27 de ago de 2018

Kernicterus in an Adult Dog

Acta Scientiae Veterinariae, 2018. 46(Suppl 1): 250.


Luciana Sonne , Djeison Lutier Raymundo , Bianca Santana de Cecco , Adriana da Silva Santos , Caroline Argenta Pescador , Eduardo Conceição de Oliveira1 & David Driemeier

Background: Kernicterus or bilirubin encephalopathy is a condition rarely observed in animal characterized by a yellowish discoloration of the central nervous system. It is a potentially fatal condition due to bilirubin neurotoxic effects caused by the increase of non-conjugated bilirubin pigment, which passes blood brain barrier and has been attributed to an imbalance between albumin and bilirubin levels. Intracellular bilirubin is toxic for cells and can cause decrease in protein synthesis, specially albumin, depression of cell respiration and cellular death. This paper describes kernicterus in a 2-year-old Great Dane female dog. 
Case: Clinically, the animal showed apathy, lethargy, weight loss and jaundice, which progressed to vomiting and neurological signs characterized by loss of consciousness and eventually coma. Blood parameters were within normal range, except for high levels of alanine aminotransferase (523 U/L), suggesting a liver lesion. The animal was submitted to euthanasia due to the poor prognosis, and at post-mortem examination it showed dehydration and severe jaundice, especially oral, vaginal and ocular mucosas, subcutaneous tissue and blood vessels intima surface. The liver had an accentuated lobular pattern, and the stomach mucosa was reddened. Multiple petechiae were observed in the epicardium, as well as icterus in the blood vessels of the heart. Furthermore, the brain and cerebellum cortex, thalamic region and nuclei region of brainstem showed extensive icteric areas. Microscopically, the liver presented a mononuclear portal hepatitis, centrilobular necrosis and presence of yellowish pigments. The brain had neuronal necrosis, mild vacuolization of the white matter, perineuronal edema and Alzheimer type II astrocytes, while cerebellum showed Purkinje cells necrosis. Hepatic cooper measurement was within range values, and direct imunofluorescence for the detection of Leptospira sp. was negative. 
Discussion: Kernicterus pathogenesis has been extensively studied, as the condition is commonly seen in neonatal humans. Diagnosis is based on gross and microscopic lesions in brain, which are consistent with bilirubin encephalopathy caused by the necrosis and degeneration of neurons. This condition is related to cases of intense hyperbilirubinemia, which exceeds the albumin binding capacity and, therefore, the excess of unconjugated bilirubin that can pass through the blood brain barrier. Liver disease causes deficient production of protein, especially albumin, decreasing the potential binding capacity to bilirubin, and consequently causing hyperbilirubinemia. In this case, the previously detected hepatic lesion suggested by liver enzymes increased, probably led to protein production dysfunction, causing hypoalbuminemia and hyperbilirubinemia. Unfortunately, albumin and bilirubin seric levels could not be measured. Decrease in albumin production along with the excess of unconjugated bilirubin caused the jaundice, and in cases like this one described, the blood brain barrier is compromised and the kernicterus occurs. Unconjugated bilirubin has negative effect in the glutamate uptake causing extracellular accumulation of it, which is consequently neurotoxic, causing necrosis and degeneration leading to a characteristic encephalopathy in animals with kernicterus. In this report, it was not possible to determine the primary hepatic disease, however this caused clinical neurotoxic disease, known as bilirubin encephalopathy.

24 de ago de 2018

Surgical Excision of an Osteochondroma in a Nerve Root of the Cauda Equina of a Dog

Acta Scientiae Veterinariae, 2018. 46(Suppl 1): 327


Juliana Campos de Barros , Larissa Garbelini Valentim , Raira Costa Dias , Alfredo Hajime Tanaka Pereira , Giovana Wingeter Di Santis & Mônica Vicky Bahr Arias


