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Ludewig E, Jopp I, Vali Y. Imaging findings in otitis media and resulting secondary lesions in dogs and cats - an image essay. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2024; 52:151-161. [PMID: 38925135 DOI: 10.1055/a-2324-0318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Over the past 2 decades, the increasing availability of computed tomography (CT) and magnetic resonance imaging (MRI) as well as the growing professional expertise have significantly improved the diagnostics of middle and inner ear diseases in dogs and cats. In answering some of the diagnostic questions, CT and MRT demonstrate equivalent performance. For most questions, however, there are differences in the diagnostic performance due to the physical imaging properties of the 2 modalities.CT is more sensitive in demonstrating involvement of the bulla wall and is more effective for detecting abnormal content within the tympanic bulla. In addition, with CT it is often easier to guide tissue samplings. On the other hand, structural changes of the soft tissues of the skull, head, meninges, brain, and nerves are not or only insufficiently detectable on CT images. MRI is clearly superior here. Therefore, MRI is essential for the characterization of materials inside the bulla cavity and for demonstrating the extent of any central spread of otitis media (OM).In this image essay, CT and MRI features of OM and resulting secondary lesions described in the literature are analyzed and summarized. Own image examples are used for illustration. Information on the etiology, pathogenesis, pathomorphology, and clinical signs important for understanding these changes are presented in concise descriptions.
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Affiliation(s)
- Eberhard Ludewig
- Division of Diagnostic Imaging, Department of Small Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Ilka Jopp
- Link & Jopp Small Animal Veterinary Specialists, Starnberg, Germany
| | - Yasamin Vali
- Division of Diagnostic Imaging, Department of Small Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
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Jacobson LS, Janke KJ, Kennedy SK, Lockwood GA, Mackenzie SD, Porter CD, Ringwood PB. A Pandora's box in feline medicine: presenting signs and surgical outcomes in 58 previously hoarded cats with chronic otitis media-interna. J Feline Med Surg 2023; 25:1098612X231197089. [PMID: 37728478 PMCID: PMC10812028 DOI: 10.1177/1098612x231197089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
OBJECTIVES The aim of the present study was to report clinical findings, surgical complications and outcomes for previously hoarded cats treated surgically for otitis media-interna (OMI) and to investigate the risk factors for complications and poor outcomes. METHODS A retrospective study was conducted of 58 cats from an institutional hoarding environment that underwent ventral bulla osteotomy (VBO). RESULTS Inappetence was uncommon at presentation (9/58, 16%) compared with pruritus/alopecia (50%), nasopharyngeal signs (45%), otitis externa (OE) (79%) and otitis interna (OI) (ataxia ± head tilt/head excursions) in 40%. Purulent aural discharge occurred in 36% and polyps in 26%. The tympanic bulla wall was moderately or severely thickened radiographically in 38/108 (35%) ears. Cultures were positive for Streptococcus equi subspecies zooepidemicus in 26/48 (54%) cats. Of the 58 cats, 40 (69%) had complications after the first VBO and 19/30 (63%) after the second. Of 101 complications, 56 (55%), from 27/88 (31%) surgeries, were considered serious, including life-threatening perioperative complications in seven, OI in eight, prolonged anorexia in six and worsening of pruritus/alopecia in nine cases. Three cats developed xerostomia (dry mouth) after the second VBO. Pruritus/alopecia, nasopharyngeal signs, OE and purulent aural discharge resolved in a statistically significant proportion of cats but persisted in some. Full resolution of OI was uncommon. OI preoperatively, and surgery performed by a generalist (vs specialist) surgeon, were risk factors for OE at recheck (OI: odds ratio [OR] 4.35; 95% confidence interval [CI] 1.21-15.70; P = 0.02; surgery: OR 3.64; 95% CI 1.03-12.87; P = 0.045). No other prognostic indicators were identified. No variables tested were significantly associated with risk of serious complications or euthanasia. CONCLUSIONS AND RELEVANCE Surgical management of chronic OMI was successful in most cases but was not benign and not always beneficial. The analysis was unable to identify clinically helpful outcome predictors. Optimal management of chronic feline OMI remains a challenge, particularly for animal shelters. Less invasive approaches and chronic medical management require further investigation.
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Affiliation(s)
| | | | | | | | | | - Carl D Porter
- Toronto Veterinary Emergency Hospital, Toronto, ON, Canada
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Rawson F, Foreman M, Mignan T, Galer J, Fraser A, Crawford A. Clinical presentation, treatment, and outcome of 24 dogs with bacterial meningitis or meningoencephalitis without empyema (2010-2020). J Vet Intern Med 2023; 37:223-229. [PMID: 36639963 PMCID: PMC9889693 DOI: 10.1111/jvim.16605] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/23/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Bacterial meningitis (BM) and meningoencephalitis (BMEM) are associated with high case fatality rates and neurologic sequelae in people, but limited data exists on outcome in dogs. HYPOTHESIS/OBJECTIVES To report the clinicopathologic features, treatment and outcome of BM/BMEM in dogs, with a focus on clinical presentation, relapse and long-term neurological deficits. ANIMALS Twenty-four client-owned dogs diagnosed with BM/BMEM without empyema. METHODS Retrospective case series of dogs diagnosed with BM/BMEM from 5 veterinary referral hospitals between January 2010 and August 2020. RESULTS Twenty-four dogs were included. Median duration of clinical signs was 2 days (range ≤24 hours to 30 days) and signs recorded included pyrexia (3) and cervical hyperesthesia (10). Neurological deficits were present in 18 dogs including altered mentation (12), ataxia (8), nonambulatory status (8), head tilt (8), and cranial nerve deficits (13). Intracellular bacteria were visualized on cerebrospinal fluid (CSF) analysis in 15/24 dogs, with positive CSF bacteriological culture in 8/21. Otitis media/interna (OMI) was diagnosed in 15/24 dogs, of which 6/15 dogs underwent total ear canal ablation and lateral bulla osteotomy. Twenty dogs survived to hospital discharge. Median duration of antibiotic administrations was 8 weeks (range, 2-16 weeks). Glucocorticoids were administered to 15 dogs. Median follow-up time was 92 days (range, 10-2233 days). Residual neurological deficits were reported in 9 dogs, with a single case of suspected relapse. CONCLUSIONS AND CLINICAL IMPORTANCE Clinical signs were variable in dogs with BM/BMEM, the nidus of bacterial infection was often OMI and the majority of dogs made a full recovery with treatment.
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Affiliation(s)
- Faye Rawson
- Royal Veterinary CollegeNorth MymmsUK,Langford Veterinary ServicesUniversity of BristolBristolUK
| | | | | | | | - Anne Fraser
- Davies Veterinary SpecialistsHitchinUK,Anderson Moores Veterinary SpecialistsWinchesterUK
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Dutil GF, Guevar J, Schweizer D, Roosje P, Kajin F, Volk HA, