Tuesday, July 12, 2016

 

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The top 10 neurologic disorders of cats are much different than the most common neuro presentations of dogs.


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Cats can be very uncooperative during the neurologic exam…they often will do a somersault when you try to wheelbarrow them!



 

Zuku’s Top 10 Feline Neurological Conditions to know for NAVLE®: Part 1

  1. Hypokalemic myopathy

                    Cervical ventroflexion in a cat with hypokalemia

    • Classic case: Cervical ventroflexion in an older cat, generalized weakness, stiff, stilted gait
    • Dx: Low blood potassium level (less than 3.5 mEq/L), renal profile, thyroid panel, CK
    • Rx: Oral potassium gluconate, dopamine infusion if life-threatening, DO NOT add potassium to fluids
    • Pearls:
      • Good prognosis
      • DDX for cervical ventroflexion include: polymyositis, myasthenia gravis, organophosphate toxicity, coral snake envenomation
      • Hypokalemia is usually associated with chronic renal disease
    • Click here to see a video of a cat with hypokalemia courtesy of John Kjær

  2. Aortic thromboembolism

                    Paraplegia secondary to saddle thrombus

    • Classic case:
      • Middle-aged or geriatric cat; usually male Persian or DSH
      • Acute pain and paraplegia, cool paws, cyanotic nail beds, absent femoral pulses, painful gastrocnemius muscles, tachypnea
    • Dx:
      • Minimum database
      • Heartworm test, T4, coagulation panel
      • Echocardiography
      • Doppler ultrasonography
      • Abdominal ultrasonography
    • Rx: Treat underlying disease, manage pain, hydrate, clot dissolution (warfarin or heparin)
    • Pearls:
      • Prevent with aspirin
      • Guarded to poor prognosis and high recurrence rate

  3. Traumatic CNS injury

                    Spinal fractures at L4-5 and L7-S1 (also left ileal fracture)

    • Classic case:
      • History of trauma, contusions, lacerations
      • Paraparesis, paraplegia, tetraparesis, pain, altered consciousness, seizures
    • Dx: Survey spinal radiographs, CT, +/- MRI
    • Rx:
      • Check airway/breathing/circulation, then IV fluid support, administer O2
      • Surgical decompression and/or stabilization
      • Cage rest, external splint
      • STEROIDS are highly controversial and detrimental to traumatic brain injury
    • Pearls: Cats often have sacro-caudal fractures
    • Click here for spinal radiography tips on NeuroWebVet and a podcast on steroids in head trauma: indicated or contraindicated? by VetGirl

  4. Brain tumor

                    Sagittal MRI of brain tumor

    • Classic case: Older cat, signs depends on location of tumor:
      • Seizures, altered consciousness, pacing, head-pressing, turns only toward side of lesion, loss of conscious proprioception
      • Hypermetria, head bobbing, ataxia, intention tremors
      • Head tilt, nystagmus, facial nerve paralysis, tongue paralysis, strabismus, poor swallowing
    • Dx:
      • MRI - safe, fast, and best quality
      • CT - safe and fast
      • CSF analysis may show elevated protein but tumor cells are rarely found; risk of brain herniation
    • Rx:
      • Definitive - surgical resection, radiation, chemotherapy
      • Supportive - prednisolone, anticonvulsants (levetiracetam preferred)
    • Pearls:
      • Most common type of brain tumor in cats is meningioma
      • Meningiomas can often be easily resected by an experienced neurologist or surgeon
    • Click here for more information and images on feline brain tumors from NeuroWebVet

  5. Feline infectious peritonitis (dry form)

                    Kitten with left head tilt, a possible sign of feline infectious peritonitis

    • Classic case: Often under 2 years of age, usually intact, purebred from multi-cat household, signs depends on area(s) of brain affected – most often involves brainstem and/or cerebellum
      • Nystagmus, circling, head tilt
      • Hypermetria, intention tremors, ataxia
      • Seizures, pacing, dementia, loss of conscious proprioception
      • Paraparesis, cranial neuropathies
      • Uveitis/chorioretinitis (*change in iris color)
    • Dx:
      • CSF analysis: protein over 200 mg/dL, WBC over 100 cells/microliter (neutrophilic)
      • CSF antibody titer to FIP
    • Rx: Supportive only
    • Pearls: Grave prognosis, usually succumbs in days to months


  6.  

owl    Zuku-certified bodacious websites:


 

 de Lahunta’s video resources for neurologic cases

39 videos of neurologic cases in cats like hypokalemia, spinal fracture, and FIP.

Courtesy, Cornell University.

 The University of Minn feline neurology video-clips

More videos of neurologic cases in cats like vestibular syndrome and diabetic polyneuropathy which are in the next 5 of the top 10.

 Neuropetvet

Quizzes, “What’s your neurologic diagnosis?” and Terminology.

Courtesy, Dr. Mark Troxel.

 NeuroWebVet

A consultation website, with original articles and reviews.

Check out the neuro history tips and neuro exam videos.

 Simon’s Cat

For fun:

Simon’s cat goes on a field trip.

"There are two means of refuge from the misery of life — music and cats.”

~ Albert Schweitzer

cat cat

Example of NAVLE®-format feline neurology question:

A 1-year-old male intact Abyssinian cat from a purebred cattery is presented with ataxia and nystagmus.

The owner reports that cat's eyes have changed color and he seems depressed.

The cat is hypermetric on the left thoracic limb. Neurological exam reveals head bobbing, vertical nystagmus, left facial nerve paralysis, and loss of conscious proprioception in the left pelvic limb.

Routine bloodwork is normal.

Which one of the following choices is the best next step?

   A. Observation, the cat should recover with time

   B. Chest and skull radiographs

   C. CSF analysis

   D. Check response to palliative high-dose steroids

   E. Magnetic resonance imaging (MRI)

Click here for the answer and explanatory text…

 

zukureview

 

Images courtesy Madisonbauer (cat in a Sees bag), Dr Shirley Scott (ventroflexion in a cat, spinal fractures), Uwe Gille (aortic thromboembolism in a cat), NeuroWebVet (MRI brain tumor), Wouter Hagens (kitten with head tilt), Azuri (serious cat), and Nicholas Titkov (Malsan Bunny Funny).

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