Background: Spinal neoplasms are classified into extradural, intradural/extramedullary or intramedullary. Intradural/extramedullary tumors include meningiomas and nerve sheath tumors, which arise from meninges or peripheral nerves around the spinal cord. Clinical signs are related to dysfunction of the involved nerve and include pain, nerve root signature and atrophy. Osteochondromas are benign tumors located within the bone, on its surface or in extra-osseous regions, when they are classified as soft tissue osteochondoma. The aim of this study is to describe a case of an osteochondroma in a nervous root of the cauda equina in a dog, whose surgical resection allowed the resolution of the clinical signs.
Case: A 12-year-old, male, Labrador Retriever dog, was presented with a 40-day history of progressive, painful, pelvic limb paresis, with no improvement when treated with analgesics and acupuncture. Neurological abnormalities included paraparesis, sometimes worse in the left pelvic limb, that was carried flexed at the level of the stifle, hindlimb atrophy, decreased interdigital reflexes and pain in the lumbar spinal region, mainly over L6 vertebra. Results of blood count and serum biochemical analysis were unremarkable. Computed tomography (CT) of the lumbosacral area was performed and the evaluation of images in transverse and reconstructed dorsal and sagittal planes allowed the visualization of a hyperattenuating and calcified round structure with 8 mm x 6 mm, in the left side of vertebral canal, at the level of caudal epiphysis of L6. Lumbosacral (L7-S1) CT abnormalities, as subchondral sclerosis, mild disc margin bulging, spondylosis deformans and foraminal proliferation were also observed but were considered clinically insignificant. Then, a dorsal L6 laminectomy was performed and after opening of the vertebral canal it was observed the presence of an ovoid mass, in the left side of the medullary cone, measuring approximately 0.9 cm in length, originating from a sacral nerve root. This structure was excised and submitted to histopathological evaluation. The dog improved after surgery without any complications, and neurological functions were gradually recovered. The histopathology of the mass was confirmed as an osteochondroma. Discussion: The history and neurologic examination findings as well the improvement after surgery were compatible with the lesion visualized by TC in L6, rather than the degenerative changes in L7-S1. Regarding the position of the mass, the main differential would be nerve sheath tumor, one of the most common types of primary neoplasia of the peripheral nervous system, however in a CT study in dogs with brachial plexus and nerve roots neoplasms, calcification of the tumor was not observed. Most of benign cartilaginous tumors of soft tissue are chondromas/osteochondromas, and this lesion should not be confused with multiple osteochondroma or multiple cartilaginous exostoses, which have been reported as multifocal, proliferative lesions involving the surface of ribs, vertebrae and pelvis of young dogs. If this lesion is unique, it is called osteochondroma. There are two reports of chondromas into the first lumbar vertebrae of dogs, with adherence to the floor of the vertebral canal and one report of an osteochondroma originated from the left pedicle of T11 in a cat. Radiculopathy and myelopathy caused by osteochondromas inside the spine are rare in humans and description of this tumor arising from nerve roots were not found in the veterinary literature. Probably the origin of the mass was metaplasia of the meninges surrounding the nervous root. In conclusion, neurological examination, CT and surgical exploration allowed the diagnosis and removal of a soft tissue osteochondroma, a rare benign tumor, with good patient recovery

21 de ago de 2018

Doenças do sistema nervoso central em cães

Pesq. Vet. Bras. 38(5):935-948, maio 2018


Maria T.S. Frade, Jefferson S. Ferreira , Maria J.R. Nascimento , Vitória V.F. Aquino , Isabel L. Macêdo , Rosileide S. Carneiro , Almir P. Souza e Antônio F.M. Dantas

RESUMO: São descritas doenças do sistema nervoso central (SNC) em cães diagnosticadas no sertão da Paraíba. Os registros de necropsia de 1.205 cães foram revisados. Em 354 casos (29,38%) foram registrados história clínica de alterações do sistema nervoso. Duzentos e noventa e seis casos tiveram diagnóstico definitivo e 58 foram inconclusivos. As doenças infecciosas foram observadas em 59,60% (211/354) de casos que representam a principal causa de distúrbios neurológicos; 53% dos casos (186/354) foram representadas por doenças virais; 3,11% (11/354) foram de etiologia parasitária, 2,54% (9/354) foram causadas por bactérias e 1,41% (5/354) por fungos. Os agentes físicos representaram a segunda causa mais importante de transtornos do SNC com 9,89% (35/354) e os tumores a terceira causa com 5,93% (21/354). Outras alterações pouco frequentes foram alterações metabólicas secundárias a insuficiência hepática ou renal, representando 2,54% (9/354). Casos raros de hidrocefalia congênita foram observados, 1,41% (5/354). Os casos de manifestações neurológicas associadas a alterações vasculares, degenerativas e inflamatórias não infecciosas, muitas das quais uma causa específica não foi estabelecida representaram 4,24% (15/354); Estavam dentro das seguintes categorias de doenças: Infartos isquêmicos e hemorrágicos (6/15), necrose vascular fibrinoide (5/15), doença do disco intervertebral (2/15), meningoencefalite granulomatosa (1/15) e granuloma de colesterol (1/15). Os distúrbios do sistema nervoso central representam uma importante causa de morte ou eutanásia em cães na região semiárida da Paraíba. Os sinais clínicos variaram de acordo com o agente envolvido, localização e distribuição das lesões. O conhecimento dos principais agentes que pode afetar o SNC canino é importante ao fazer uma lista de diagnóstico diferencial.

17 de ago de 2018

Estabilização vertebral segmentar modificada no tratamento de trauma medular em ouriço-cacheiro (Coendou spinosus): relato de caso

Arq. Bras. Med.Vet. Zootec., v.70, n.4, p.1221-1226, 2018


N.J. Tagliari , B.Z. Silva , E.A.R. Santos , M.E. Baier , P.C.S. Gonzalez , M.M. Alievi

RESUMO: Uma fêmea, adulta, de ouriço-cacheiro (Coendou spinosus, F. Cuvier, 1823), foi atendida com histórico de trauma medular. No exame neurológico, foi constatada paraplegia com nocicepção preservada e sinais compatíveis com choque espinhal. Exame radiográfico e mielografia apontaram presença de fratura e luxação vertebral torácica entre T10-11. O paciente foi submetido à técnica de estabilização vertebral segmentar modificada, com pinos de Steinmann e fios de cerclagem. A técnica utilizada mostrou-se eficaz na estabilização da fratura/luxação vertebral e na recuperação dos sinais neurológicos. O paciente apresentou recuperação progressiva da deambulação. Para o conhecimento dos autores, este é o primeiro relato utilizando estabilização vertebral segmentar modificada para o tratamento de fratura/luxação vertebral torácica em Coendou spinosus.

13 de ago de 2018

Modalidades fisioterapêuticas na reabilitação de cães com doença do disco intervertebral toracolombar submetidos à cirurgia descompressiva: 30 casos (2008-2016)

Arq. Bras. Med. Vet. Zootec., v.70, n.4, p.1089-1098, 2018


A.O. Andrades, G. Aiello , A.C.T. Colvero , D.A. Ferrarin , L. Schneider , A. Ripplinger1 , M.L. Schwab , A. Mazzanti

Este estudo retrospectivo teve como objetivo demonstrar as modalidades fisioterapêuticas empregadas no tratamento de cães com doença do disco intervertebral (DDIV) toracolombar após descompressão cirúrgica da medula espinhal, bem como relatar os fatores que determinaram as alterações das modalidades. Foram incluídos 30 cães que apresentavam sinais neurológicos desde paraparesia ambulatória a paraplegia com dor profunda na primeira sessão de fisioterapia. As modalidades utilizadas nos protocolos de todos os pacientes foram a crioterapia, massagem, alongamento passivo, movimentação passiva articular, estímulo do reflexo flexor e estimulação elétrica neuromuscular. A inclusão ou exclusão de exercícios terapêuticos, como a tipoia corporal, a plataforma proprioceptiva circular, a natação, a hidroesteira, os obstáculos e a caminhada em colchão, foi de acordo com a evolução clínica e a adaptação de cada paciente. Oitenta por cento (80%) dos cães alteraram o grau de disfunção neurológica antes de iniciar a fisioterapia e 93% retornaram à habilidade de caminhar (paraparesia ambulatória) ao final da fisioterapia. O número de sessões e o tempo de recuperação foram maiores quanto pior foi o grau de lesão do paciente.

