TiHo Bibliothek elib - Tierärztliche Hochschule Hannover

Falldarstellung
set at a rate of 49 ml/h (4.2 ml/kg/hr). Prednisolone was increased to 5 mg (0.43
mg/kg, PO, q 12 hrs) to better cope with the stress of illness in the face of
hypoadrenocorticism. Clinical signs improved dramatically within three hours of
presentation and the onset of treatment. The head tilt and nystagmus resolved.
Proprioception was delayed to absent in the left hind limb. However, ataxia and wide
circling to the left were still apparent. The clinical signs were considered to be caused
by a left central vestibular system disease, although multifocal disease could not be
excluded.
Differential diagnoses included trauma with CNS damage subsequent to fracture
and/or edema, secondary bacterial meningoencephalitis, intracranial abscess,
hemorrhage, or neoplasia. Given the history that this dog was attacked and
sustained head trauma caused by a bite wound, the most likely differential diagnosis
was a brain abscess. MRI was strongly recommended and scheduled for the next
day. Clinical signs worsened over night and a change in behavior was seen.
The MRI was performed under general anesthesia with a Vet-MR Grande 0.25 Tesla
field (Esaote, Italy). The animal was pre-oxygenated before receiving anesthesia and
pre-medicated with glycopyrrolate 0.12 mg (0.01mg/kg, SQ) due to a heart rate of 72/
min. The pug was also pre-medicated with fentanyl 33 mcg (2.8mcg/kg, IV) and
midazolam 2.2 mg (0.18mg/kg, IV), induced with etomidate 22 mg (1.89mg/kg, IV)
and maintained with isoflurane. The cerclage wire anchoring the mandibular fracture
together was removed and the MRI sequences T1 weighted (W), T2W, T2 FLAIR
(fluid attenuated inversion recovery), T2*W, T1W/+contrast performed. The dog
received 110 ml/h (10ml/kg/h) of an isotonic solution of balanced electrolytes
(Normosol R) which was reduced to 28 ml/h (2.5ml/kg/h) following the procedure.
T2W and FLAIR MRI showed an intra- and extraaxial heterogeneously hyperintense
lesion affecting the left cerebral hemisphere, extending through the frontal, temporoparietal
and occipital lobes, and diffusely within the overlying temporal muscle.
Multiple sequences disclosed a fracture of the temporal bone with extensive high
signal lesion within and outside the calvaria. At the level of the skull fracture, the
hyperintensity was located within the superficial left cerebrocortical grey matter as
well as the corona radiata and deeper white matter including the left internal capsule
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