS with concurrent ipsilateral xeromycteria. RESULTS Thirty-four cases were identified. Mean age at presentation was 8.2 years, median 8.9 years (0.3-14.7). Twenty dogs were male, and 14 dogs were female. Concurrent neurological deficits included facial neuropathy (n = 13, 38%), peripheral vestibular syndrome (n = 10, 29%), and Horner's syndrome (n = 5, 15%). Advanced imaging was acquired in 53% of cases (n = 18). Etiologies included idiopathic (n = 18, 53%), endocrinopathy (n = 6, 18%), otitis interna (n = 4, 12%), head trauma (n = 3, 9%), iatrogenic (post-TECA-LBO, n = 1, 3%), brainstem mass (n = 1, 3%), and an area of inflammation in the pterygopalatine fossa (n = 1, 3%). Treatment for NKCS was initiated in most cases (n = 30, 88%) including: oral pilocarpine 2% and lacrimostimulant (n = 19), oral pilocarpine 2% only (n = 3), or lacrimostimulant only (n = 8). A mean time follow-up of 3.7 months, median 3 months (1-14) was available in 23 cases (68%). Eleven cases with follow-up were responsive (48%) with resolution of the clinical signs in a median time 4 months (1-10), and all of them were treated with oral pilocarpine (±lacrimostimulant). CONCLUSIONS Most cases presented as idiopathic NKCS; in others, an underlying cause of facial neuropathy was identified. All responsive cases were treated with oral pilocarpine 2%.
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Affiliation(s)
- Amy P Galley
- Royal Veterinary College (RVC), Queen Mother Hospital for Animals (QMHA), London, UK
| | - Elsa Beltran
- Royal Veterinary College (RVC), Queen Mother Hospital for Animals (QMHA), London, UK
| | - Roser Tetas Pont
- Royal Veterinary College (RVC), Queen Mother Hospital for Animals (QMHA), London, UK
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Unilateral decrease in inner ear signal in fluid-attenuated inversion recovery sequences in previously suspected canine idiopathic vestibular syndrome. Vet J 2021; 277:105748. [PMID: 34537343 DOI: 10.1016/j.tvjl.2021.105748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 12/27/2022]
Abstract
The aetiology of canine idiopathic vestibular syndrome (IVS) remains unclear. In human medicine, characteristic magnetic resonance imaging (MRI) techniques are used to demonstrate differences in endolymph composition between affected and unaffected inner ears. The purpose of this study was to determine whether similar MRI techniques could help to detect changes in the inner ears of canine IVS patients. Medical records from two veterinary referral clinics were reviewed retrospectively. Dogs were included if they had a diagnosis of IVS, obvious lateralisation of clinical signs, and an MRI of the vestibular system. A region of interest (ROI) was manually outlined by defining the anatomical area of the inner ear in T2-weighted and fluid-attenuated inversion recovery (FLAIR) images. In order to calculate the ratio of FLAIR suppression of each ear, the mean grey value of the ROI was determined in both sequences. If a unilateral decrease in suppression was identified, it was compared with the direction of clinical signs. In total, 80 dogs were included in the study. There was a significantly lower degree of suppression on the affected compared to the unaffected side (0.8886 vs. 0.9348, respectively; P = 0.0021). In 92.5% of cases, there was agreement between the most suppressed side on MRI and the direction of clinical signs. This study provides preliminary evidence about the appearance of endolymph on MRI of dogs with IVS. Further studies are needed to investigate associations between the severity of MRI changes and prognosis.
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Foth S, Meller S, Kenward H, Elliott J, Pelligand L, Volk HA. The use of ondansetron for the treatment of nausea in dogs with vestibular syndrome. BMC Vet Res 2021; 17:222. [PMID: 34154584 PMCID: PMC8218477 DOI: 10.1186/s12917-021-02931-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/07/2021] [Indexed: 12/12/2022] Open
Abstract
Background Vestibular syndrome is often accompanied by nausea. Drugs currently approved for its treatment have been developed to stop vomiting but not nausea. The efficacy of 5-HT3 receptor antagonists to reduce nausea has been described for chemotherapy, but not for nausea secondary to vestibular disorders. Methods Sixteen dogs with vestibular syndrome-associated nausea were included in the open-label, multicentre study. The intensity of nausea-like behaviour was analysed before ondansetron administration (0.5 mg/kg i.v.) and 2 h afterwards, using a validated 5-point-scale. The occurrence and frequency of salivation, lip licking, restlessness, vocalisation, lethargy, and vomiting were assessed. Results All dogs initially showed signs of nausea, whereas only 31% showed vomitus. The intensity of nausea was significantly reduced in all dogs (p ≤ 0.0001) 2 h after ondansetron administration, including the clinical signs of nausea analysed in 11 dogs (salivation [p = 0.0078], lip licking [p = 0.0078], restlessness [p = 0.0039], and lethargy [p = 0.0078]) except for vocalisation (p > 0.9999). Conclusions The results provide preliminary evidence of the potential benefit of ondansetron in the treatment of nausea, which was present in all examined dogs. Vomiting was only observed in 5 dogs indicating that nausea can occur separately and should not be perceived only as a preceding stimulation of the vomiting centre. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-021-02931-9.
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Affiliation(s)
- S Foth
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - S Meller
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - H Kenward
- Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, Hatfield, UK
| | - J Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, Hertfordshire, Hatfield, UK
| | - L Pelligand
- Department of Clinical Science and Services, Royal Veterinary College, Hertfordshire, Hatfield, UK
| | - H A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany.
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Danciu CG, Szladovits B, Crawford AH, Ognean L, De Decker S. Cerebrospinal fluid analysis lacks diagnostic specificity in dogs with vestibular disease. Vet Rec 2021; 189:e557. [PMID: 34101197 DOI: 10.1002/vetr.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 04/20/2021] [Accepted: 05/23/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although, vestibular syndrome is a common neurological presentation, little is known about the diagnostic value of cerebrospinal fluid (CSF) analysis in vestibular syndrome in dogs. METHODS Medical records were retrospectively reviewed, and dogs with vestibular disease that had undergone magnetic resonance imaging of the head, CSF analysis and were diagnosed with central or peripheral vestibular syndrome were included. Disorders affecting the central vestibular system included meningoencephalitis of unknown origin (MUO), brain neoplasia, ischaemic infarct, intracranial empyema or metronidazole toxicity. Disorders affecting the peripheral vestibular system included idiopathic vestibular disease, otitis media/interna or neoplasia affecting the inner ear structures. Total nucleated cell concentration (TNCC), total protein concentration (TP) and cytologic assessment were recorded. RESULTS A total of 102 dogs met the inclusion criteria. The sensitivity and specificity of increased CSF TNCC to differentiate central from peripheral vestibular syndrome was 49% and 90%, while the sensitivity and specificity of increased TP was 58% and 39%, respectively. The TNCC and TP in dogs with MUO were significantly higher than in dogs with idiopathic vestibular disease (p = 0.000 and p = 0.004). MUO was associated with lymphocytic pleocytosis, while idiopathic vestibular disease and ischaemic infarct were associated with the presence of activated macrophages or normal cytology (p = 0.000). CONCLUSION Although consistent CSF abnormalities were observed in dogs with MUO, CSF analysis did not allow reliable differentiation between central and peripheral vestibular syndrome. CSF analysis is not reliable as the sole diagnostic technique in dogs with vestibular disease.
