Myelopathy secondary to an intramedullary arteriovenous malformation in a mature dog.

A 2-year-old crossbreed dog was presented for evaluation of a 6-week history of progressive paraparesis. Magnetic resonance imaging and computed tomography angiography of the thoracic and lumbar spinal cord disclosed multifocal, anomalous, small, vascular structures, distributed throughout the subarachnoid space of the included section of the spinal cord. An additional focal intramedullary lesion was identified extending from T9 to T10 to T12. Histopathological examination confirmed the presence of an intramedullary arteriovenous malformation affecting the thoracic spinal cord and leading to diffuse congestion and focal hemorrhages into the affected spinal cord.

Incidence and type of brain herniation associated with intracranial meningioma in dogs and cats.

The incidence of brain herniation (BH) in association with intracranial meningioma (ICM) in dogs and cats is poorly described. The aim of this study was to evaluate the rate and type of brain herniations in client-owned dogs and cats with ICMs and to determine the meningioma volume (MV) relative to cranial cavity volume (CCV). A retrospective magnetic resonance imaging (MRI) analysis study of 24 cats and 45 dogs with ICMs was conducted to ascertain the presence and characteristics of BH. MV and CCV were measured and their ratio was calculated for each animal. Correlations of MV/CCV with independent variables were analyzed. BH was encountered in 24/24 cats (100%) and 30/45 dogs (66.7%) with ICMs. In cats, the most frequent presentation was foramenal herniation (FMH; 23/24, 95.8%), followed by caudotentorial (CTH; 21/24, 87.5%) and subfalcine (SH; 18/24, 75.0%) herniation. In dogs, the most frequent presentation was SH (28/45; 62.2%), followed by CTH (9/45; 20%) and FMH (2/45; 4.4%). Relative to dogs, cats with ICM had greater incidences of FMH (P<0.001) and CTH (P<0.001). Mean MV/CCV ratio was higher in cats (0.098) than in dogs (0.038; P<0.001). The most common clinical sign of ICM was altered behavior in cats (43%, P<0.01) and seizures in dogs (74.4%, P<0.001). In conclusion, cats were found to be more likely than dogs to present FMH and CTH, with a proportionally greater neoplasia volume.

Clinical features of muscle cramp in 14 dogs.

BACKGROUND: Muscle cramps (MCs) are prolonged, involuntary, painful muscle contractions characterized by an acute onset and short duration, caused by peripheral nerve hyperactivity. OBJECTIVES: To provide a detailed description of the clinical features and diagnostic findings in dogs affected by MCs. ANIMALS: Fourteen dogs. METHODS: Multicenter retrospective case series. Cases were recruited by a call to veterinary neurologists working in referral practices. Medical records and videotapes were searched for dogs showing MCs. The follow-up was obtained by telephone communication with the owner and the referring veterinarian. RESULTS: Three patterns of presentation were identified depending on the number of affected limbs and presence/absence of migration of MCs to other limbs. In 9/14 (64%) of dogs, MCs were triggered by prompting the dogs to move. 8/14 (58%) dogs were overtly painful with 6/14 (42%) showing mild discomfort. The cause of MCs was hypocalcemia in 11/14 (79%) dogs: 9 dogs were affected by primary hypoparathyrodism, 1 dog by intestinal lymphoma and 1 dog by protein losing enteropathy. In 3/14 cases (21%) the cause was not identified, and all 3 dogs were German Shepherds. CONCLUSIONS AND CLINICAL IMPORTANCE: Muscle cramps can manifest in 1 of 3 clinical patterns. Muscle cramps are elicited when dogs are encouraged to move and do not always appear as painful events, showing in some cases only discomfort. The main cause of MCs in this study was hypocalcemia consequent to primary hypoparathyroidism. In dogs having MCs of unknown etiology, idiopathic disease or paroxysmal dyskinesia could not be ruled out.

Low Field MRI Measurements of the Normal Canine Trigeminal Nerve.

There is no available measuring protocol and reference range for the normal canine trigeminal nerve. This can be problematic in cases of suspected bilateral trigeminal neuropathy since contralateral nerves cannot be a usefully compared. Trigeminal nerves and brain measurements were retrospectively assessed via multiplanar reconstruction (MPR) of 3DT1 post-contrast MR sequences from 137 dogs with no signs or diagnosis of trigeminal disease. Direct measurements of vertical brain height (BH), trigeminal nerves transverse height (TTH) and trigeminal nerves width in dorsal reconstruction (TDW) were made in a plane immediately caudal to the foramen ovale and used to derive trigeminal nerve-to-brain (NB) ratios, including height-to-brain ratio (HBR) and width-to-brain ratio (WBR). HBR (0.09, IQR = 0.08-0.09) and WBR (0.10, IQR = 0.09-0.11) maintained more consistent values across the study population compared to direct measurements of TTH (3.72, IQR = 3.42-4.07) and TDW (4.35 +/- 0.63). Calculated normal reference intervals for HBR and WBR were 0.07-0.11 and 0.08-0.13, respectively and the largest NB ratios recorded in normal dogs were 0.13 and 0.14 for HBR and WBR, respectively. All measurements varied proportionally with weight, including HBR (r = 0.41, p < 0.0001) and small dogs had a significantly smaller HBRs compared to medium (p = 0.0294), large (p < 0.0049) and giant dogs (p < 0.0044). Median HBR was the same across skull types (0.09), however post-hoc analysis detected significantly smaller HBRs in brachycephalic compared to mesaticephalic dogs (p = 0.0494). In conclusion, trigeminal NB ratios may allow for accurate, objective assessment of the canine trigeminal nerves on MRI but further quantification of the effects of weight and skull type on suggested reference intervals is needed.

A methodological approach for deep learning to distinguish between meningiomas and gliomas on canine MR-images.

BACKGROUND: Distinguishing between meningeal-based and intra-axial lesions by means of magnetic resonance (MR) imaging findings may occasionally be challenging. Meningiomas and gliomas account for most of the total primary brain neoplasms in dogs, and differentiating between these two forms is mandatory in choosing the correct therapy. The aims of the present study are: 1) to determine the accuracy of a deep convolutional neural network (CNN, GoogleNet) in discriminating between meningiomas and gliomas in pre- and post-contrast T1 images and T2 images; 2) to develop an image classifier, based on the combination of CNN and MRI sequence displaying the highest accuracy, to predict whether a lesion is a meningioma or a glioma. RESULTS: Eighty cases with a final diagnosis of meningioma (n = 56) and glioma (n = 24) from two different institutions were included in the study. A pre-trained CNN was retrained on our data through a process called transfer learning. To evaluate CNN accuracy in the different imaging sequences, the dataset was divided into a training, a validation and a test set. The accuracy of the CNN was calculated on the test set. The combination between post-contrast T1 images and CNN was chosen in developing the image classifier (trCNN). Ten images from challenging cases were excluded from the database in order to test trCNN accuracy; the trCNN was trained on the remainder of the dataset of post-contrast T1 images, and correctly classified all the selected images. To compensate for the imbalance between meningiomas and gliomas in the dataset, the Matthews correlation coefficient (MCC) was also calculated. The trCNN showed an accuracy of 94% (MCC = 0.88) on post-contrast T1 images, 91% (MCC = 0.81) on pre-contrast T1-images and 90% (MCC = 0.8) on T2 images. CONCLUSIONS: The developed trCNN could be a reliable tool in distinguishing between different meningiomas and gliomas from MR images.

Presumed Caudal Cerebellar Artery Infarction in Three Cats: Neurological Signs, MRI Findings, and Outcome.

Ischemic cerebrovascular disease (CVD) is a relatively common condition in dogs but infrequent in cats, with acute or peracute onset of non-progressive neurological signs. Cerebellar artery infarction appears to be very uncommon in cats, with only two cases reported affecting the rostral cerebellar artery (RCA). This study aims to report for the first time the neurological signs, magnetic resonance imaging (MRI) findings and outcome in three cats diagnosed with presumed caudal cerebellar artery (CCA) infarction. Unique presentation of vestibular signs associated with CCA in three cats and similarities between dogs and humans are discussed.

