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An Unusual Case of Neurological Signs in a Dog Amy B. Worell, DVM, ABVP-Avian
subheading An 8 year old miniature pincher named "Sammy" was presented to a local clinic with an acute onset of circling, stumbling, shaking his head and bumping into things. The local veterinarian reported that "Sammy" was blind, laying on his side unable to get up, and had dilated, unresponsive pupils. He was given an injection of intravenous steroids and referred to a specialty clinic. At the specialty referral hospital, a physical examination demonstrated that "Sammy" had minor postural or neurological deficits, was quiet, and decreased sensations on the left side of his face. Blood work and radiographs were normal. The pet was observed for 24 hours then released home. The clinic was concerned about the possibility of a brain tumor or encephalitis. A recheck was recommended for the following week. The pet was presented at All Pets Medical Centre three weeks after the initial incident for a second opinion. The pet had been doing ok at home but seemed slow and lethargic to the owner.
A tentative diagnosis of erythrocytosis was considered. Also called polycythemia, this condition can be defined as an increase of the red blood cell count, packed cell volume or Hematocrit, and hemoglobin concentration. Thus, what clinically occurs as the result of too many red blood cells is a situation where not enough oxygen is present. The increased number of red blood cells causes the blood to be "sludged," and clinical signs can result. Clinical signs can include listlessness and neurological signs, due to the decreased oxygen in the body. This condition can be divided into two forms, absolute and secondary erythrocytosis. In both forms, the number of red blood cell is greatly increased above normal levels, with resulting clinical signs. Absolute erythrocytosis most commonly results when an underlying or secondary condition exists, which usually can be attributed to underlying neoplasia, or cancer. This underlying cancer usually involves the kidneys. This is compared to secondary erythrocytosis which is caused by altered regulatory activity or excessive production of EPO, or erythropoietin. EPO, basically, is a hormone which is produced by the kidneys that stimulates the bone marrow to produce more red blood cells. When more red blood cells are produced such as in this type of situation, the result is systemic (or whole body) hypoxia (deceased or lowered amount of oxygen). Common underlying causes for this would be heart or lung problems, and cancer. In light of this tentative diagnosis, a search for an underlying cause, including cancer was undertaken. Chest and abdominal radiographs were performed, and the findings were within normal limits. A subsequent ultrasound of the aforementioned cavities demonstrated no gross abnormalities either. It was thus concluded that "Sammy" had secondary erythrocytosis. In the case of "Sammy," the referral center, for whatever reason, did not have a red blood cell count or any other red blood cell indices on the labwork, and hence the cause of the pet's presentation was not understood. Treatment for polycythemia can involve several methods. With "Sammy," therapeutic phlebotomies were instigated. This technique involves removing significant amounts of blood to reduce the Hct and number of red blood cells, so that a more normal level exists in the body. The goal would be to only perform these every 4 to 8 weeks, once the Hct has stabilized at 55-60%. The amount to be removed is related to the pet's body weight. For "Sammy," the recommended amount for this 11 pound pet was between 50 and 100 cc of blood. For this procedure, the pet was hospitalized, an initial Hct was taken, which at the time was 78%. The pet was started on intravenous fluids, and serial removal of blood was accomplished over some time with the total removal of 50 cc of blood. The resulting Hct was 72%. The pet returned in a week for a recheck examination at which time the pet was better during the day but still listless at night. The Hct at this time was 70%. The pet was scheduled to return in several days for a second phlebotomy. On the next recheck examination, the pet was unchanged at home and the Hct at this time was 76%. 60 cc of whole blood was once again removed with a resulting Hct of 68%. The pet returned several days later for a subsequent recheck, at which time the Hct was 66%. This time, 85cc of blood was removed with a resulting Hct of 58%. It was then decided to discontinue the phlebotomies as the results were not as good as desired. The pet was then started on a drug called hydroxyurea, which causes myelosuppression (suppression of the bone marrow). As the pet's Hct at this time was in the high 50s, this also is an ideal time to begin the hydroxyurea. The pet was rechecked one week after commencing the new medication. At this time, the pet was improved at home, and the Hct was 54%. A CBC or complete blood count was submitted to assure that the new medication was not causing negative side effects. The pet has been rechecked several times since then, with the last Hct being 38%. The owner reports that the pet is now clinically normal with no reoccurrence of neurological signs. The pet will remain on this medication for the rest of his life, with intermittent rechecks. The outlook for "Sammy" is guarded but good. Animal and Avian Websites The Morris Animal Foundation California CageWorks House Rabbit Society Home Page and Rabbit Care Guide |
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All Pets Medical Centre/Rolling Oak Aviaries
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