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Affiliation(s)
- Cecilia Gabriella Danciu
- Department of Veterinary Preclinical and Clinical Science and Service, Faculty of Veterinary Medicine, University of Agricultural Science and Veterinary Medicine, Cluj-Napoca, Romania
| | - Balazs Szladovits
- Department of Pathobiology and Populations Sciences, Royal Veterinary College, University of London, Hatfield, UK
| | - Abbe Harper Crawford
- Department of Veterinary Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Laurentiu Ognean
- Department of Veterinary Preclinical and Clinical Science and Service, Faculty of Veterinary Medicine, University of Agricultural Science and Veterinary Medicine, Cluj-Napoca, Romania
| | - Steven De Decker
- Department of Veterinary Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
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Harrison E, Grapes NJ, Volk HA, De Decker S. Clinical reasoning in canine vestibular syndrome: Which presenting factors are important? Vet Rec 2021; 188:e61. [PMID: 33739504 DOI: 10.1002/vetr.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Although the use of clinical reasoning has been evaluated for several neurological presentations, this approach has not yet been investigated for dogs with vestibular syndrome. METHODS Two hundred and thirty-nine dogs presenting with vestibular syndrome were included in this retrospective study. Univariate analysis of variables (clinical history, signalment, clinical presentation and neurological examination findings) was performed. Variables with p < 0.3 were selected for logistic regression. RESULTS Ninety-five percent of dogs were represented by eight conditions: idiopathic vestibular disease (n = 78 dogs), otitis media interna (n = 54), meningoencephalitis of unknown origin (n = 35), brain neoplasia (n = 26), ischaemic infarct (n = 25), intracranial empyema (n = 4), metronidazole toxicity (n = 3) and neoplasia affecting the middle ear (n = 3). Idiopathic vestibular disease was associated with higher age, higher bodyweight, improving clinical signs, pathological nystagmus, facial nerve paresis, absence of Horner's syndrome and a peripheral localisation. Otitis media interna was associated with younger age, male gender, Horner's syndrome, a peripheral localisation and a history of otitis externa. Ischaemic infarct was associated with older age, peracute onset of signs, absence of strabismus and a central localisation. CONCLUSIONS Discrete clinical features can be used to identify the most likely diagnosis in dogs with vestibular syndrome.
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Affiliation(s)
- Eleanor Harrison
- Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Nick J Grapes
- Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Holger A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Steven De Decker
- Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
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Radulescu SM, Humm K, Eramanis LM, Volk HA, Church DB, Brodbelt D, O'Neill DG. Vestibular disease in dogs under UK primary veterinary care: Epidemiology and clinical management. J Vet Intern Med 2020; 34:1993-2004. [PMID: 32776616 PMCID: PMC7517853 DOI: 10.1111/jvim.15869] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vestibular disease (VD), central or peripheral, can be a dramatic primary-care presentation. Current literature describes mostly dogs examined in referral centers. HYPOTHESIS/OBJECTIVES Describe the prevalence, presentation, clinical management, and outcomes of VD in dogs under primary veterinary care at UK practices participating in VetCompass. ANIMALS Seven hundred and fifty-nine vestibular cases identified out of 905 544 study dogs. METHODS Retrospective cohort study. Potential VD cases clinically examined during 2016 were verified by reviewing clinical records for signalment, presenting clinical signs, treatments, and outcomes. Multivariable logistic regression was used to evaluate factors associated with VD. RESULTS The overall prevalence of VD was 8 per 10 000 dogs (95% CI = 7-9). Median age at first diagnosis was 12.68 years (interquartile range [IQR], 11.28-14.64). Compared with crossbreeds, breeds with the highest odds of VD diagnosis included French Bulldogs (odds ratio [OR] = 9.25, 95% CI = 4.81-17.76, P < .001), Bulldogs (OR = 6.53, 95% CI = 2.66-16.15, P < .001), King Charles Spaniels (OR = 4.96, 95% CI = 2.52-9.78, P < .001), Cavalier King Charles Spaniels (OR = 3.56, 95% CI = 2.50-5.06, P < .001), and Springer Spaniels (OR = 3.37, 95% CI = 2.52-4.52, P < .001). The most common presenting signs were head tilt (69.8%), nystagmus (68.1%), and ataxia (64.5%). The most frequently used treatments were antiemetics (43.2%), systemic glucocorticoids (33.1%), antimicrobials (25%), and propentofylline (23.25%). There were 3.6% of cases referred. Improvement was recorded in 41.8% cases after a median of 4 days (IQR, 2-10.25). CONCLUSIONS Our study identifies strong breed predispositions for VD. The low referral rates suggest that primary-care data sources offer more generalizable information for benchmarking to help clinicians review their own clinical activities.
