The treatment and outcome of central nervous system hemangiosarcoma has rarely been documented in dogs, seldom intracranially. We present the first two canine cases of ante-mortem diagnosis, surgical & post-operative adjunctive treatment, and outcome of intracranial hemangiosarcoma presenting as a solitary mass. Each patient originally presented following onset of seizure activity. Both patients underwent magnetic resonance imaging (MRI) of the brain which revealed an intracranial mass. The masses were surgically removed, and histopathological evaluation was consistent with hemangiosarcoma in each case. Both patients underwent screening for primary and metastatic neoplasia, but there was no evidence of neoplasia elsewhere in the body, raising a suspicion of primary intracranial hemangiosarcoma (not confirmed due to absence of necropsy). One patient solely underwent surgical resection with no additional adjuvant therapy and was humanely euthanized 87 days post-operatively due to worsening of quality of life. The other patient received post-operative adjuvant therapy with doxorubicin. Recurrent cluster seizure activity prompted repeat MRI 280 days post-operatively, which confirmed regrowth. Radiation therapy with stereotactic radiosurgery (SRS, CyberKnife®) was pursued on day 310; however, the dog was humanely euthanized due to worsening behavioral changes 314 days post-operatively. This series discusses that surgical resection of this solitary mass is doable and may be associated with good quality of life in the short to intermediate term.

Neural tube defects (NTDs) are a group of congenital malformations characterized by various levels of protrusions of meninges with or without nervous tissue through incomplete osseous coverage (cranium bifidum for the cranial forms and spina bifida for spinal meningoceles/myelomeningoceles [MCs/MMCs]), with associated dorsal midline cutaneous signs. Amongst a confusing vocabulary, spina bifida is both the term most used to refer to NTDs and the most common manifestation of NTDs, with a predilection for the lumbosacral area in screw-tail breeds. With the growing popularity of bulldogs, lumbosacral (LS) MCs/MMCs are increasingly encountered, and small animal practitioners should learn to recognize them. Clinical signs may include urinary and/or fecal incontinence, pelvic limb neurological deficits with bunny hopping (neurolocalization L4-caudal or subset), and cutaneous signs (swirl of hair and dimple); the combination of which is pathognomonic of these disorders in bulldog puppies. Since these malformations often trigger a tethered cord syndrome (TCS), neurological worsening is possible. While historically reported to be somewhat hopeless regarding neurological improvement, isolated case reports, small case series, and personal experience of the author indicates that post-operative improvement is possible. Review of the literature (14 cases) and personal surgical experience (9 cases) retrieved 23 canine cases of LS MC/MMC treated surgically with follow-up. Clinical presentation, diagnostic imaging findings (CT and MRI), and intra- and post-operative findings are discussed in this article, along with a detailed description of the surgical technique. Pelvic limb deficits improve post-surgically in most cases (14/17 [82%] cases with pre-operative deficits and follow-up ≥1 month) albeit sometimes only marginally. Urinary/fecal continence can improve also, although less frequently (10/21 [48%] at 1 month follow-up and 8/21 [38%] at ≥6 months).

ObjectiveTo determine if a single brain biopsy utilizing a freeze-core needle harvest system Cassi II under ultrasound guidance provides a diagnostic sample; to evaluate the technique's efficacy in procuring diagnostic samples in comparison with “open” surgical biopsies; and to describe intraoperative complications associated with the technique.Study designExperimental clinical study.AnimalsSeventeen dogs and four cats with magnetic resonance imaging (MRI) diagnoses of readily surgically accessible intracranial masses.MethodsImmediately prior to surgical biopsy (SB), freeze-core biopsy (FCB) sample was obtained from each patient under ultrasound guidance.ResultsHistopathology results from single FCB samples were found to be in 100% agreement with the SB samples. Freezing artifact was minimal and did not interfere with histopathologic interpretation. There were no intraoperative complications specifically attributable to the use of the FCB system.ConclusionBased on the results of this small experimental study, the FCB system is expected to safely yield diagnostic quality intracranial masses biopsy specimens.Clinical significanceThis system has the potential of obtaining diagnostic biopsies of more deeply seated brain lesions (i.e., intra-axial tumors considered inaccessible or with large risks/difficulties by standard surgical means) which would provide a definitive diagnosis to guide appropriate therapy.

Chapter 21 Integrative Approach to Neurology Patrick Roynard, Patrick RoynardSearch for more papers by this author Patrick Roynard, Patrick RoynardSearch for more papers by this author Book Editor(s):Mushtaq A. Memon, Mushtaq A. MemonSearch for more papers by this authorHuisheng Xie, Huisheng XieSearch for more papers by this author First published: 30 May 2023 https://doi.org/10.1002/9781119823551.ch21 AboutPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Abstract Integrative treatment modalities can be used to treat companion animal neurological disorders, most commonly as adjunct but also as occasional alternative to conventional management. Acupuncture is a passive treatment modality (hence well suited when rest is indicated), which may help through decreasing inflammatory mediators and neuronal damage. It is commonly used in myelopathies such as canine IVDD, as adjunct to medical/conservative management or post-operatively for surgical cases. 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Status epilepticus (SE) and cluster seizures (CS) are common occurrences in veterinary neurology and frequent reasons of admission to veterinary hospitals. With prolonged seizure activity, gamma amino-butyric acid (GABA) receptors (GABAa receptors) become inactive, leading to a state of pharmacoresistance to benzodiazepines and other GABAergic medications, which is called refractory status epilepticus (RSE). Prolonged seizure activity is also associated with overexpression of N -methyl- D -aspartic (NMDA) receptors. Rodent models have shown the efficacy of ketamine (KET) in treating RSE, and its use has been reported in one canine case of RSE. Boluses of KET 5 mg/kg IV have become the preferred treatment for RSE in our hospital. A retrospective study was performed to evaluate and report our experience with KET IV bolus to treat prolonged and/or repeated seizure activity in cases of canine CS, SE, and RSE. A total of 15 dogs were retrieved, for 20 hospitalizations and 28 KET IV injections over 3 years. KET IV boluses were used 12 times for RSE (9 generalized seizures, 3 focal seizures) and KET terminated the episode of RSE 12/12 times (100%); however, seizures recurred 4/12 times (33%) within ≤6 h of KET IV bolus. When used for CS apart from episodes of RSE, KET IV bolus was associated with termination of the CS episode only 4/14 times (29%). Only 4/28 (14%) KET IV boluses were associated with adverse effects imputable only to the use of KET. One dog experienced a short, self-limited seizure activity during administration of KET IV, which was most likely related to a pre-mature use of KET IV (i.e., before GABAergic resistance and NMDA receptor overexpression had taken place). This study indicates that KET 5 mg/kg IV bolus may be successful for the treatment of RSE in dogs.

Syringobulbia is a pathologic condition characterized by one or more fluid-filled cavities within the brainstem. This retrospective case series describes observations in eight dogs with syringobulbia diagnosed during MRI. All dogs were adult, small-breed dogs with concurrent syringomyelia and neurologic deficits localized to sites rostral to the spinal cord, which cannot be explained by syringomyelia (eg, six dogs had vestibular signs). On MRI, the fluid-filled cavities had signal intensity characteristics like cerebrospinal fluid, were in the medulla oblongata, and were solitary in each dog. Initially, the shape of the cavity was a slit in five dogs and bulbous in two dogs. Magnetic resonance imaging was repeated in five dogs (6-55 months of age). One dog had progression of syringobulbia from slit-like to bulbous, and four dogs had unchanged slit-like syringobulbia. One dog developed slit-like syringobulbia after cranioplasty. A variety of medical and surgical treatments were performed with improvement of some but not all clinical signs. One dog died following surgery due to cardiopulmonary failure and the other seven dogs were alive at least 1 year after the initial diagnosis, which was the least time of follow-up. One surviving dog developed a unilateral hypoglossal nerve deficit 2 months after the initial diagnosis and megaesophagus 14 months later. In conclusion, detecting a fluid-filled cavity in the medulla oblongata consistent with syringobulbia is possible in dogs undergoing MRI. The cavity is likely acquired, slit-like or bulbous, progressive, or static, and might be associated with breed size and neurologic signs localized to the medulla oblongata.

The increase in client willingness to pursue surgical procedures, the heightened perceived value of veterinary patients, and the desire to provide comprehensive medical care have driven the recent demand of using an integrative treatment approach in veterinary rehabilitation. Physical therapy following neurologic injury has been the standard of care in human medicine for decades, whereas similar rehabilitation techniques have only recently been adapted and utilized in veterinary medicine. Spinal cord injury is the most common neurologic disease currently addressed by veterinary rehabilitation specialists and will be the primary focus of this review; however, research in other neurologic conditions will also be discussed. Of particular interest, to clients and veterinarians are techniques and modalities used to promote functional recovery after neurologic injury, which can mean the difference between life and death for many veterinary patients.

Modern research on traditional Chinese veterinary medicine (TCVM), including herbal medicine and acupuncture, has made evident the role of the nervous system as a cornerstone in many of the mechanisms of action of TCVM. Laboratory models and clinical research available are supportive for the use of TCVM in the management of neurologic conditions in small animals, specifically in cases of intervertebral disk disease, other myelopathies, and painful conditions. This article is meant to help guide the use of TCVM for neurologic disorders in small animals, based on available information and recommendations from experienced TCVM practitioners.

The increase in client willingness to pursue surgical procedures, the heightened perceived value of veterinary patients, and the desire to provide comprehensive medical care have driven the recent demand of using an integrative treatment approach in veterinary rehabilitation. Physical therapy following neurologic injury has been the standard of care in human medicine for decades, whereas similar rehabilitation techniques have only recently been adapted and utilized in veterinary medicine. Spinal cord injury is the most common neurologic disease currently addressed by veterinary rehabilitation specialists and will be the primary focus of this review; however, research in other neurologic conditions will also be discussed. Of particular interest, to clients and veterinarians are techniques and modalities used to promote functional recovery after neurologic injury, which can mean the difference between life and death for many veterinary patients. The trend in human neurologic rehabilitation, often regardless of etiology, is a multimodal approach to therapy. Evidence supports faster and improved recoveries in people after neurologic injury using a combination of rehabilitation techniques. Although the primary neurological disorders researched tend to be spinal cord injury, peripheral neuropathies, allodynia, multiple sclerosis, and strokes-many correlations can be made to common veterinary neurological disorders. Such comprehensive protocols entail gait training activities in combination with neuromuscular electrical stimulation and directed exercises. Additionally, pain-relieving and functional benefits are bolstered when acupuncture is used in addition to rehabilitation. Studies, both laboratory and clinical, support the use of acupuncture in the management of neurologic conditions in small animals, specifically in cases of intervertebral disc disease, other myelopathies, and neuropathic pain conditions. Acupuncture's ability to promote analgesia, stimulate trophic factors, and decrease inflammation, including neuroinflammation, make it an alluring adjunct therapy after neurologic injury. Although there is limited research in veterinary medicine on physical techniques that expedite recovery after neurologic injury, there are sparse publications on clinical veterinary research suggesting the benefits of acupuncture, rehabilitation, and LASER in dogs with intervertebral disk disease. Accordingly, due to the relative lack of evidence-based studies in veterinary neurologic rehabilitation, much of the data available is human or laboratory-animal based, however, evidence supports the utilization of an early, comprehensive treatment protocol for optimal neurologic recovery. The rationale for why an integrative approach is critical will be detailed in this review; in addition, literature on specific physical rehabilitation techniques that have evidence of improved recoveries after neurologic injury, will be addressed.

OBJECTIVES : To report the clinical presentation, magnetic resonance imaging features, treatments and outcomes of canine vertebral chondrosarcoma.MATERIALS AND METHODS : Retrospective review of medical records of dogs with confirmed vertebral chondrosarcoma and magnetic resonance imaging of the lesions, from four different veterinary referral institutions.RESULTS : A total of six dogs were included in this report. In all cases, magnetic resonance imaging revealed a lobulated mass involving the dorsal vertebral compartment, markedly hyperintense with few foci of hypointensity on T2-weighted images, iso to hypointense on T1-weighted images with contrast enhancement after gadolinium administration. Intralesional surgical resection was performed in three dogs and medical management in one, two dogs were euthanased and all lesions were submitted for histopathology. Magnetic resonance imaging findings correlated with histological findings of a low tumour grade. Rapid clinical improvement was noted after surgery but two of three dogs had local regrowth.CLINICAL SIGNIFICANCE : Chondrosarcomas show local aggressiveness and resistance to conventional radiotherapy and chemotherapy, and so prognosis depends on feasibility of en bloc resection. Magnetic resonance imaging may be helpful in establishing a presumptive diagnosis and prognosis based on the feasibility of surgical resection.

Idiopathic hypertrophic pachymeningitis has been described in humans as a rare, chronic progressive non-specific inflammatory and fibrotic disease of the dura mater. This is a case series of six canine cases of presumptive or confirmed intracranial idiopathic hypertrophic pachymeningitis. These dogs were included in this retrospective study, based on magnetic resonance imaging findings. All presented with pachymeningeal thickening and enhancement without involvement of the leptomeninges on magnetic resonance imaging and no underlying cause identified on cerebrospinal fluid analysis, complete blood count, serum biochemistry and infectious disease titres. Histopathological examination was available in one case. Response to immunomodulatory treatment (corticosteroids and cytosine arabinoside) was achieved in five cases. Idiopathic hypertrophic pachymeningitis should be considered as a possible differential diagnosis for dogs with pachymeningeal thickening on magnetic resonance imaging and no identified underlying cause. The prognosis appears to be fair to poor.