8 de ago de 2018

Complicações observadas em cães e gatos com doenças neurológicas

Complications observed in dogs and cats with neurological diseases

Pesq. Vet. Bras. 38(6):1159-1171, junho 2018


Marina B. Santoro e Mônica V. Bahr Arias

RESUMO: Cães e gatos com problemas neurológicos estão sujeitos a várias sequelas e complicações, em decorrência das deficiências motoras, sensoriais e viscerais. Algumas complicações estão relacionadas a maior mortalidade, principalmente aquelas relacionadas ao trauma vertebromedular. O objetivo do presente estudo foi avaliar nessas espécies a frequência do aparecimento de complicações, a epidemiologia, localização da lesão e etiologia, avaliando ainda a evolução e o tempo de sobrevida. Foram acompanhados 100 cães e gatos com doenças neurológicas trazidos para atendimento no Serviço de Neurologia do Hospital Veterinário da Universidade Estadual de Londrina. Observou-se que 91% dos animais desenvolveram complicações, sendo que as mais frequentes foram atrofia muscular (n=32), retenção urinária (n=24), incontinência urinária (n=24), incontinência fecal (n=17) e feridas de decúbito (n=16). O principal local de lesão associado ao aparecimento das complicações foi medula espinhal (91,3%) e a principal etiologia foi o trauma vertebromedular (37,3%). O tempo mediano e médio de vida estimado foram, respectivamente, dois e sete meses sendo que as principais causas de morte ou eutanásia estavam relacionadas ao trauma vertebromedular, trauma cranioencefálico ou doença inflamatória/infecciosa. O tempo de vida estimado foi menor para animais mais velhos e mais pesados. Embora o índice de sobrevivência dos animais com complicações tenha sido alto, muitos permaneceram com sequelas, indicando que a sobrevivência não significou capacidade funcional normal. Cães e gatos com problemas neurológicos requerem alto grau de atenção do veterinário e de seus tutores, sendo fundamental a orientação a respeito da real expectativa de recuperação e das dificuldades de manejo que poderão ser encontradas no curso da doença.

ABSTRACT:  Dogs and cats with neurological diseases can show several sequelae and complications asa result of motor, sensory and visceral deficiencies. Some complications are an important cause of mortality, mainly complications related to spinal cord injury. The aim of this study was to evaluate in 100 dogs and cats brought to the Neurology Service of Veterinary Hospital from Universidade Estadual de Londrina the frequency of complications, epidemiology, lesion localization and etiology, still assessing the evolution and survival time. It was observed that 91% of the animals developed complications. The most frequent were muscular atrophy (n=32), urinary retention (n=24), urinary incontinence (n=24), fecal incontinence (n=17) and pressure sores (n=16). The main site of injury associated with the onset of complications was spinal cord (91%) and the main cause was the spinal cord trauma (37.3%). The median survival time of animals with complications was two months and the mean was seven months. The main causes of death or euthanasia were related do spinal cord trauma, traumatic brain injury or inflammatory/infectious disease. The estimated lifetime was lower for older and heavier animals. Although the survival rate of animals with complications was high, most of them remained with sequelae, indicating that survival does not mean normal functional capacity. Dogs and cats with neurological problems require a high degree of attention of the veterinarian and their guardians, and guidelines regarding the real expectation of recovery and management difficulties that may be encountered in the course of the disease are essential.

6 de ago de 2018





Curtis W. DeweyProfessor Associado e Chefe da Seção de Neurologia/Neurocirurgia da Cornell University; Christine Thomson, University of Alaska Fairbanks, Department of Veterinary Medicine e  Ronaldo Casimiro da Costa, autores dos livros abaixo: