Lead intoxication mimicking idiopathic epilepsy in a young dog

An 11-month-old neutered female cocker spaniel was referred for two generalised tonic-clonic epileptic seizures with a one-week interval of mild depression. On admission, physical and neurological examinations were unremarkable. Neurolocalisation was forebrain. Haematology, biochemistry, serology for infectious diseases, urinalysis and urine culture were unremarkable. Cerebral MRI revealed T1-weighted hyperintensity in the lentiform nuclei. Cerebrospinal fluid analysis was unremarkable. Idiopathic epilepsy was mistakenly diagnosed and phenobarbital was started. A delayed blood film examination revealed metarubricytosis, polychromasia and basophilic stippling, raising the suspicion of lead intoxication. Abdominal radiography revealed a metallic lead foreign body (lead curtain weight), which removed endoscopically. Treatment with CaEDTA, thiamine and D-penicillamine was started. This report highlights the importance of including haematology, blood smear examination, biochemistry and urinalysis in the diagnostic workup of acute epileptic seizures particularly in young dogs. Lead intoxication should be included in the differential diagnosis in these patients, as modern lead sources still exist in our environment.