Response to: Was the ‘alternating head tilt’ a ‘positioning head tilt’?

Liatis, Theophanes; Gutierrez‐Quintana, Rodrigo

doi:10.1111/jsap.13427

Cited by 3 publications

(6 citation statements)

References 8 publications

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“…As PHT had not been described until 2016, it might have been overlooked in some veterinary patients. The clinical sign described as “alternating head tilt” in a dog with a tumor, including NU ( 3 ), was recognized as PHT ( 5 ) only after it was pointed out that it might be PHT ( 4 ). Although further observation of many cases with cerebellar diseases that cause NU dysfunction, including vascular diseases, inflammatory diseases, and trauma, is required, PHT may be a common clinical sign and pathophysiology in dogs with NU dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…The original documented cases were three dogs with presumptive NU hypoplasia (1). Recently, PHT was observed in a dog with gliomatosis cerebri affecting NU (3)(4)(5). We hypothesized that other diseases, such as lysosomal storage diseases (LSDs) that cause degeneration in the whole brain, including the cerebellum, may also cause NU dysfunction and PHT.…”

Section: Introductionmentioning

confidence: 99%

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Positioning Head Tilt in Canine Lysosomal Storage Disease: A Retrospective Observational Descriptive Study

Tamura¹,

Tamura²,

Nakamoto

et al. 2021

Front. Vet. Sci.

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Positioning head tilt is a neurological sign that has recently been described in dogs with congenital cerebellar malformations. This head tilt is triggered in response to head movement and is believed to be caused by a lack of inhibition of the vestibular nuclei by the cerebellar nodulus and ventral uvula (NU), as originally reported cases were dogs with NU hypoplasia. We hypothesized that other diseases, such as lysosomal storage diseases that cause degeneration in the whole brain, including NU, may cause NU dysfunction and positioning head tilt. Videos of the clinical signs of canine lysosomal storage disease were retrospectively evaluated. In addition, post-mortem NU specimens from each dog were histopathologically evaluated. Nine dogs were included, five with lysosomal storage disease, two Chihuahuas with neuronal ceroid lipofuscinosis (NCL), two Border Collies with NCL, one Shikoku Inu with NCL, two Toy Poodles with GM2 gangliosidosis, and two Shiba Inus with GM1 gangliosidosis. Twenty-eight videos recorded the clinical signs of the dogs. In these videos, positioning head tilt was observed in seven of nine dogs, two Chihuahuas with NCL, one Border Collie with NCL, one Shikoku Inu with NCL, one Toy Poodle with GM2 gangliosidosis, and two Shiba Inus with GM1 gangliosidosis. Neuronal degeneration and loss of NU were histopathologically confirmed in all diseases. As positioning head tilt had not been described until 2016, it may have been overlooked and may be a common clinical sign and pathophysiology in dogs with NU dysfunction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Positioning Head Tilt in Canine Lysosomal Storage Disease: A Retrospective Observational Descriptive Study

Tamura¹,

Tamura²,

Nakamoto

et al. 2021

Front. Vet. Sci.

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“…However, the head tilts to the opposite side when the animal turns its head, and the side it tilts to changes every time the animal turns its head. 1 , 2 PHT has been reported in dogs with the cerebellar nodulus and uvula (NU) hypoplasia, 1 in dogs with five different types of lysosomal storage disease, 3 in one case of a dog with gliomatosis cerebri affecting NU 4 – 6 and in cats with hypokalaemic myopathy. 7 The mechanism for PHT can be explained by the following hypothesis: in order to maintain equilibrium of the head while moving, the vestibular nuclei contract the oblique and rectus capitis muscles bilaterally through the vestibulospinal tract based on information provided by movement from the vestibular apparatus.…”

Section: Introductionmentioning

confidence: 99%

Positioning head tilt observed in two cats with myasthenia gravis

Tamura,

Nakamoto,

Sozu

et al. 2024

Journal of Feline Medicine and Surgery Open Reports

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Case series summary A 1-year-old castrated male domestic shorthair cat was suspected with myasthenia gravis (MG) based on neurological examination, complete blood count (CBC), serum biochemistry, radiography and electrophysiological examination. In addition, a 9-year-old spayed female domestic shorthair cat was diagnosed with MG based on neurological examination, CBC, serum biochemistry, radiography, ultrasonography and increased acetylcholine receptor antibody titre. Positioning head tilt (PHT) was observed at the time of diagnosis in both cats. Relevance and novel information Although the pathophysiology of PHT in cats is not fully understood, the mechanism for PHT in cats with MG may be similar to that of cats with hypokalaemic myopathy, supporting our hypothesis that muscle spindle dysfunction causes PHT.

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“…1 To date, PHT has been reported in three dogs with NU hypoplasia, 1 in dogs with five different types of lysosomal storage disease 9 and in a dog with gliomatosis cerebri affecting NU. [10][11][12] Hypokalaemic myopathy is a relatively common myopathy in cats associated with low extracellular potassium concentration. It often occurs in cats with chronic kidney disease (CKD), hyperthyroidism, dietary potassium deficiency, hyperaldosteronism, fluid over-administration, chronic vomiting/diarrhoea and overuse of potassiumwasting diuretics.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reversible positioning head tilt observed in 14 cats with hypokalaemic myopathy

Tamura¹,

Nakamoto²,

Tamura³

2023

Journal of Feline Medicine and Surgery

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Case series summary Positioning head tilt (PHT) is a dynamic neurological sign in which the head tilts to the opposite side to which it is moving. This sign is triggered in response to head movement and is thought to be due to the lack of inhibition of vestibular nuclei by the cerebellar nodulus and uvula (NU). The occurrence of PHT in animals has been suggested to be an indicator of NU dysfunction. Here, we describe the acute onset of PHT in 14 cats. All the cats were diagnosed with hypokalaemic myopathy caused by a range of pathologies. The PHT resolved along with other signs related to myopathy, such as cervical flexion and generalised weakness, after electrolyte correction in all cats. Relevance and novel information Hypokalaemic myopathy was the likely cause of PHT in the present feline cases.

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Response to: Was the ‘alternating head tilt’ a ‘positioning head tilt’?

Abstract: Therefore, we consider that our dog manifested positioning head tilt, positioning vertical (downbeat) nystagmus and skew deviation associated with CNU neoplastic lesion. References

Cited by 3 publications

References 8 publications

Positioning Head Tilt in Canine Lysosomal Storage Disease: A Retrospective Observational Descriptive Study

Positioning Head Tilt in Canine Lysosomal Storage Disease: A Retrospective Observational Descriptive Study

Positioning head tilt observed in two cats with myasthenia gravis

Reversible positioning head tilt observed in 14 cats with hypokalaemic myopathy

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