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Affiliation(s)
| | - Karen Humm
- Department of Clinical Science and ServicesThe Royal Veterinary CollegeNorth MymmsHertsUK
| | - Louis Mark Eramanis
- Department of Clinical Science and ServicesThe Royal Veterinary CollegeNorth MymmsHertsUK
- Department of Veterinary Clinical Sciences, Faculty of Veterinary and Agricultural SciencesUniversity of MelbourneWerribeeVictoriaAustralia
| | - Holger A. Volk
- Department of Clinical Science and ServicesThe Royal Veterinary CollegeNorth MymmsHertsUK
- Department of Small Animal Medicine and SurgeryUniversity of Veterinary Medicine HannoverHannoverGermany
| | - David B. Church
- Department of Clinical Science and ServicesThe Royal Veterinary CollegeNorth MymmsHertsUK
| | - David Brodbelt
- Department of Pathobiology and Population SciencesThe Royal Veterinary CollegeNorth MymmsHertsUnited Kingdom
| | - Dan Gerard O'Neill
- Department of Pathobiology and Population SciencesThe Royal Veterinary CollegeNorth MymmsHertsUnited Kingdom
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Won S, Yoon J. MRI utricle diameter asymmetry is significantly greater in dogs with idiopathic vestibular syndrome compared with unaffected dogs. Vet Radiol Ultrasound 2020; 61:540-544. [PMID: 32663342 DOI: 10.1111/vru.12893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/02/2020] [Accepted: 05/07/2020] [Indexed: 11/26/2022] Open
Abstract
Idiopathic vestibular syndrome (IVS) is the most common cause of acute unilateral peripheral vestibular dysfunction in older dogs. The purpose of this retrospective, cross-sectional study was to characterize morphological changes in the utricle of dogs affected by IVS, using MRI. To evaluate differences between affected and unaffected utricles, the ratio of the largest to the smallest utricle diameter was obtained, as measured on transverse T2-weighted images, and defined as the utricle asymmetricity ratio (UAR). Out of 137 patients diagnosed with IVS after excluding other vestibular diseases by MRI, 101 were eligible for inclusion. Additionally, 31 older dogs with no signs of vestibular disorders or other intracranial diseases were included as a control group. The disease group was divided into two subgroups in which the direction of head tilt and nystagmus symptoms versus the decreased utricle diameters were consistent or inconsistent. The medians of UARs of the IVS and control groups were 0.83 (range 0.37-1.00) and 0.98 (0.70-1.00), respectively. The medians of the UARs of the consistent and inconsistent IVS subgroups were 0.82 (0.37-0.99) and 0.90 (0.74-1.00), respectively. The UAR of the IVS group was significantly decreased than that of the control group and UAR of the consistent sub-group was significantly decreased than that of the inconsistent sub-group (P < .01). In conclusion, significant asymmetry of utricle diameter was identified in dogs with IVS versus unaffected dogs. We propose that canine IVS may possibly be correlated with structural atrophy of the vestibular system.
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Affiliation(s)
| | - Junghee Yoon
- College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul, Korea
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10
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Castillo G, Parmentier T, Monteith G, Gaitero L. Inner ear fluid-attenuated inversion recovery MRI signal intensity in dogs with vestibular disease. Vet Radiol Ultrasound 2020; 61:531-539. [PMID: 32564460 DOI: 10.1111/vru.12876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/23/2020] [Accepted: 03/29/2020] [Indexed: 11/29/2022] Open
Abstract
The inner ear contains endolymph and perilymph. The second is comparable and in continuity with the cerebrospinal fluid (CSF) so it is expected to suppress in fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) if normal. Even though inner ear FLAIR abnormalities have been extensively described in humans with inner ear disease, its diagnostic value in dogs is yet to be proven. The goal of this retrospective cohort study was to investigate the diagnostic utility of FLAIR MRI in dogs with vestibular disease. A review of medical records identified 101 dogs that had brain MRI performed because of vestibular signs. Based on the final diagnosis, patients were allocated to three groups: otitis media/interna, idiopathic vestibular disease, and central vestibular disease. Additionally, a control group (n = 73) included dogs with normal MRI and without vestibular signs. Inner ears were delineated using a region of interest, and signal intensity was measured in FLAIR and T2-weighted images. The percentages of suppression in FLAIR were calculated and compared between affected and unaffected sides of each individual and between groups using a general linear mixed model. Correlation between suppression and CSF cell count and protein concentration was assessed. Affected inner ears in dogs with otitis media/interna had decreased suppression in FLAIR compared to the unaffected side (P < .001), and all other groups (P < .01). No significant correlation was detected between CSF results and suppression. These results show the diagnostic value of FLAIR in otitis media/interna due to lack of suppression in the affected inner ear.
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Affiliation(s)
- Gibrann Castillo
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Thomas Parmentier
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Gabrielle Monteith
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Luis Gaitero
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Orlandi R, Gutierrez-Quintana R, Carletti B, Cooper C, Brocal J, Silva S, Gonçalves R. Clinical signs, MRI findings and outcome in dogs with peripheral vestibular disease: a retrospective study. BMC Vet Res 2020; 16:159. [PMID: 32450859 PMCID: PMC7249679 DOI: 10.1186/s12917-020-02366-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vestibular dysfunction is relatively common in dogs, with a prevalence of 0.08% reported in primary veterinary care in the UK. There are several studies investigating how to differentiate between peripheral and central vestibular disease but only limited information regarding the possible underlying causes for peripheral vestibular dysfunction in dogs. This study therefore aimed to describe the clinical signs, magnetic resonance imaging findings (MRI), underlying causes and outcome in a large population of dogs diagnosed with peripheral vestibular disease. RESULTS One hundred eighty-eight patients were included in the study with a median age of 6.9 years (range 3 months to 14.6 years). Neurological abnormalities included head tilt (n = 185), ataxia (n = 123), facial paralysis (n = 103), nystagmus (n = 97), positional strabismus (n = 93) and Horner syndrome (n = 7). The most prevalent diagnosis was idiopathic vestibular disease (n = 128), followed by otitis media and/or interna (n = 49), hypothyroidism (n = 7), suspected congenital vestibular disease (n = 2), neoplasia (n = 1) and cholesteatoma (n = 1). Long-term follow-up revealed persistence of head tilt (n = 50), facial paresis (n = 41) and ataxia (n = 6) in some cases. Recurrence of clinical signs was observed in 26 dogs. Increasing age was associated with a mild increased chance of diagnosis of idiopathic vestibular syndrome rather than otitis media and/or interna (P = 0.022, OR = 0.866; CI 0.765-0.980). History of previous vestibular episodes (P = 0.017, OR = 3.533; CI 1.251-9.981) was associated with an increased likelihood of resolution of the clinical signs whilst contrast enhancement of cranial nerves VII and/or VIII on MRI (P = 0.018, OR = 0.432; CI 0.251-0.868) was associated with a decreased chance of resolution of the clinical signs. CONCLUSIONS Idiopathic vestibular disease is the most common cause of peripheral vestibular dysfunction in dogs and it is associated with advanced age. Incomplete recovery from peripheral vestibular disease is common, especially in dogs presenting with cranial nerve enhancement on MRI but less so if there is previous history of vestibular episodes.
