Journal of Feline Medicine and Surgery Flashcards
Prospective crossover clinical trial comparing transdermal with oral phenobarbital administration in epileptic cats. Heller et al. 2019
- 9 cats. Half study with oral pheno and second half with transdermal pheno.
- Therapeutic S-PB concentrations were achievable in some cats using TD-PB at 18 mg/kg/day q12h.
- Poor correlation between TD dosage and S-PB concentrations was observed and more dosage adjustments were required during TD administration.
- These findings necessitate close therapeutic drug monitoring if TD-PB is prescribed.
- However owners overall preferred transdermal formulation
Feline head trauma: A CT analysis of skull fractures and their management in 75 cats. Knight et al. 2019
- 75 cats
- 85% has multiple fractures including mandible, upper jaw etc.
- Road traffic accidents (RTAs) were the most common cause of skull fractures, occurring in 89% of cats
- RTAs were also associated with high levels of concurrent injuries, particularly ophthalmic, neurological and thoracic injuries
- Mortality rate was 8% and complications were reported in 22% of cats.
- 50/50 treated surgically vs medically
- Increasing age at presentation and presence of internal upper jaw fractures were risk factors for development of complications
MRI in 30 cats with traumatic brain injury. Caine et al. 2018
- 21/30 cats had a good outcome (full recovery or minor deficits only)
- 9 either died or had ongoing neurological deficits that significantly affected quality of life.
- There was evidence of parenchymal injury in only 20/30 cats, including 8/9 that had a poor outcome.
- Frequency of bilateral or multifocal parenchymal lesions on T2-weighted imaging, and mass effect, particularly caudal transtentorial herniation, was statistically significantly higher in patients with a poorer outcome.
- Concurrent soft tissue injury was noted in all cats, with a poorer prognosis statistically associated with a peripharyngeal pattern of injury and orbital trauma.
Radiation therapy for intracranial tumours in cats with neurological signs. Korner et al. 2018
- 22 cats with intracranial space-occupying lesions, presenting with neurological signs and/or epileptic seizures and treated with external beam radiation therapy, were reviewed.
- In all but one cat (95.5%), neurological signs improved after radiation therapy.
- The median progression-free survival was 510 days
- The proportion free of progression at 1 year was 55.7%
- Fourteen cats died (only in five cases was death related to the intracranial tumour) and eight cats were still alive or lost to follow-up.
- Mean age was 12.0 years (± 2.3) and ranged from 6.5–16.4 years.
- Radiation therapy seems to represent a viable treatment option in cats with intracranial tumours, relieving neurological signs and improving local tumour control.
Comparison of medical and/or surgical management of 23 cats with intracranial empyema or abscessation. Martin et al. 2018
- 23 cats with imaging findings consistent with intracranial abscessation and empyema
- 10 had surgery and medication, 10 had medical management only and 3 died.
- Short-term outcome showed that 90% of surgically managed and 80% of medically managed cats were alive at 48 h post-diagnosis.
- Long-term survival showed that surgically managed cases 730 days
- Long-term survival showed that medically managed cases 183 days
- But not significantly different
Assessment of menace response in neurologically and ophthalmologically normal cats. Quitt et al. 2018
- 50 cats and two examiners
- The majority of visually healthy cats revealed a strong/complete menace when the contralateral eye remained uncovered,
- 40% failed when the contralateral eye was covered.
- The most reliable examination mode was achieved standing behind the cat.
Lumbosacral transitional vertebrae in cats and its relationship to lumbosacral vertebral canal stenosis. Harris et al. 2018
- 13 cats with lumbosacral stenosis were retrospectively reviewed for lumbosacral abnormalities.
- Compared to 405 cats with normal CT
- Clinical signs associated with lumbosacral stenosis included lumbosacral pain, low tail carriage, difficulty jumping, and urinary or faecal incontinence.
- Duration of clinical signs ranged from 1 day to 10 months (mean 3 months).
- Cats with clinical signs, 53.8% were diagnosed with lumbosacral transitional vertebrae
- Control cats 5.9% were diagnosed with lumbosacral transitional vertebrae
- Despite lumbosacral stenosis being a rare spinal condition in cats, lumbosacral transitional vertebrae can be considered a risk factor for its development.
A lateral approach to the feline cerebellar fossa: case report and identification of an external landmark for the tentorium ossium. Kent et al. 2019
- The aim of this study was to describe the use of an external landmark that defines the attachment of the tentorium ossium for planning a craniectomy to access the cerebellar fossa.
- The external landmark was defined by a line where the caudal aspect of the convexity of the cranium transitions to a flat surface in the caudal aspect of the temporal fossa
- Between the attachment of the tentorium ossium and nuchal crest exists an area adequately sized for a craniectomy in cats.
Clinical reasoning in feline spinal disease: which combination of clinical information is useful. Mella et al. 2020
- 221 cats
- 44 non-lymphoid neoplasia
- 42 intervertebral disc disease (middle-aged, purebred cats with a normal general physical examination and an acute onset of painful and progressive clinical signs.)
- 34 fracture/luxation (younger cats and resulted most often in a peracute onset, painful, non-ambulatory neurological status.)
- 222 ischaemic myelopathy (older cats with a stable or improving, non-painful, lateralising, C6–T2 myelopathy.)
- 18 feline infectious peritonitis virus myelitis (Concurrent systemic abnormalities)
- 6 lymphoma (Concurrent systemic abnormalities)
- 11 thoracic vertebral canal stenosis
- 11 acute non-compressive nucleus pulposus extrusion
- 8 traumatic spinal cord contusion
- 7 spinal arachnoid diverticula
- 5 lumbosacral stenosis
- 3 spinal empyema (Concurrent systemic abnormalities)
Imaging features of discospondylitis in cats. Gomes et al. 2019
- L7-S1 in 50% of cases
- MRI features included;
> Hyperintense NP on T2W (71%) and STIR (85%)
> Contrast enhancement in 100%
> Adjacent endplate involvement 77%
> T2W hyperintense adjacent soft tissue 79%
> Presence of spondylosis deforms 71%
> Narrowed or collapsed IVD 57%
> Contrast enhancement of vertebral bodies 46%
> Epidural space involvement 36%
> Compression of spinal cord and/or nerve root 36%
> Paraspinal abscessation 21%
> Most common radiological featuresollapse or narrowing of the affected IVDS (80%) and endplate erosion (60%).
Evaluation of prognostic factors for return or urinary and defecatory function in cats with sacrocaudal luxation. Couper et al. 2020
- 90% regained voluntary urinary function
- Higher neurological grade was associated with decreased likelihood and longer duration of regaining urinary function.
- Cats that regained defecatory function had longer survival times than those that did not recover defecatory function.
- Defecatory outcome was not significantly associated with any other variables.
Thoracic vertebral canal stenosis in cats: clinical features, diagnostic imaging findings, treatment and outcome. Gillespie et al. 2020
- 9 cats, with BSH and MN cats over-represented
- Median age 9 years
- Chronic, progressive, painful, ambulatory, T3-L3 myelopathies
- Surgery in 2 cats, both improved but one relapsed
- Medical in 5 cats with 3 getting worse and 2 improving.
-Compared with controls, affected cats had a lower vertebral canal height at multiple thoracic vertebral levels.
-Unaffected British Shorthairs had a lower thoracic vertebral canal height at multiple levels than control domestic shorthairs (P <0.05).
Assessment of the cutaneous trunci muscle reflex in neurologically abnormal cats. Paushter et al. 2020
- 182 cats
- 64.8% has present CTR
- 35.2% it was absent
- Only significant finding was found between spinal pain and CTR outcome (P = 0.037).
- Further evidence the CTR in cats is unreliable
Surgical treatment of rostrotentorial meningioma complicated by foraminal herniation in the cat. Kouno et al. 2020
- Median overall tumour excision rate was 90.6%.
- Preoperative intracranial pressure (ICP) ranged from 15 to 32 mmHg (median 29 mmHg).
- In all cases, the ICP dropped to 0 mmHg immediately after tumour removal.
- No adjuvant therapy was required after surgery.
- The median survival period was 612 days (range 55–1453 days).
Prevalence and clinical characteristics of phenobarbitone-associated adverse effects in epileptic cats. Marsh et al. 2020
- 77 cats in study and 45% of them had side effects reported.
- Sedation (89%)
- Ataxia (53%)
- Polyphagia (22%)
- Polydipsia (6%)
- Polyuria (6%)
- Anorexia (6%)
- Dose dependant; for each 1 mg/kg q12h increment of phenobarbitone, the likelihood of adverse effects increased 3.1 times.
- When a second AED was used, the likelihood of adverse effects increased 3.2 times.
MRI findings, including diffusion-weighted imaging, in seven cats with nasal lymphoma and two cats with nasal adenocarcinoma. Tanaka et al. 2020
- All cats showed hyper intensity on DWI.
- Median ADC values of lymphoma tended to be lower than adenocarcinoma.
Transient hyperammonaemia following epileptic seizures in cats. Nilsson et al. 2020
- 5 epileptic cats
- Nh3 was taken in close proximity to or during an active seizure.
- Blood ammonia on initial testing was all in-between 146-195umol/l.
- All cats shown spontaneous decrease in ammonia levels 2h-3days after.
Clinical reasoning in feline vestibular syndrome: which presenting features are the most important? Grapes et al. 2020
- Most common presentations were;
- OM/OI 27%
- Idiopathic 22% (associated with non-purebred cats and improves with time)
- Neoplasia 13% (seen more with older cats, chronic signs and central localisation and postural deficits)
- Middle ear polyp 9% (8.8x more likely to also have Horners)
- FIP 7%
- Thiamine deficiency 7% (more common in females and 6.8times more likely to have bilateral vestibular)
- Intracranial empyema 6%
MRI of the optic nerve sheath and globe in cats with and without presumed intracranial hypertension. Lodzinska et al. 2020
- The measurement of the ONSD and the ONSD:ETD ratio on T2-weighted MRI might not be reliable as non-invasive tests for diagnosing intracranial hypertension in cats.
CT findings and prognostic value of the Koret CT score in cats with traumatic brain injury. Mann et al. 2021
- 14 cats in study, 9 survived and 5 died.
-Abnormal CT findings included;
> lateral ventricle asymmetry/midline shift (42.8%),
> intracranial haemorrhage (35.7%),
> caudotentorial lesions (14.2%)
> cranial vault fractures (14.2%), all of which were depressed. - Intracranial haemorrhage was found to be significantly and negatively associated with short-term and long-term survival.
- KCTS was significantly associated with short-term and long-term survival.
- A KCTS cut-off value of 2 yielded a 100% sensitivity and 100% specificity for short-term survival and 100% sensitivity and 80% specificity for long-term survival.
- A MGCS cut-off value of ⩾13 was associated with a 100% sensitivity and 100% specificity for short-term survival, and with a 100% sensitivity and 80% specificity for long-term survival.
Clinical features, treatment and outcome of discospondylitis in cats. Gomes et al. 2021
- 17 cats
- 76.5% DSH
- Median age 9 years
- Median duration of signs 3 weeks
- Only 3 cats had pyrexia
- Neurological dysfunction in 64.7% of cats
- T3-L3 or L4-S2
- 11.8% had positive bacterial cultures.
- Medical management was 3 months of antibiotics and NSAID +/or gabapentin, and restricted exercise for 4 weeks.
- 12 cats had excellent outcome, and improved neurological signs in 83.3%
- Recurrence occurred in 1 cat.
-Spinal hyperaesthesia was universally present, with neurological dysfunction also highly prevalent. Bacterial culture was unrewarding in most cases. Amoxicillin–clavulanic acid or cephalosporins are reasonable choices for first-line antibiotics. Prognosis was favourable
Outcome of thoracolumbar surgical feline IVDD. Fowler et al. 2021
- 35 cats
- 54.2% has difficulty walking
- 57% of cats were L4-S3
- 34% had an IVDE at L6-L7
- 62.5% has positive outcome immediately after surgery and 91.3% improved at 2 week recheck.
Phenotypic characterisation of paroxysmal dyskinesia in Sphynx cats. James et al. 2021
- 10 cats
- All <4 years
- Episodes lasted <5 mints in 90%
- Impaired ambulation due to muscle hypertonicity, most commonly affecting hips and pelvic limbs (90%), shoulders and thoracic limbs (80%).
- Head, neck, back and abdomen were also seen to be involved.
Epilepsy in British Shorthair cats in Sweden. Tenger et al. 2021
- Prevalence of epilepsy in BSH was 0.9%
- Infrequent but consistent epileptic seizures.
- 27% had clusters and none has SE
- None were treated with AEDs
Feline temporal lobe epilepsy: seven cases of hippocampal and piriform lobe necrosis in England and literature review. Scalia et al. 2021
- Seizures are typically focal and feature uni- or bilateral orofacial or head twitching, hypersalivation, lip smacking, mydriasis, vocalisation and motionless staring, with inter-ictal behavioural changes such as unprovoked aggression and rapid running.
- Diagnosis is achieved clinically and with brain MRI; electroencephalography and voltage-gated potassium channel-complex autoantibodies are currently the subject of research.
- Affected cats are frequently refractory to conventional antiepileptic treatment.
- The hippocampus and piriform lobe are proposed as the neuroanatomical localisation for focal seizures with orofacial involvement in cats
Survey of risk factors and frequency of clinical signs observed with feline cognitive dysfunction syndrome. MacQuiddy et al. 2022
- 80 cats in FCD positive and 114 as FCD negative
- Most common signs was vocalising (40%)
- The only variable determined to have an association with the FCD group was the environmental setting.
- Cats living in a rural environment had a reduced chance of FCD
Relationship between admission vitals and brain herniation in 32 cats: a retrospective study. Her et al. 2021
- 33 cats with brain herniation and 44 with abnormal brain MRI without herniation.
- Cats with intracranial neoplasia were found to be at increased risk of herniation.
- Odds of herniation increased with age.
- Cats with herniation has a significantly lower level of consciousness in their MGCS
- No significant difference in either motor activity or brainstem reflexes
- Admission heart rate and blood pressure were not associated with brain herniation.
Prevalence, clinical presentation and MRI of intervertebral disc herniations in cats. Bibbiani et al. 2022
- 39 cats had single IVDH and 4 had multiple
- ANNPE in 22 cats (51%)
- IVDP in 19 cats
- IVDE in 9 cats (20%)
- Males more commonly affected by IVDE and females ANNPE
- Cats with IVDP had longer clinical signs compared to ANNPE and had milder signs.
- IVDEs were statistically significantly associated with spinal hyperaesthesia while ANNPEs were not (P = 0.014).
Otitis media and interna with or without polyps in cats association between meningeal enhancement on post contrast MRI, CSF abnormalities, and clinician treatment choice and outcome. Dutil et al. 2022
- 58 cats diagnosed with OMI with or without polyps.
- Meningeal enhancement reported in 26 cats (48%) of which 9 had an abnormal CSF.
- 32 cats had no meningeal enhancement (55%), and 10 of then had abnormal CSF
- No association was found between MgE, CSF or bacteriology findings
- 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.
Reversible positioning head tilt observed in 14 cats with hypokalaemic myopathy. Tamura et al. 2023
- Positioning head tilt (PHT) is a dynamic neurological sign in which the head tilts to the opposite side to which it is moving.
- This sign is triggered in response to head movement.
- Here, we describe the acute onset of PHT in 14 cats.
- All the cats were diagnosed with hypokalaemic myopathy caused by a range of pathologies.
- The PHT resolved along with other signs related to myopathy, such as cervical flexion and generalised weakness, after electrolyte correction in all cats.
Suppression of inner ear signal intensity on fluid-attenuated inversion recovery magnetic resonance imaging in cats with vestibular disease. Everest et al.
- The OMI group had significantly lower FLAIR suppression scores compared with all other groups.
- The CSF cell count was also significantly increased in the OMI and inflammatory CNS disease groups compared with the control group.
Diagnostic value of CSF in epileptic cats with unremarkable brain MRI or hippocampal signal changes only. Majercikova et al. 2023
- 87 cats
- 80.5% had unremarkable MRI - 5.7% had hippocampal signal changes with contrast enhancement.
- 13.8% had hippocampal changes without contracts enhancement.
- Only 4 cats (4.6%) had abnormalities on CSF (raised TNCC only)
- Our results show that, in our cohort of epileptic cats with unremarkable brain MRI or with hippocampal signal changes, CSF analysis was usually normal. This should be considered before performing a CSF tap.
Manifestations of hypertensive encephalopathy in cats. Moretto et al. 2023
- 56 hypertensive cats (2 sets of systolic blood measure >160mmHg)
- 31 had neurological signs.
- in 16 cats the neuro signs were the primary complaint.
- Most common neuro signs were ataxia, seizures, altered behaviour.
- in 28/30 cats retinal lesions were detected.
- A fundic examination in cats with suspected hypertensive encephalopathy is a sensitive test to support the diagnosis.
Does preappointment gabapentin affect neurological examination findings? A prospective randomised and blinded study in healthy cats. Azevedo et al.
- Gabapentin significantly altered gait analyses and postural reactions in this group of healthy cats.
- The administration of gabapentin could lead to false–positive results and, possibly, an incorrect identification of neurological lesions.
- In contrast, gabapentin did not impair the assessment of cranial nerves and spinal reflexes, which can be assessed in patients receiving the drug.
Outcome and quality of life after intracranial meningioma surgery in cats. Koch et al. 2023
- 14 cats who underwent craniotomy
- Contacted via telephone after a median time of 967 days
-Owners reported a statistically significant improvement from immediately after the operation to 240 days after surgery. - Preoperative clinical signs resolved in 95% of cases.
- All questioned owners would opt for surgery again.
Demographics, clinical findings and diagnoses of cranial thoracic myelopathies (T1–T6 vertebrae) in cats. Benito et al. 2023
- 21 cases
- 76% had chronic histories.
- 86% has progressive signs.
- Median duration was 29 days
- 90% localised to T3-L3, and most common location was T3-T4 (29%)
- Neoplasia diagnosed in 42.9%
- Inflammatory in 24%
- Anomalous in 19%
- Degenerative in 9.5%
- Vascular in 4.8%
- CTMR was normal in 86% of cases
- Non-painful. 71% did not show pain.
Once-a-day oral treatment with phenobarbital in cats with presumptive idiopathic epilepsy. Mojarradi et al. 2023
- 9 cats with presumptive IE
- All received PB once a day
- Seizure remission was achieved in 88% of cats
- Good seizure control in the other cat.
- Mean dose of oral PB was 2.6mg/kg SID (range 1.4-3.8)
- No cats required an increase of their PB frequency at any time during mean follow up of 3.5years
Alpha-chloralose poisoning in 25 cats: clinical picture and evaluation of treatment with intravenous lipid emulsion. Lundgren et al. 2024
- Alternative version of rodenticide.
- CNS signs including bradycardia, hypothermia, tremors (88%) and cranial nerve deficits (80%)
- No significant difference in AC concentration or change in intoxication score over time was found when being treated with or without intralipid.
- ILE did not have any effect on the AC serum concentration or clinical signs in AC-poisoned cats. All cats survived until follow-up. In cats with an acute onset of the described neurological signs, AC intoxication is an important differential diagnosis with an excellent prognosis.