Retrobulbar steatitis and meningitis/empyema secondary to right otitis media, right otitis interna and an inflammatory polyp in a cat.

The purpose was to describe a case of retrobulbar steatitis and meningitis in a cat caused by otitis media, otitis interna and an inflammatory polyp in the middle ear. Investigations included ophthalmic and neurological examinations, haematology and biochemistry, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis and aerobic, anaerobic bacterial and fungal culture of material from the middle ear. A 6-year-old female neutered domestic-short-haired cat presented with right-sided exophthalmos and resistance to retropulsion. Anisocoria, reduced corneal sensation and oculocephalic movements and low Schirmer tear test (STT1) were found. An MRI revealed the right external ear canal and tympanic bulla to be fluid filled with presence of a thickened contrast-enhancing mucosa. Contrast enhancement extended into the calvarium, as marked thickening and contrast enhancement of the pachymeninges, and further rostrally through the right orbital fissure into the orbit. The retrobulbar tissues were swollen, resulting in mild exophthalmos. Enrichment culture of material from the middle ear revealed Klebsiella pneumonia susceptible to marbofloxacin. The cat underwent a total ear canal ablation with removal of the cartilaginous cuff at the external auditory meatus and local debridement and curettage. A polypoid structure was removed from the middle ear. No bulla osteotomy was performed. Horner's syndrome was present immediately following surgery. The cat received a course of systemic dexamethasone (1mg/cat SID/3 weeks) tapered off and marbofloxacin (2mg/kg SID/2 weeks). Follow up at 120 days showed no recurrence of the symptoms. The Horner's syndrome and low STT1 had resolved and returned to normal values respectively. This case highlights the importance of MRI in the investigation of retrobulbar diseases. MRI is a useful tool for the evaluation of the extent of the lesion and the appearance of adjacent structures in which additional potentially life-threatening abnormalities, such as meningitis, can be seen.

Texture analysis of magnetic resonance images to predict histologic grade of meningiomas in dogs.

OBJECTIVE To predict histologic grade of meningiomas in dogs via texture analysis (TA) of MRI scans of the brain and spinal cord. SAMPLE 58 sets of MRI scans of the brain and spinal cord of dogs with histologically diagnosed meningioma. PROCEDURES MRI sequences were divided into a training set and a test set, and results of histologic assessment were obtained. Tumors were histologically grouped as benign (stage I) or atypical-anaplastic (stage II or III). Texture analysis was performed by use of specialized software on T2-weighted (T2W) and pre- and postcontrast T1-weighted (T1W) images. A set of 30 texture features that provided the highest discriminating power between the 2 histologic classes in the training set was automatically selected by the TA software. Linear discriminant analysis was performed, and the most discriminant factor (MDF) was calculated. The previously selected texture features were then used for linear discriminant analysis of the test set data, and the MDF was calculated. RESULTS For the training set, TA of precontrast T1W images provided the best diagnostic accuracy; a cutoff MDF of < 0.0057 resulted in a sensitivity of 97.4% and specificity of 95.0% for discriminating benign from atypical-anaplastic meningiomas. Use of postcontrast T1W and T2W images yielded poorer diagnostic performances. Application of the MDF cutoff calculated with the training set to the MDF calculated with the test set provided a correct classification rate of 96.8% for precontrast T1W images, 92.0% for postcontrast T1W images, and 78.9% for T2W images. CONCLUSIONS AND CLINICAL RELEVANCE Findings supported the potential clinical usefulness of TA of MRI scans for the grading of meningiomas in dogs.

Results of magnetic resonance imaging performed within 48 hours after head trauma in dogs and association with outcome: 18 cases (2007-2012).

OBJECTIVE: To review results of MRI performed within 48 hours after head trauma in dogs and identify associations between MRI findings and outcome. DESIGN: Retrospective case series. ANIMALS: 18 dogs that underwent MRI within 48 hours after known head trauma. PROCEDURES: Medical records were reviewed for information on signalment, history, clinical findings, MRI findings, treatment, and outcome. RESULTS: 2 dogs were euthanized, 1 died, and 1 had major persistent deficits. The remaining 14 dogs had a good outcome, including 9 that recovered completely and 5 that had minor persistent deficits. The most common MRI abnormalities were intra-axial changes (n = 13) and extra-axial hemorrhage (13). Intra-axial changes were best seen on T2-weighted and fluid attenuation inversion recovery (FLAIR) images. A mass effect was detected in 9 dogs, 6 of which had a midline shift (mean, 2.18 mm). Three dogs had transtentorial herniation, and 2 had transcranial herniation. Extra-axial hemorrhage was best seen on FLAIR images. The most common location was subdural, with subdural extra-axial hemorrhage most often seen on the same side as the injury. Epidural hemorrhage was seen in 2 dogs. The affected area was larger in these dogs than in dogs with subdural hemorrhage. One dog required surgery and the other was euthanized. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that in dogs with acute (< 48 hours' duration) head trauma, T2-weighted and FLAIR images provided the most diagnostic information. Dogs with injuries affecting the caudal fossa or affecting both the rostral and caudal fossae typically had poorer outcomes.

Lumbosacral intraspinal extradural ganglion cyst in a cat.

CASE SUMMARY: A 16-year-old neutered female domestic shorthair cat was referred for chronic history of reluctance to jump, stiffness of the tail and lower back pain. Mild pelvic limb ataxia, reduced perianal reflex and lumbosacral discomfort were present on neurological examination. On magnetic resonance imaging, a well-defined rounded structure of 3 mm in diameter was identified on the right dorsal aspect of the epidural space at L7-S1, causing displacement of the cauda equina. The lesion was hyperintense to spinal cord parenchyma on T2-weighted images and hypointense on T1-weighted images, consistent with a fluid-filled structure. A Lumbosacral dorsal laminectomy was performed. A clear fluid-containing structure was identified between the right L7 nerve root and the cauda equina. Following surgical excision, histopathology confirmed the cystic nature of the lesion and revealed thick disorganised sheaths of fibrocollagenous tissue and flattened mesenchymal cells lining the luminal part of the cyst wall. A diagnosis of intraspinal ganglion cyst was made. The cat recovered uneventfully. Seven months after surgery euthanasia was performed for unrelated reasons; no neurological deficits were present. RELEVANCE AND NOVEL INFORMATION: This is the first reported case of intraspinal ganglion cyst in a cat. Intraspinal extradural cysts should be considered among other differential diagnoses for cats with lumbosacral myelopathy/radiculopathy.

MRI characteristics of fourth ventricle arachnoid diverticula in five dogs.

Intracranial arachnoid diverticula (cysts) are rare accumulations of cerebrospinal fluid (CSF) within the arachnoid membrane. The purpose of this retrospective study was to describe magnetic resonance imaging (MRI) characteristics of fourth ventricle arachnoid diverticula in a group of dogs. The hospital's medical records were searched for dogs with MRI studies of the brain and a diagnosis of fourth ventricle arachnoid diverticulum. Clinical characteristics were recorded from medical records and MRI studies were reinterpreted by a board-certified veterinary radiologist. Five pediatric dogs fulfilled inclusion criteria. Clinical signs included cervical hyperaesthesia, obtundation, tetraparesis, and/or central vestibular syndrome. In all five dogs, MRI findings were consistent with obstructive hydrocephalus, based on dilation of all ventricles and compression of the cerebellum and brainstem. All five dogs also had cervical syringohydromyelia, with T2-weighted hyperintensity of the gray matter of the cord adjacent to the syringohydromyelia. A signal void, interpreted as flow disturbance, was observed at the mesencephalic aqueduct in all dogs. Four dogs underwent surgical treatment with occipitalectomy and durotomy. A cystic lesion emerging from the fourth ventricle was detected in all four dogs during surgery and histopathology confirmed the diagnosis of arachnoid diverticula. Three dogs made excellent recovery but deteriorated shortly after surgery and were euthanized. Repeat MRI in two dogs revealed improved hydrocephalus but worsening of the syringohydromyelia. Findings from the current study supported theories that fourth ventricle arachnoid diverticula are secondary to partial obstruction of the central canal or lateral apertures and that arachnoid diverticula are developmental lesions in dogs.

Neuropharmacological lesion localization in idiopathic Horner's syndrome in Golden Retrievers and dogs of other breeds.

OBJECTIVE: To investigate whether idiopathic Horner's syndrome (HS) in Golden Retrievers is an exclusively preganglionic disorder based on denervation hypersensitivity pharmacological testing with phenylephrine. ANIMALS STUDIED: Medical records of dogs presented with HS between 2000 and 2012. Dogs presented with additional ocular or systemic signs were excluded. PROCEDURES: Clinical data examined included age, sex, duration of clinical signs, ancillary diagnostic test results, and time to mydriasis on topical ocular application of 1% phenylephrine. Lesions were diagnosed as postganglionic (mydriasis within 20 min) or preganglionic (mydriasis between 20 and 45 min). RESULTS: Medical records of 21 dogs of nine different breeds were included. An etiopathogenesis for Horner's syndrome was determined in five dogs, none of which were Golden Retrievers. All diagnoses correlated with pharmacological lesion localization. Ten Golden Retrievers were included (eight male and two female) with a mean age of 8.5 years (range: 4-13). Lesion localization was diagnosed as postganglionic in eight (mean: 10 min [range: 6-18]) and preganglionic in two Golden Retrievers (20 and 24 min). All cases were unilateral and had completely resolved within 15 weeks (range: 11-20). Recurrence was not reported in any of the patients. CONCLUSIONS: Idiopathic postganglionic HS was diagnosed in eight of 10 Golden Retrievers contradicting previous reports of a purely preganglionic localization. Etiopathogenesis of canine idiopathic HS remains to be determined; nevertheless, a vascular etiology cannot be excluded. Future studies using magnetic resonance angiography may aid in clarifying the pathogenesis.

Effect of extradurally administered morphine on postoperative analgesia in dogs undergoing surgery for thoracolumbar intervertebral disk extrusion.

OBJECTIVE: To investigate the effect of intraoperative extradural morphine administration on postoperative analgesia in dogs undergoing thoracolumbar spinal surgery to treat disk extrusion. DESIGN: Prospective clinical trial. ANIMALS: 26 client-owned dogs undergoing thoracolumbar spinal surgery. PROCEDURES: Animals were randomly allocated to receive morphine (0.1 mg/kg [0.045 mg/lb], extradurally) or no treatment (control group). Following preanesthetic medication with methadone (0.25 mg/kg [0.11 mg/lb], IM), anesthesia was induced with propofol and maintained with isoflurane or sevoflurane in oxygen. Lidocaine and fentanyl were administered during surgery in both groups at fixed rates. In the morphine administration group, morphine was splashed over the dura mater immediately prior to wound closure. Postoperative analgesia was assessed for 48 hours by assessors unaware of group allocation, and methadone was administered as rescue analgesic. Demographic characteristics, urinary output, days of hospitalization, and perioperative use of analgesics were compared via a Mann-Whitney U test. RESULTS: Demographic data were similar between groups. In the morphine administration group, 2 of 13 dogs required postoperative methadone, and in the control group, methadone was administered to 11 of 13 dogs. The total number of doses of methadone administered in the 48 hours after surgery was 28 in the control group and 3 in the morphine administration group. No adverse effects were recorded in any group. CONCLUSIONS AND CLINICAL RELEVANCE: Intraoperative extradural morphine administration was effective in reducing postoperative analgesic requirement. Dogs undergoing thoracolumbar spinal surgery benefited from topical administration of preservative-free morphine administered directly on the dura mater as part of analgesic management.

