Cerebral Cholesterol Granuloma in a Cat

Abstract

A 13-year-old, female, spayed, domestic shorthair cat was referred to the neurology service of the Small Animal Clinic at the University of Berne (Switzerland) with a history of behavioral changes for the past 10 days. According to the owner, the cat seemed to be mostly apathetic but occasionally attacked objects and displayed bizarre playing behavior. She was also reluctant to jump on furniture or to walk over obstacles and did not recognize her sleeping places anymore. In addition, the cat showed intermittent compulsive walking and refused to eat dry food. Before being referred to our clinic, the cat was treated with carprofen (2 mg/kg PO q24h) for 5 days, with no effect.The clinical examination of the cat revealed a poor body condition and obesity. The heart and respiration rates, as well as the body temperature, were within normal limits. The cat was apathetic and disorientated. The cat's aggressive behavior was striking, seemingly without reason. Head and neck postures were very rigid, and the cat reacted aggressively when manipulated. The gait was characterized by a generalized sensory ataxia, with a tendency for compulsive walking. There were slight proprioceptive deficits of the left hind and front limbs. The menace response on the left side was slightly decreased. The cervical vertebral column appeared painful on palpation. The neurologic findings suggested a localization in the right forebrain.Results of a CBC were within normal values. Serum biochemistry results revealed a slightly increased total protein concentration (8.9 g/dL; reference range, 5.6-7.8 g/dL) and a fasted cholesterol serum concentration at the upper limit, with 175 mg/dL (reference range, 64-229 mg/dL). The erythrocyte sedimentation rate was increased, at 13 mm after 1 hour (reference range, 0-2 mm) and 41 mm after 2 hours (reference range, 2-10 mm). The urine pH was 7.4 (reference range, pH 5-7), with trace protein but no other abnormalities. Feline leukemia virus and feline immunodeficiency virus tests were both negative.Cerebrospinal fluid revealed a negative Pandy's test, 21 cells/mL and 30 mg/dL albumin. The differential cell count revealed 80% lymphocytes, 15% monocytes, and 5% macrophages.Magnetic resonance imaging (MRI) of the brain was performed with a 0.3 Tesla MRI unit.a Sequences included a fast spin echo (FSE) T2 in sagittal and transverse orientation, a field echo (FE) T2 a and a FE three dimensional (3D) T1 in transverse plane; a fluid attenuating inversion recovery (FLAIR) cerebrospinal fluid (CSF-suppression), a short tau inversion recovery (STIR) (fat-suppression), and a FE 3D multiplanar reconstruction (MPR) (high resolution T1w gradient echo) in the dorsal plane. After IV injection of 0.15 mmol gadodiamide b ), the T1-weighted sequences were repeated. The MRI showed an extensive spaceoccupying lesion in the area of the falx cerebri, which reached from the olfactory bulbs to the tentorium cerebelli. It compressed both hemispheres and deformed the third and the lateral ventricles, as well as the thalamus. The lesion...

Intracranial Cholesterol Granuloma in a Cat

“…Sporadic descriptions of identical intracranial lesions have been reported in other animals, such as meerkats (Suricata suricatta sp., family Herpestidae) [2,21,22], lemurs [11], reptiles [19], Cuban tree frogs [16] and leaf-tailed geckos [5]. Single cases have been described in one bear [27], one dog [23] and one cat [3].…”

Cholesterol Granuloma Associated with Otitis Media and Destruction of the Tympanic Bulla in a Dog

“…4,7,9 In domestic animals, there are reports of CG in the brain of the horse, 8 the middle ear, the maxilla and brain of the dog, 2,10,12 and the uterus and brain of the cat. 5,14 This report describes a canine case of CG that is associated with otitis media and destruction of the tympanic bulla.An 8-year-old, 36.6-kg, male neutered Irish Setter was referred with a 2-week history of lethargy, anorexia, difficulty chewing, and pain upon opening the mouth. Additionally, there had been a 2-year history of intermittent otitis externa on the left.…”

“…4,7,9 In domestic animals, there are reports of CG in the brain of the horse, 8 the middle ear, the maxilla and brain of the dog, 2,10,12 and the uterus and brain of the cat. 5,14 This report describes a canine case of CG that is associated with otitis media and destruction of the tympanic bulla.…”

Diagnostic Exercise

“…Local recurrent microhemorrhages are again considered as a plausible underlying mechanism, but the possible role of dyslipidemia and hypercholesterolemia has also been speculated. 1,3,4,11 The overall results of the immunohistochemical evaluation-including expression of MHC-II and CD18 in the large round/polygonal and multinucleate cells associated with the cholesterol clefts, along with the presence of a spindle cell component characterized by expression of vimentin, S100, and NSE-may support interesting speculations on the histogenesis of cholesterol cleft-rich masses in the feline brain. Recruitment and proliferation of MHC-IIand CD18-positive dendritic cells associated with variable numbers of arachnoid cells from the leptomeninges might be hypothesized as a mechanism underlying a local response to the accumulation of cholesterol crystals.…”

“…10 Sporadic cases of feline cerebral cholesterol granuloma have been reported. 3,9,11 The first reported case offered a detailed clinical description, with pathologic characterization limited to the microscopic features in hematoxylin and eosin-stained sections, 3 whereas a more detailed histochemical and immunohistochemical characterization was reported by Ricci et al, 11 demonstrating HAM56-positive macrophages as the dominant cell population. Recently, coexistence of intraventricular meningioma and cholesterol granuloma of the choroid plexus was reported in a cat.…”