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Affiliation(s)
- Rocio Orlandi
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK.
| | - Rodrigo Gutierrez-Quintana
- School of Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Garscube Estate, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Beatrice Carletti
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
| | - Camilla Cooper
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
| | - Josep Brocal
- Wear Referrals Veterinary Hospital, Bradbury, Stockton-on-Tees, TS21 2ES, UK
| | - Sara Silva
- School of Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Garscube Estate, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Rita Gonçalves
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
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12
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Bertram CA, Klopfleisch R, Erickson NA, Lübke-Becker A, Müller K. Leiomyosarcoma of the external ear canal as a cause of otitis externa, media, interna in a chinchilla (Chinchilla lanigera). J Exot Pet Med 2019. [DOI: 10.1053/j.jepm.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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13
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Desprez I, Donnelly TM, Mayousse V, Thibaud JL, Parker DL, Pignon C. A case of otitis interna in a ferret (Mustela putorius furo). J Exot Pet Med 2019. [DOI: 10.1053/j.jepm.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Bongartz U, Nessler J, Maiolini A, Stein VM, Tipold A, Bathen-Nöthen A. Vestibular disease in dogs: association between neurological examination, MRI lesion localisation and outcome. J Small Anim Pract 2019; 61:57-63. [PMID: 31515806 DOI: 10.1111/jsap.13070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/26/2019] [Accepted: 08/19/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To determine whether the neurological examination correctly distinguishes between central and peripheral vestibular lesions in dogs. MATERIALS AND METHODS Retrospective study on dogs with vestibular disease presenting to two referral clinics in Germany. RESULTS Ninety-three dogs were included; neurological examination suggested central vestibular disease in 62 and a peripheral lesion in 31. MRI diagnosis was central vestibular disease in 68 dogs and peripheral in 25. Of the 62 dogs with a lesion localisation diagnosed as central vestibular by neurological exam, 61 were correctly identified (98.4%). Twenty-four of the 31 dogs diagnosed with a peripheral lesion by neurological exam had a consistent lesion on MRI (77.4%). CLINICAL SIGNIFICANCE The neurological examination is efficient at identifying lesions in the central vestibular system but less so for peripheral lesions. Therefore it is prudent to recommend imaging in dogs that show signs of peripheral vestibular syndrome but do not rapidly respond to treatment.
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Affiliation(s)
- U Bongartz
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany.,Veterinary Practice A. Bathen-Nöthen, Hatzfeldstraße 6, 51069, Köln, Germany
| | - J Nessler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
| | - A Maiolini
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
| | - V M Stein
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
| | - A Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
| | - A Bathen-Nöthen
- Veterinary Practice A. Bathen-Nöthen, Hatzfeldstraße 6, 51069, Köln, Germany
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15
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Ratliff CM, Ewing JR, McLeland SM, Riedesel EA, Zaffarano BA. Paradoxical Vestibular Syndrome Secondary to Temporal Bone Osteomyelitis and Chronic Otitis Interna in a Guinea Pig (Cavia porcellus). J Exot Pet Med 2019. [DOI: 10.1053/j.jepm.2017.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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16
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Boudreau CE, Dominguez CE, Levine JM, Mankin J, Anderson KM, Voges AK, Fosgate GT. Reliability of interpretation of neurologic examination findings for the localization of vestibular dysfunction in dogs. J Am Vet Med Assoc 2018; 252:830-838. [DOI: 10.2460/javma.252.7.830] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Belmudes A, Pressanti C, Barthez PY, Castilla-Castaño E, Fabries L, Cadiergues MC. Computed tomographic findings in 205 dogs with clinical signs compatible with middle ear disease: a retrospective study. Vet Dermatol 2017; 29:45-e20. [DOI: 10.1111/vde.12503] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2017] [Indexed: 02/02/2023]
Affiliation(s)
- Audrey Belmudes
- Small Animal Hospital; Dermatology Service; Université de Toulouse; ENVT; 23 chemin des Capelles 31076 Toulouse France
| | - Charline Pressanti
- Small Animal Hospital; Dermatology Service; Université de Toulouse; ENVT; 23 chemin des Capelles 31076 Toulouse France
| | | | - Eloy Castilla-Castaño
- Small Animal Hospital; Dermatology Service; Université de Toulouse; ENVT; 23 chemin des Capelles 31076 Toulouse France
| | - Lionel Fabries
- Centre Scanner Vétérinaire; 45 avenue de Toulouse 31650 Saint Orens France
| | - Marie C. Cadiergues
- UDEAR; Université de Toulouse; INSERM; ENVT; 23 chemin des Capelles 31076 Toulouse France
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18
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Mayousse V, Desquilbet L, Jeandel A, Blot S. Prevalence of neurological disorders in French bulldog: a retrospective study of 343 cases (2002-2016). BMC Vet Res 2017; 13:212. [PMID: 28676057 PMCID: PMC5497356 DOI: 10.1186/s12917-017-1132-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/26/2017] [Indexed: 12/18/2022] Open
Abstract
Background French Bulldog (FB) has significantly gained in popularity over the last few years, and seems to be frequently affected by various neurological conditions. The purpose of this retrospective study was to report the prevalences of neurological diseases in a large population of FB, presented with neurological signs between 2002 and 2016, and for which a definitive diagnosis was established. A secondary objective was to identify epidemiological characteristics regarding specific diseases in this singular breed. Results During the study period, 533 FBs were presented for neurological signs, representing 18.7% of all admitted FBs (N = 2846). In total, 343 FBs with definitive diagnosis were included in this descriptive epidemiological study. Hansen type I intervertebral disk herniation (IVDH) was by far the most common neurological disorder (45.5% of all cases). The IVDH location was cervical in 39.8%, and thoracolumbar in 60.2% of cases. The median ages for cervical and thoracolumbar IVDH were 4.2 and 4 years, respectively. C3-C4 was the most commonly affected disk (57.8% of cervical IDVH) all locations combined. Spinal arachnoid diverticulum (SAD) was detected in 25 FBs, representing the second most common myelopathy (11.3%). A concurrent spinal abnormality was identified in 64.0% of SAD cases. Brain tumours represented 36.8% of encephalopathies, with glioma (confirmed or suspected) being the most common. Meningoencephalitis of unknown origin (MUO) represented 25.0% of brain disorders, females less than 5.5 years being more likely to be affected. Aside from central nervous system conditions, otitis interna associated with peripheral vestibular signs and bilateral congenital deafness (associated with white coat) were also common. Conclusions The findings of this study suggest that FB seems to be prone to several neurological diseases. IVDH is clearly predominant in FB and cervical location seems more represented than in other breeds. FBs affected by IVDH tend to be younger than previously described, either for both cervical and thoracolumbar locations. Thoracic SAD was the second most common myelopathy, with a concurrent spinal anomaly identified in two thirds of the cases. MUO was more likely to affect young to middle-aged females. These findings could be of interest for owners, breeders, practicing veterinarians and insurance companies.
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Affiliation(s)
- Vincent Mayousse
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort (EnvA), Unité de Neurologie, 7 avenue du général de Gaulle, 94700, Maisons-Alfort, France. .,Inserm, IMRB U955-E10, 8 rue du général Sarrail, 94000, Créteil, France. .,UMR BNMS Neurobiologie, Ecole Nationale Veterinaire d'Alfort, 7 avenue du General de Gaulle, 94700, Maisons Alfort, France.
| | - Loïc Desquilbet
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort (EnvA), Unité de Biostatistiques et d'Epidémiologie Clinique, 7 avenue du général de Gaulle, 94700, Maisons-Alfort, France
| | - Aurélien Jeandel
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort (EnvA), Unité de Neurologie, 7 avenue du général de Gaulle, 94700, Maisons-Alfort, France.,Present adress: Davies Veterinary Specialists, Manor Farm Buisiness Park, Higham Gobion, Herts, SG5 3HR, United Kingdom
| | - Stéphane Blot
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort (EnvA), Unité de Neurologie, 7 avenue du général de Gaulle, 94700, Maisons-Alfort, France.,Inserm, IMRB U955-E10, 8 rue du général Sarrail, 94000, Créteil, France.,UMR BNMS Neurobiologie, Ecole Nationale Veterinaire d'Alfort, 7 avenue du General de Gaulle, 94700, Maisons Alfort, France
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19
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Hainsworth AH, Allan SM, Boltze J, Cunningham C, Farris C, Head E, Ihara M, Isaacs JD, Kalaria RN, Lesnik Oberstein SAMJ, Moss MB, Nitzsche B, Rosenberg GA, Rutten JW, Salkovic-Petrisic M, Troen AM. Translational models for vascular cognitive impairment: a review including larger species. BMC Med 2017; 15:16. [PMID: 28118831 PMCID: PMC5264492 DOI: 10.1186/s12916-017-0793-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 01/12/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Disease models are useful for prospective studies of pathology, identification of molecular and cellular mechanisms, pre-clinical testing of interventions, and validation of clinical biomarkers. Here, we review animal models relevant to vascular cognitive impairment (VCI). A synopsis of each model was initially presented by expert practitioners. Synopses were refined by the authors, and subsequently by the scientific committee of a recent conference (International Conference on Vascular Dementia 2015). Only peer-reviewed sources were cited. METHODS We included models that mimic VCI-related brain lesions (white matter hypoperfusion injury, focal ischaemia, cerebral amyloid angiopathy) or reproduce VCI risk factors (old age, hypertension, hyperhomocysteinemia, high-salt/high-fat diet) or reproduce genetic causes of VCI (CADASIL-causing Notch3 mutations). CONCLUSIONS We concluded that (1) translational models may reflect a VCI-relevant pathological process, while not fully replicating a human disease spectrum; (2) rodent models of VCI are limited by paucity of white matter; and (3) further translational models, and improved cognitive testing instruments, are required.
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Affiliation(s)
- Atticus H Hainsworth
- Clinical Neurosciences (J-0B) Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK. .,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Stuart M Allan
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, UK
| | - Johannes Boltze
- Department of Translational Medicine and Cell Technology, University of Lübeck, Lübeck, Germany.,Neurovascular Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Catriona Cunningham
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, UK
| | - Chad Farris
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Elizabeth Head
- Department of Pharmacology & Nutritional Sciences, Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Masafumi Ihara
- Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Jeremy D Isaacs
- Clinical Neurosciences (J-0B) Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Raj N Kalaria
- Institute of Neuroscience, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, UK
| | | | - Mark B Moss
- Department of Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Björn Nitzsche
- Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany.,Clinic for Nuclear Medicine, University of Leipzig, Leipzig, Germany.,Institute for Anatomy, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Gary A Rosenberg
- Department of Neurology, Health Sciences Center, University of New Mexico, Albuquerque, NM, USA
| | - Julie W Rutten
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands.,Department of Human Genetics, Leiden University Medical Center, Leiden, Netherlands
| | - Melita Salkovic-Petrisic
- Department of Pharmacology, Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Aron M Troen
- Institute of Biochemistry Food and Nutrition Science, Hebrew University of Jerusalem, Rehovot, Israel
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20
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Janssens SDS, Haagsman AN, Ter Haar G. Middle ear polyps: results of traction avulsion after a lateral approach to the ear canal in 62 cats (2004–2014). J Feline Med Surg 2016; 19:803-808. [DOI: 10.1177/1098612x16660356] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives The objective of this study was to report the surgical outcome and complication rate of deep traction avulsion (TA) of feline aural inflammatory polyps after a lateral approach (LA) to the ear canal. Methods This was a retrospective analysis of data retrieved from an electronic database of 62 cats treated with TA after an LA (TALA) for removal of ear canal polyps. Long-term outcome was assessed via a telephone questionnaire survey with the owners. Results Domestic shorthair cats (48%) and Maine Coons (37%) were over-represented. The most common presenting clinical signs were otorrhoea, ear scratching and head shaking. Video-otoscopic examination confirmed a polypous mass in the ear canal in all patients. All 62 cats underwent TALA, with a mean surgical time of 33 mins for experienced surgeons (n = 4) and 48 mins (n = 12) for less experienced surgeons. The recurrence rate of polyp regrowth for experienced surgeons was 14.3% vs 35% for the less experienced surgeons. Postoperative complications included Horner’s syndrome (11.5%) and facial nerve paralysis (3%). Otitis interna was not observed. Conclusions and relevance A lateral approach to the ear canal in combination with deep TA of an aural inflammatory polyp is an effective first-line technique that results in a low recurrence and complication rate.
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Affiliation(s)
- Sara DS Janssens
- Department of Clinical Sciences of Companion Animals, Utrecht University, Utrecht, The Netherlands
| | - Annika N Haagsman
- Department of Clinical Sciences of Companion Animals, Utrecht University, Utrecht, The Netherlands
| | - Gert Ter Haar
- Department of Clinical Sciences and Services, Royal Veterinary College, London, UK
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21
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Jeandel A, Thibaud JL, Blot S. Facial and vestibular neuropathy of unknown origin in 16 dogs. J Small Anim Pract 2016; 57:74-8. [DOI: 10.1111/jsap.12428] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 09/14/2015] [Accepted: 10/27/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A. Jeandel
- Neurology Unit & UPR de Neurobiologie, Ecole nationale vétérinaire d'Alfort; Université Paris-Est Créteil; 94700 Maisons Alfort France
| | | | - S. Blot
- Neurology Unit & UPR de Neurobiologie, Ecole nationale vétérinaire d'Alfort; Université Paris-Est Créteil; 94700 Maisons Alfort France
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22
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Itoh T, Uchida K, Nishi A, Shii H, Nagayoshi T, Sakamoto H. Choroid plexus papilloma in a dog surviving for 15 months after diagnosis with symptomatic therapy. J Vet Med Sci 2015; 78:167-9. [PMID: 26321300 PMCID: PMC4751140 DOI: 10.1292/jvms.15-0330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A 4-year-old female French bulldog presented with a 6-month history of
right-sided head tilt and acute onset ataxia. Magnetic resonance imaging (MRI) showed a
large mass lesion at the cerebellomedullary pontine angle. The dog was able to stand and
walk after beginning symptomatic therapy with prednisolone, acetazolamide and glycerin.
Magnetic resonance imaging 10 months after the first examination indicated slight
expansion of the tumor. The dog was able to walk with continuous symptomatic therapy for
15 months until death, although the head tilt persisted. On postmortem examination, the
gross tumor was slightly larger than when seen on the second MRI scan and was
histopathologically diagnosed as a choroid plexus papilloma.
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Affiliation(s)
- Teruo Itoh
- Division of Animal Medical Research, Hassen-kai, 2-27 Onozaki, Saito-shi, Miyazaki 881-0012, Japan
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23
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Fraser AR, Long SN, le Chevoir MA. Concurrent idiopathic vestibular syndrome and facial nerve paralysis in a cat. Aust Vet J 2015; 93:252-4. [DOI: 10.1111/avj.12338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 11/30/2022]
Affiliation(s)
- AR Fraser
- The University of Melbourne Veterinary Hospital; The University of Melbourne; 250 Princes Hwy Werribee Victoria 3030 Australia
| | - SN Long
- The University of Melbourne Veterinary Hospital; The University of Melbourne; 250 Princes Hwy Werribee Victoria 3030 Australia
| | - MA le Chevoir
- The University of Melbourne Veterinary Hospital; The University of Melbourne; 250 Princes Hwy Werribee Victoria 3030 Australia
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25
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Garosi LS, Lowrie ML, Swinbourne NF. Neurological Manifestations of Ear Disease in Dogs and Cats. Vet Clin North Am Small Anim Pract 2012; 42:1143-60. [DOI: 10.1016/j.cvsm.2012.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
SUMMARY The primary purpose of diagnostic imaging is to enable clinicians to make correct decisions about a patient's diagnosis and severity of its condition and, thereby, to contribute to effective and efficient treatment. Advanced imaging modalities are inherently better detectors of morphological lesions than radiography; hence, they offer the possibility of more accurate diagnosis and staging, with correspondingly better patient outcomes. However, there is a lack of evidence that better outcomes are being realised for veterinary patients. Furthermore, increased use of advanced imaging carries the possibility of increased misuse, primarily through unnecessary studies that contribute little to patient management other than increased costs. SCOPE This article is intended to be relevant to all veterinary species. Advanced imaging of cats is not sufficiently developed as a specific discipline that a balanced review could be based purely on feline examples or references.
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Affiliation(s)
- Christopher R Lamb
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire AL9 7TA, UK.
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27
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Wolf D, Lüpke M, Wefstaedt P, Klopmann T, Nolte I, Seifert H. Optimising magnetic resonance image quality of the ear in healthy dogs. Acta Vet Hung 2011; 59:53-68. [PMID: 21354941 DOI: 10.1556/avet.59.2011.1.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aim of this study was to develop an examination protocol for magnetic resonance imaging, in order to display diagnostically important information of the canine middle and inner ear. To ensure that this protocol could also be used as a basis for determining pathological changes, the anatomical structures of the ear were presented in detail. To minimise stress through anaesthesia in live animals, preliminary examinations were carried out on four dog cadavers. During these initial examinations, three-dimensional (3D) sequences proved to be superior to two-dimensional ones. Therefore, only 3D sequences were applied for the main examinations performed on six clinically healthy Beagles. The anonymised MR images were rated by three experienced reviewers using a five-point scale. The most valuable sequence was a T2-weighted CISS sequence (TR = 16.7 ms, TE = 8.08 ms). This sequence proved to be most suitable for illustrating the inner ear structures and enabled good tissue contrasts. The sequence ranked second best was also a T2-weighted DESS sequence (TR = 19 ms, TE = 6 ms), allowing the imaging of the tympanic cavity and enabling 3D reconstruction due to its isotropic voxels. Due to low contrast and strong noise, the other sequences (TSE, FISP, MP RAGE) were not suitable for anatomical illustration of the middle and inner ear.
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Affiliation(s)
| | - Matthias Lüpke
- 1 University of Veterinary Medicine Hanover, Foundation Institute for General Radiology and Medical Physics Bischofsholer Damm 15 D-30173 Hanover Germany
| | - Patrick Wefstaedt
- 2 University of Veterinary Medicine Hanover, Foundation Small Animal Clinic Bischofsholer Damm 15 D-30173 Hanover Germany
| | - Thilo Klopmann
- 2 University of Veterinary Medicine Hanover, Foundation Small Animal Clinic Bischofsholer Damm 15 D-30173 Hanover Germany
| | - Ingo Nolte
- 2 University of Veterinary Medicine Hanover, Foundation Small Animal Clinic Bischofsholer Damm 15 D-30173 Hanover Germany
| | - Hermann Seifert
- 1 University of Veterinary Medicine Hanover, Foundation Institute for General Radiology and Medical Physics Bischofsholer Damm 15 D-30173 Hanover Germany
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28
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The neurology of balance: Function and dysfunction of the vestibular system in dogs and cats. Vet J 2010; 185:247-58. [DOI: 10.1016/j.tvjl.2009.10.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Revised: 10/28/2009] [Accepted: 10/29/2009] [Indexed: 11/23/2022]
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Abstract
The vestibular system is the major sensory (special proprioceptive) system that, along with the general proprioceptive and visual systems, maintains balance. Clinical signs of vestibular disease include asymmetric ataxia, head tilt, and pathologic nystagmus. Neuroanatomic localization of observed vestibular signs to either the peripheral or central components of the vestibular system is paramount to the management of the patient with vestibular dysfunction, as the etiology, diagnostic approaches, and prognoses are dependent on the neuroanatomic diagnosis. This article reviews functional vestibular neuroanatomy as well as the diagnosis and treatment of common causes of small animal vestibular disease.
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Affiliation(s)
- John H Rossmeisl
- Neurology and Neurosurgery, Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, VA 24061, USA.
