Global brain ischemia in a dog with concurrent multiorgan dysfunction syndrome after bite wound trauma

Abstract

Background Bite wounds are one of the most common traumatic injuries in dogs and depending on their severity, location, etc., urgent care including antibiotic therapy may be necessary. Serious complications can result from these injuries, such as multiple organ dysfunction syndrome (MODS), as well as a generalized reduction in cerebral perfusion, e.g. during cardiac arrest, shock, or severe hypotension that may cause global brain ischemia (GBI). Case presentation A 5-year-old spayed female Maltese dog was presented with generalized seizures, ataxia, and obtunded mentation. The dog was injured by severe bite wounds that penetrated its abdomen and had received blood transfusions, antibiotic therapy (including metronidazole and cefazoline) and underwent emergency surgery 4 days before its visit. Based on a clinical examination, intracranial hypoxic damage with elevated intra-cranial pressure and MODS were highly suspected, and GBI was confirmed following magnetic resonance imaging. Increased signal intensity diffusely distributed in the olfactory bulb and frontal, temporal, and parietal grey matter was evident on the T2-weighted and fluid attenuated inversion recovery transverse images, along with corresponding high signal intensity observed on diffusion weighted imaging. During the 10-month follow-up period, the clinical signs gradually improved, but intermittent circling and cognitive dysfunction deficits remained. Conclusions GBI should be included among the differential diagnoses in case of any peracute non-progressive neurological dysfunction that occurs with episodes of hypotension or hypoxia. The abnormal signal intensity observed on diffusion weighted imaging was a useful indicator for diagnosing this condition. Long-term medical management with antibiotics and anti-convulsant and anti-oxidant therapies were considered to be helpful in managing the GBI concurrent with MODS in this dog.

Brain magnetic resonance imaging and histopathology findings in a dog with global brain ischaemia following cardiopulmonary arrest

“…21 Neurolocalisation to the brainstem may indicate more severe ischaemic injury, though other veterinary case reports of GBI have neurolocalised lesions to the brainstem and these patients survived. [7][8][9] Current literature describing post-GBI neurological deficits in dogs is scarce, limited to individual case reports or small case series. Common abnormalities in all these patients included ataxia, seizures, blindness, pupillary size changes and altered mentation from obtunded to stuporous.…”

“…Areas of the brain commonly susceptible to hypoxic‐ischaemic injury include the cerebral cortex, cerebellum, hippocampus and thalamus, with the brainstem reportedly more tolerant to such injury in humans 21 . Neurolocalisation to the brainstem may indicate more severe ischaemic injury, though other veterinary case reports of GBI have neurolocalised lesions to the brainstem and these patients survived 7–9 …”

“…2,6 In veterinary medicine, three case reports have described magnetic resonance imaging (MRI) findings in three dogs and one cat with GBI. [7][8][9] In these cases the hypoxic-ischaemic injury was associated with anaesthesia. Two case reports included more advanced MRI sequences such as diffusion-weighted imaging (DWI) with concurrent apparent diffusion coefficient (ADC) maps to confirm ischaemia in the cerebrum of a dog with multiple organ dysfunction 8 and a dog poststrangulation.…”

“…A multimodal approach is recommended that includes physical exam, electrophysiologic measurements, biomarkers and neuroimaging 2, 6 . In veterinary medicine, three case reports have described magnetic resonance imaging (MRI) findings in three dogs and one cat with GBI 7–9 . In these cases the hypoxic‐ischaemic injury was associated with anaesthesia.…”

Late‐onset seizures in a domestic shorthaired cat with global brain ischaemia and cortical laminar necrosis

“…9 GBI is a diagnosis based on clinical history and MRI findings. 25 The brain has a 'selective vulnerability' to ischaemic injury. Areas with a higher metabolic demand are at increased risk of injury, as are regions at the border of vascular supply.…”