Imaging diagnosis--magnetic resonance imaging findings in a dog with sequential brain infarction.

An adult greyhound was evaluated on three occasions for acute, intracranial neurologic signs. Based on magnetic resonance (MR) imaging, there were T2-hyperintense and T1-hypointense, noncontrast enhancing lesions in the cerebellum, and brain stem. Using diffusion-weighted imaging (DWI), the lesions were characterized initially by restricted water diffusion. The presumptive diagnosis on each occasion was acute ischemic cerebrovascular accident leading to infarction. This allowed us to characterize the changes in appearance of infarcted neural tissue on the standard MR sequences over time, and to confirm that the DWI could be successfully used in low-field imaging. © 2012 Veterinary Radiology & Ultrasound.

Imaging diagnosis--spinal cord hemangioma in two dogs.

Intramedullary masses are a dilemma due to the limited access for a nonsurgical biopsy, thus, accurate imaging characterization is crucial. Magnetic resonance imaging findings of two confirmed canine thoracic intramedullary hemangiomas are described. A capillary hemangioma was of mixed intensity but predominantly T2-hyperintense and mildly T1-hyperintense to spinal cord with strong contrast enhancement. A cavernous hemangioma had a target-like appearance in both T1-weighted (T1w) and T2-weighted (T2w) images. In T2w images there was a small isointense center surrounded by a relatively large hyperintense area. In T1w images, there was a large isointense centre with a relatively small hyperintense periphery. Such characteristics should prioritize hemangioma as a consideration in a progressive myelopathy due to an intramedullary mass.

MRI findings, surgical treatment and follow-up of a myelomeningocele with tethered spinal cord syndrome in a cat.

A 7-month-old male neutered cat was referred for paraparesis and painful sensation at the level of T13 vertebra where a dermal cyst was observed. Spine radiographs and magnetic resonance imaging (MRI) showed a well-encapsulated cyst communicating with the meninges and spinal cord, suggestive of hydromyelia and myelodysplasia. Dorsal laminectomy was performed and the cyst was completely removed. The day after surgery, the cat was ambulatory paraparetic. Involuntary defecation was observed for only a few days. The surgical specimen was cystic and covered by skin. Microscopic examination revealed a hollow hemispheric mass of glial fibrillary acidic protein (GFAP)-positive neural tissue lined by ependyma and formed of glia and vascular structures consistent with myelomeningocele (MMC). Only anecdotal descriptions of MMC have been published in the veterinary literature, mainly in the lumbosacral spinal cord. To the authors' knowledge, this is the first report of a MMC with tethered spinal cord syndrome in a cat successfully treated surgically.

Clinical signs, magnetic resonance imaging findings and outcome in 77 cats with vestibular disease: a retrospective study.

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.

Results of magnetic resonance imaging in 14 cats with meningoencephalitis.

Medical records and magnetic resonance (MR) images of 14 cats with inflammatory diseases affecting the central nervous system (CNS) were reviewed retrospectively. Cases included eight cats with feline infectious peritonitis and two cats with toxoplasmosis. Abnormalities affecting the CNS were observed in MR images in 10 (71%) cats. Intracranial lesions appeared as slightly hypointense foci in T1-weighted images in two (14%) cats, as hyperintense foci in T2-weighted images in seven (50%) cats and as hyperintense foci after intravenous administration of a gadolinium-based contrast medium in 10 (71%) cats. In six cats with lesions in T1- and/or T2-weighted images, additional lesions were visible in T1-weighted images obtained after gadolinium-based contrast medium administration. In three cats, lesions were visible only after contrast medium administration. In our study, MR imaging (MRI) did not appear to detect all cases of CNS inflammation in the population of cats with inflammatory cerebrospinal fluid (CSF); however, MRI adds information about the sites and morphology of intracranial lesions that should help to distinguish between neoplasia and inflammatory conditions and, possibly, between different inflammatory conditions.