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30
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Hecht S, Adams WH. MRI of Brain Disease in Veterinary Patients Part 1: Basic Principles and Congenital Brain Disorders. Vet Clin North Am Small Anim Pract 2010; 40:21-38. [DOI: 10.1016/j.cvsm.2009.09.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Negrin A, Cherubini GB, Lamb C, Benigni L, Adams V, Platt S. Clinical signs, magnetic resonance imaging findings and outcome in 77 cats with vestibular disease: a retrospective study. J Feline Med Surg 2009; 12:291-9. [PMID: 19932040 DOI: 10.1016/j.jfms.2009.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 10/06/2009] [Indexed: 10/20/2022]
Abstract
Medical records of 77 cats that had clinical signs of vestibular disease and magnetic resonance imaging (MRI) of the head were reviewed retrospectively. The aetiological, clinical and MRI characteristics were described and evaluated for a relationship with patient outcome. Forty cats (52%) had signs of central vestibular dysfunction (CVD), which was part of a multifocal disease in 17 cats (43%). The most frequent causes of CVD were inflammatory conditions (18 cats; 45%), including bacterial inflammation as an intracranial extension of otitis interna (five cats; 13%), feline infectious peritonitis (three cats; 8%) and toxoplasmosis (two cats; 5%). Neoplasia (12 cats; 30%) and vascular disease (four cats; 10%) were respectively the second and the third most frequent causes of CVD. Thiamine deficiency was diagnosed in one cat based on MRI findings and improvement following vitamin B(1) supplementation. Of 37 cats (48%) with peripheral vestibular dysfunction (PVD), idiopathic vestibular syndrome (IVS) was suspected in 16 (43%) and otitis media/interna was suspected in 16 (43%). Within the group of cats with evident MRI lesions, the location of the imaged lesions agreed with the clinical classification of vestibular dysfunction in 52/55 (95%) cats. Most of the cats (nine cases; 56%) with presumed IVS had rapid and complete recovery of their clinical signs. As most of these cats presented with progressive clinical signs over 3 weeks they were classified as having 'atypical' IVS to differentiate them from cats with the typical non-progressive IVS. No underlying systemic diseases were documented in any of these cases. Statistically significant predictors of survival included neurolocalisation (central or peripheral vestibular system), age and gender. No difference in survival was observed between cats with presumed idiopathic peripheral syndrome and cats with otitis media/interna.
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Affiliation(s)
- Arianna Negrin
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, Autonomous University of Barcelona, 08193 Bellaterra, Barcelona, Spain.
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33
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Kneissl S, Konar M, Fuchs-Baumgartinger A, Nell B. Magnetic resonance imaging features of orbital inflammation with intracranial extension in four dogs. Vet Radiol Ultrasound 2007; 48:403-8. [PMID: 17899971 DOI: 10.1111/j.1740-8261.2007.00267.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This retrospective study describes the clinical and magnetic resonance (MR) imaging features of chronic orbital inflammation with intracranial extension in four dogs (two Dachshunds, one Labrador, one Swiss Mountain). Intracranial extension was observed through the optic canal (n=1), the orbital fissure (n=4), and the alar canal (n=1). On T1-weighted images structures within the affected skull foramina could not be clearly differentiated, but were all collectively isointense to hypointense compared with the contralateral, unaffected side, or compared with gray matter. On T2-, short tau inversion recovery (STIR)-, or fluid-attenuated inversion recovery (FLAIR)-weighted images structures within the affected skull foramina appeared hyperintense compared with gray matter, and extended with increased signal into the rostral cranial fossa (n=1) and middle cranial fossa (n=4). Contrast enhancement at the level of the affected skul foramina as well as at the skull base in continuity with the orbital fissure was observed in all patients. Brain edema or definite meningeal enhancement could not be observed, but a close anatomic relationship of the abnormal tissue to the cavernous sinus was seen in two patients. Diagnosis was confirmed in three dogs (one cytology, two biopsy, one necropsy) and was presumptive in one based on clinical improvement after treatment. This study is limited by its small sample size, but provides evidence for a potential risk of intracranial extension of chronic orbital inflammation. This condition can be identified best by abnormal signal increase at the orbital fissure on transverse T2-weighted images, on dorsal STIR images, or on postcontrast transverse or dorsal images.
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Affiliation(s)
- Sibylle Kneissl
- Department for Diagnostic Imaging, Infectious Diseases and Clinical Pathology, University of Veterinary Medicine, Veterinärplatz 1, A-1210 Vienna, Austria.
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Doust R, King A, Hammond G, Cave T, Weinrauch S, Mellor D, Sullivan M. Assessment of middle ear disease in the dog: a comparison of diagnostic imaging modalities. J Small Anim Pract 2007; 48:188-92. [PMID: 17381763 DOI: 10.1111/j.1748-5827.2007.00295.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To compare radiography and ultrasound for the assessment of the tympanic bulla against computed tomography results. METHODS Thirty-one dogs had dorsoventral, left and right lateral oblique and rostrocaudal open mouth radiographs compared with ultrasound images and computed tomography scans of the tympanic bullae. RESULTS Radiography was superior to ultrasonography for the evaluation of the middle ear. However, computed tomography assessment was best predicted by a combination of radiographic and ultrasonographic findings. CLINICAL SIGNIFICANCE A combination of radiography and ultrasound can provide a more accurate assessment of the bulla than either of them alone. Ultrasound may have a role in the evaluation of middle ear disease in the dog. Results are operator dependent and not reproducible with current recording techniques.
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Affiliation(s)
- R Doust
- Division of Companion Animal Studies, University of Glasgow, Bearsden Road, Bearsden, Glasgow G61 1QH, UK
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Sturges BK, Dickinson PJ, Kortz GD, Berry WL, Vernau KM, Wisner ER, LeCouteur RA. Clinical Signs, Magnetic Resonance Imaging Features, and Outcome After Surgical and Medical Treatment of Otogenic Intracranial Infection in 11 Cats and 4 Dogs. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb02910.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Platt SR. Vestibular Disorders. CONSULTATIONS IN FELINE INTERNAL MEDICINE 2006. [PMCID: PMC7158340 DOI: 10.1016/b0-72-160423-4/50059-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kneissl S, Probst A, Konar M. LOW-FIELD MAGNETIC RESONANCE IMAGING OF THE CANINE MIDDLE AND INNER EAR. Vet Radiol Ultrasound 2004; 45:520-2. [PMID: 15605841 DOI: 10.1111/j.1740-8261.2004.04088.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A series of low-field magnetic resonance images of the normal canine middle and inner ear are presented to serve as a reference. A completely balanced steady-state gradient echo pulse sequence with a slice thickness of 0.9 mm can be used to acquire images of the relevant structures within and neighboring the inner ear. These were the cochlear duct, semicircular ducts, vestibule, facial and vestibulocochlear nerves, as well as the temporal sinus. Within the middle ear, no applied sequence was able to allow identification of the auditory ossicles or the tympanic membrane.
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Affiliation(s)
- Sibylle Kneissl
- Clinic of Radiology, University of Veterinary Medicine, Veterinärplatz 1, A-1210 Vienna, Austria.
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Abstract
Radiographic evaluation of the tympanic bulla is limited. Improper obliquity or angulation of the skull for radiographs or malpositioning of the tongue can result in an inadequate study [4]. Additionally, because of the complex anatomy of the canine and feline skull, with superimposition of multiple osseous structures, radiography can result in false-negative examinations or understimation of the disease present [2]. When compared with surgical findings of 19 clinical cases of presumptive middle ear disease, false-negative radiographic findings were found in 25% of the surgically confirmed cases of otitis media [4]. Therefore, radiographs are not considered to be a highly sensitive mode of diagnosing otitis media. Radiographs may be helpful in determining lysis associated with neoplasia; however, the extent of involvement is still underestimated. In a study comparing CT and radiographic evaluation of otitis media, CT was determined to be more sensitive but less specific than radiography [11]. CT is the preferred modality for the evaluation of the tympanic bulla at our institution. This opinion may be biased by the fact that most cases are presented for recurrent or chronic otitis. Although radiography is more accessible, the availability of CT in local referral settings is increasing as opposed to being limited to university settings. After the cost (i.e., anesthesia, radiographs) and amount of time necessary to make optimum radiographic studies are taken into account, a CT study may actually be faster and more informative. Given our preference for the CT examination, the cost of the examination has been adjusted to make it more appealing to the owner and clinician. For example, a bulla CT study is only 1.3 times the cost of a radiographic bulla study. In conclusion, imaging of the ear canal can provide important information about ear disease, including unilateral or bilateral ear disease, the degree of middle or inner ear involvement, peripheral versus central vestibular disease, an infectious or inflammatory versus neoplastic process, the chronicity of the disease process, involvement of adjacent structures, and postsurgical complications.
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Affiliation(s)
- Matthew G Bischoff
- Department of Veterinary Clinical Medicine, University of Illinois, 1008 West Hazelwood Drive, Urbana, IL 61802, USA.
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Owen MC, Lamb CR, Lu D, Targett MP. Material in the middle ear of dogs having magnetic resonance imaging for investigation of neurologic signs. Vet Radiol Ultrasound 2004; 45:149-55. [PMID: 15072148 DOI: 10.1111/j.1740-8261.2004.04025.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The aim of this study was to determine the prevalence and potential significance of finding material in the middle ear of dogs having magnetic resonance (MR) imaging. Of 466 MR studies reviewed, an increased signal was identified in the tympanic bulla in 32 (7%) dogs. Cavalier King Charles spaniels, Cocker spaniels, Bulldogs, and Boxers were over-represented compared to the population of dogs having MR imaging. Five (16%) dogs had definite otitis media and one (3%) had a meningioma invading the middle ear. Of the remaining dogs, 13 (41%) had possible otitis media and 13 (41%) had neurologic conditions apparently unrelated to otitis media. The most common appearance of material in the middle ear was isointense in T1-weighted images and hyperintense in T2-weighted images. There was no apparent correlation between the signal characteristics of the material and the diagnosis. Enhanced signal after gadolinium administration was observed affecting the lining of the bulla in dogs with otitis media and in dogs with unrelated neurologic conditions. In dogs without clinical signs of otitis media, finding an increased signal in the middle ear during MR imaging may reflect subclinical otitis media or fluid accumulation unrelated to inflammation. Brachycephalic dogs may be predisposed to this condition.
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Affiliation(s)
- M C Owen
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, University of London, London, UK
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Dickie AM, Doust R, Cromarty L, Johnson VS, Sullivan M, Boyd JS. Comparison of ultrasonography, radiography and a single computed tomography slice for the identification of fluid within the canine tympanic bulla. Res Vet Sci 2003; 75:209-16. [PMID: 13129669 DOI: 10.1016/s0034-5288(03)00118-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Fluid accumulation within the tympanic bulla (TB) is an important diagnostic indicator in clinical cases of canine otitis media although its identification can be a challenge using currently available imaging techniques. The aim of this study was to compare ultrasound with radiography and a single computed tomography (CT) slice for the identification of fluid within the TB of canine cadavers. A random number of TB in 66 cadavers were filled with ultrasound gel. Rostrocaudal open mouth (RCdoM) radiographs and CT images were interpreted by 2 blinded radiologists and ultrasound examinations were performed by 2 blinded sonographers. The heads were then frozen and sectioned to confirm the contents of each TB. Although CT remained the most accurate method, comparable results were obtained by one of the sonographers and even the inexperienced sonographer produced results superior to radiography. Ultrasound has several advantages over the other imaging techniques and this study suggests that it may have an application in the investigation of canine otitis media although further work in live animals would be required to confirm this.
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Affiliation(s)
- A M Dickie
- Department of Veterinary Preclinical Studies, Faculty of Veterinary Medicine, University of Glasgow, Bearsden Road, Glasgow G61 1QH, UK.
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Garosi LS, Dennis R, Schwarz T. Review of diagnostic imaging of ear diseases in the dog and cat. Vet Radiol Ultrasound 2003; 44:137-46. [PMID: 12718347 DOI: 10.1111/j.1740-8261.2003.tb01262.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Diagnostic imaging techniques (conventional radiography, computed tomography and magnetic resonance imaging) are an essential tool in the diagnostic work-up of ear diseases. Conventional radiography is commonly used, but often lacks sensitivity. Computed tomography (CT) and magnetic resonance (MR) are complementary imaging studies of the middle ear, labyrinth, internal auditory canal and their contents. CT provides excellent images of bony structures and is indicated where osseous changes are of greatest diagnostic importance. MR is superior in imaging soft tissue components including intralabyrinthine fluid. Therefore, more than one of these imaging techniques may be required in order to make a diagnosis.
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Affiliation(s)
- Laurent S Garosi
- Animal Health Trust, Centre for Small Animal Studies, Lanwades Park, Kentford, Newmarket CB8 7UU, England
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Russo M, Covelli EM, Meomartino L, Lamb CR, Brunetti A. Computed tomographic anatomy of the canine inner and middle ear. Vet Radiol Ultrasound 2002; 43:22-6. [PMID: 11866039 DOI: 10.1111/j.1740-8261.2002.tb00437.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A series of high-resolution computed x-ray tomography (CT) images of the normal canine middle and inner ear are presented to serve as a reference for optimal interpretation of clinical CT images of animals with diseases affecting this region.
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Affiliation(s)
- Marco Russo
- Dipartimento di Scienze Cliniche Veterinarie, Centro di Radiologia Veterinaria, Polo delle Scienze e delle Tecnologie per la Vita, Università degli Studi di Napoli Federico II, Naples, Italy
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