Combination of the right heart pathology and varicose disease as a factor of development of trophic changes in the lower extremities: a case report

Varicose disease is the most prevalent vascular disorder affecting lower extremities. Chronic venous insufficiency (CVI) is common in subjects with incompetent superficial and perforator veins. Major attention in pathogenesis of CVI is paid to horizontal venous reflux, while pathological blood flow in the superficial veins may sometimes be regarded as a postural reaction. At the same time cardiac pathology may also attribute to the development of CVI. The article presents a case report describing a female patient with combination of the right heart pathology and varicose disease associated with tricuspid regurgitation leading to constant venous reflux in the lower extremity superficial veins with further development of trophic changes.

Delayed forebrain syndrome due to presumptive traumatic intranasal meningoencephalocele in a cat

A 3-year-old male neutered domestic shorthair cat was referred with 1-month history of three generalised tonic-clonic epileptic seizures and left-sided thoracic limb knuckling. Nine months previously, the cat was bitten on the right upper palpebral region without manifesting neurological signs. On admission, physical and neurological examination revealed left-sided postural reaction deficits and absent menace response. Thus, a right-forebrain neurolocalisation was reached. Haematology, biochemistry, bile acid stimulation test, infectious diseases serology and cerebrospinal fluid analysis were unremarkable. Cerebral MRI revealed extension of brain and meninges into the right frontal sinus. Final diagnosis of a right-sided traumatic frontoethmoidal meningoencephalocele was made. The cat remained seizure free under phenobarbital treatment with residual left-sided postural reaction deficits at 9 months follow-up. This is the first report of presumptive traumatic meningoencephalocele in a cat, which emphasises the importance of complete neurological investigation and regular long-term follow-up checks in patients with historical head trauma despite the absence of initial neurological signs.

Thoracic vertebral canal stenosis due to articular process hypertrophy in two cats treated by hemilaminectomy with partial osteotomy of the spinous process

Case summary A 9-year-old neutered female British Shorthair cat (case 1) and a 13-year-old neutered male domestic shorthair cat (case 2) showed signs of chronic T3–L3 myelopathy, which progressed over 6 and 12 months, respectively. On presentation, case 1 had moderate pelvic limb proprioceptive ataxia and ambulatory paraparesis, and case 2 was non-ambulatory paraparetic and had urinary incontinence. Bilateral enlargement of the articular process joints at T11–T12 in case 1 and T3–T4 in case 2 causing dorsolateral extradural spinal cord compression was shown on MRI. Surgical decompression by a unilateral approach through hemilaminectomy with partial osteotomy of the spinous process was performed in both cases. The side of the approach was chosen based on the severity of the cord compression. Surgery resulted in a satisfactory outcome with short hospitalisation times. On discharge, case 1 showed mild postural reaction deficits on both pelvic limbs. Case 2 had regained urinary continence and could ambulate unassisted, although it remained severely ataxic. The 6 month follow-up showed very mild paraparesis and proprioceptive ataxia in both cats. No chronic medical treatment was required. Relevance and novel information This is the first report to describe clinical presentation, imaging features, surgical treatment and outcomes of thoracic vertebral canal stenosis owing to bilateral articular process hypertrophy in cats with no adjacent spinal diseases. Thoracic articular process hypertrophy should be included in the differential diagnosis of adult cats with chronic progressive myelopathy. Hemilaminectomy with partial osteotomy of the spinous process might be an appropriate surgical technique in these cases.

Doença vestibular central por infarto isquêmico secundário a hipotireoidismo em cão

Background: Hypothyroidism in dogs can cause lethargy, weight gain, dermatological signs and, uncommonly, neurological signs. These may involve the peripheral or central nervous system, leading to a decreased level of consciousness, central or peripheral vestibular disease, epileptic seizures, cognitive dysfunction, facial nerve paralysis, laryngeal paralysis, and polyneuropathy. There are few cases reported in the literature relating hypothyroidism and central vestibular disease. The aim of this study was to report a case of a stroke secondary to hypothyroidism that resulted in central vestibular syndrome in a dog.Case: A 13-year-old female Pitbull, weighting 37 kg, was referred to a Veterinary University Hospital with a two weeks history of dyspnea, coughing and walking difficulty. On neurological examination, the animal presented vertical nystagmus, somnolence, non-ambulatory tetraparesis, decreased postural reaction in all limbs and normal spinal reflexes. The laboratory exams revealed a mild leukocytosis and increased creatinine, glucose, cholesterol and triglycerides levels. Due to historical, clinical, neurological and laboratory tests findings, the animal was diagnosed with central vestibular syndrome secondary to an intracranial neoplasm. Clinical treatment was instituted with corticosteroids, however the animal did not respond and died. On necropsy, the heart was enlarged and coronary arteries were thicker. No macroscopic changes were found in the brain. On histological analysis, the coronary arteries were congest by lipids that almost occluded the arterial lumen. The same alteration were found in splenic and renal arterioles, and in the brain’s leptomeninges. Also in the brain, it was observed perivascular infiltration of mononuclear cells and focal gliosis. The thyroid was atrophied and fibrosed bilaterally. Therefore, those changes were compatible with atherosclerosis secondary to hypothyroidism.Discussion: Neurological sings secondary to hypothyroidism are uncommon. From 116 dogs with hypothyroidism, only 22 (19%) had neurological presentations. The majority was associated with peripheral nervous system showing polyneuropathy and cranial nerve dysfunction. When associated with central nervous system the most common sings are pathological nystagmus, postural reaction deficits, tetraparesis, hemiparesis, and paradoxical vestibular diseases. These signs are similar to the findings in the case reported here, characterizing it as a central vestibular disease. Different from humans, dogs have a natural resistance against atherosclerosis, however, hypothyroidism can result in lipids metabolic deficits, increasing its plasma levels. In this report, the arterial lesion and ischemia secondary to atherosclerosis, especially in the brain steam, have led to the neurological presentation. The dog also had hypercholesterolemia and hypertriglyceridemia, which are related to hypothyroidism. As high levels of cholesterol and triglycerides are common findings in hypothyroidism, it is important to evaluating blood levels of those lipids in dogs with central vestibular diseases, even though there are no others endocrinal signs. This case shows that, even though central vestibular disease is not a common neurological presentation in hypothyroidism, it is always important to considerer this metabolic affection as a precursor and a differential diagnosis to central vestibular disease.

Postural Response Signal Characteristics Identified by Method of Developed Statokinesigram

Human postural system is taken as complex biological system with specific input and output time characteristics, in this study. Evaluation of measured output characteristics is useful in medical diagnostics or in describing postural system disorders. System theory principle provide suitable basis for postural signals analysis. Participating volunteers were instructed to maintain quiet upright stance posture on firm support surface of stabilometric platform for 60s. Postural system actuation was realized by vibration stimuli applied bilaterally on Achilles tendons for 20s. Postural reaction signal, its time profile and static and dynamic characteristics were evaluated by Method of Developed Statokinesigram Trajectory (MDST).

MEDETOMIDINE HYDROCHLORIDE EFFICIENCY AND SAFETY IN GUINEA PIG (Cavia porcellus), IN DOSES ESTIMATED THROUGH ALLOMETRIC EXTRAPOLATION

In this study, medetomidine hydrochloride, an alfa2 adrenergic receptor agonist, was administered to five adult guinea pigs (three males and two females) to verify the efficiency and safety of using doses calculated by using an allometric scale. A surgical procedure was performed to insert a polyethylene cannula that advanced 2.0 to 2.5 cm into the left carotid artery until the aorta. A minimum recovery period of two days was observed before any other manipulation or pharmacological test were performed. The cannulas were washed every two days with heparinized saline flow and remained patent for two to three weeks after insertion. After surgery, each animal was placed in an open box measuring 45x25x20cm, in a quiet room with soft lighting. The “MS” group received exactly the allometrically calculated dose, while the “2MS” group received twice the allometric dose and the “½ MS” group received half the allometric dose. Parameters were measured and analyzed at 0, 5, 10, 20, 40, 60, 90 and 120 minutes after injection. Body mass was 709.6±169g, 742±172.87g and 710±160.2g for groups 1, 2 and 3, respectively. Body temperature was 101.68±0.19ºF; respiratory rate was 85.2±4.54 strokes per minute; heart rate was 297.13±3.46 beats per minute; PaO2 at 81.7±9.43mmHg; PaCO2 at 34.49±1.59mmHg; pH was measured at 7.41±0.07; hematocrit at 38.4±1.31%; total protein was 4.33±0.29g/dL, glucose was measured at 97.13±3.75mg/dL; systolic blood pressure was 85.53±2.50mmHg; diastolic pressure at 7.,40±3.74mmHg; and mean blood pressure was 78.73±1.13mmHg. Straightening postural reaction was lost at 7.20±2.05, 12.80±3.56 and 8.67±3.06 minutes for groups “2MS, MS and ½ MS”, respectively. Awakening time was 53.80±7.19, 67.20±5.54 and 55.67±11.06 minutes for groups “2MS, MS and ½ MS”, respectively. For the MS group, chemical restraint was considered “excellent” with “poor” analgesia, and for the 2MS group, it was considered “good”, also with “poor” analgesia. This means these protocols should be used for painless procedures when immobilization is necessary. The ½ MS protocol is not suitable for chemical restraint in guinea pigs. This paper presents new results obtained from research conducted in 2000.

Body Schema Disturbance in Adolescence: From Proprioceptive Integration to the Perception of Human Movement

There is evidence that adolescence is a critical period in development, most likely involving important modifications of the body schema and of the sensorimotor representations. The present study addressed this issue, by investigating the differences between adolescents and adults regarding the integration of proprioceptive information at both perceptual and postural levels and the visual recognition of human movement. Proprioceptive integration was examined using muscle-tendon vibration that evoked either a postural response or an illusory sensation of movement. The ability to recognize human movement was investigated from a paradigm where the participants had to discern between human movements performed with and without gravity. The study produced three main findings. First, the adolescents had larger postural responses to tendon vibrations than the adults, with visual information enabling them to reduce this exaggerated postural reaction. Second, the adolescents had a greater illusory perception of movement compared with the adults. Third, the adolescents had the same perceptual ability as adults in the human movement perception task. In conclusion, we were able to highlight notable differences between adolescents and young adults, which confirms the late maturation of multisensory integration for postural control and the privileged visual contribution to postural control.