Retrospective evaluation of the relationship between admission variables and brain herniation in dogs (2010–2019): 54 cases

Her, Jiwoong; Yanke, Amy B.; Gerken, Katherine; Yoon, Jin Sun; Peters, Ashley Antonia; Hofmeister, Erik H.; Bacek, Lenore M.; Kuo, Kendon

doi:10.1111/vec.13147

Cited by 4 publications

(5 citation statements)

References 20 publications

(48 reference statements)

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“…CR is a well-recognised ICP-related cardiovascular reflex; however, in human medicine, it is reported to have a low sensitivity for the detection of raised ICP. 10 Although, in dogs, higher BP and lower HR at admission have been associated with the presence of brain herniation, 11 this has not been seen in cats. 12 A retrospective study in cats undergoing surgical removal of intracranial meningioma reported the absence of CR in some patients where raised ICP was confirmed by continuous monitoring.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management in a cat undergoing emergency craniotomy for meningioma excision

Marchionne,

Alcoverro,

Spinillo

et al. 2023

Journal of Feline Medicine and Surgery Open Reports

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Case summary A 15-year-old female spayed domestic shorthair cat underwent an emergency craniotomy to remove an intracranial meningioma causing marked midline shift, caudal transtentorial and foramen magnum herniation. Because intracranial structures are enclosed in the cranium, any volume-occupying lesions might raise intracranial pressure (ICP), compromising cerebral perfusion. Relevance and novel information This case report discusses the anaesthetic management of a cat that presented with marked bradycardia and concomitant hypotension. Cushing’s reflex (CR) is a well-recognised cardiovascular reflex following sudden ICP increase, and it features an irregular breathing pattern and increased arterial blood pressure with reflex bradycardia. However, CR is reported to have a low sensitivity for the detection of raised ICP in humans with traumatic brain injury. In a previous study reporting seven cats undergoing surgical removal of intracranial meningioma, ICP was measured in four cases and, in these patients, CR was not observed during surgery. Because bradycardia was not secondary to hypertension, in this case, it might have been the result of direct compression of the nucleus of the vagus nerve. Based on the literature search, there is paucity of reports of cardiovascular changes in cats with increased ICP and their perianaesthetic management.

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Section: Discussionmentioning

confidence: 99%

Anaesthetic management in a cat undergoing emergency craniotomy for meningioma excision

Marchionne,

Alcoverro,

Spinillo

et al. 2023

Journal of Feline Medicine and Surgery Open Reports

View full text Add to dashboard Cite

show abstract

“…Based on a similar study conducted in dogs, 11 our hypothesis was that a Cushing reflex will likely be exhibited in cats with brain herniation. Our hypothesis was not supported by the current study.…”

Section: Discussionmentioning

confidence: 99%

“…11 While the presence of the Cushing reflex in cats in the clinical setting appears to be limited, it is important to note that the Cushing reflex may be a late sign of increased ICP. 4,6,11,20 Therefore, relying on the Cushing reflex to make treatment decisions may lead to a worse outcome.…”

Section: Discussionmentioning

confidence: 99%

“…6,10,22 A recent retrospective study in dogs also found that the Cushing reflex predicts brain herniation with high specificity and low sensitivity. 11 While the presence of the Cushing reflex in cats in the clinical setting appears to be limited, it is important to note that the Cushing reflex may be a late sign of increased ICP. 4,6,11,20 Therefore, relying on the Cushing reflex to make treatment decisions may lead to a worse outcome.…”

Section: Discussionmentioning

confidence: 99%

“…In the study, dogs with brain herniation presented with higher systolic blood pressure (SBP), lower heart rate (HR), and lower Modified GCS (MGCS) score at triage. 11 To date, this association has not been investigated in cats with naturally occurring brain herniation.…”

Section: Introductionmentioning

confidence: 99%

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Relationship between admission vitals and brain herniation in 32 cats: a retrospective study

Her

Merbl

Gerken

et al. 2021

Journal of Feline Medicine and Surgery

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Objectives The aim of the study was to evaluate whether any admission vitals correlated with the presence of brain herniation diagnosed via MRI in cats presenting with neurologic signs. Methods Medical records at two veterinary university referral centers were reviewed to identify cats that underwent brain MRI between 2010 and 2019. A control group of cats with intracranial lesions without concurrent brain herniation was analyzed for comparison. Data relating to signalment, vitals on admission, abnormalities observed on initial neurologic examination, underlying etiology, advanced imaging findings and outcome were reviewed. A Modified Glasgow Coma Scale (MGCS) score was determined retrospectively based on initial neurologic examination. Logistic regressions were performed to investigate the relationship between each risk factor and the odds of brain herniation as diagnosed on MRI. Results Thirty-two cats with brain herniation and 44 cats with abnormal brain MRI without evidence of herniation (as a control group) based on MRI findings were included. Cats with intracranial neoplasia vs other diagnoses were found to be at increased risk of herniation (odds ratio [OR] 4.8, 95% confidence interval [CI] 1.8–13.8; P = 0.001). The odds of herniation increased with age (OR 1.1, 95% CI 1.01–1.2; P = 0.031). Cats with herniation had a significantly lower level of consciousness in their MGCS score ( P <0.0001) than cats without herniation. There was no significant difference in either motor activity or brainstem reflexes between the groups ( P >0.05). Conclusions and relevance Admission heart rate and blood pressure were not associated with brain herniation. Cats with herniation were presented with a significantly lower level of consciousness in their MGCS score; however, this clinical feature cannot be directly attributable to and predictive of herniation. Older cats with intracranial neoplasia are more likely to have brain herniation.

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Anesthetic Emergencies, Resuscitation, and Adverse Events

Hofmeister

2024

Veterinary Anesthesia and Analgesia

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Retrospective evaluation of the relationship between admission variables and brain herniation in dogs (2010–2019): 54 cases

Abstract: Objective: To document the admission systolic blood pressure (SBP), heart rate (HR), and modified Glasgow coma scale (MGCS) score in dogs with and without brain herniation and to determine their relationship with brain herniation.

Cited by 4 publications

References 20 publications

Anaesthetic management in a cat undergoing emergency craniotomy for meningioma excision

Anaesthetic management in a cat undergoing emergency craniotomy for meningioma excision

Relationship between admission vitals and brain herniation in 32 cats: a retrospective study

Anesthetic Emergencies, Resuscitation, and Adverse Events

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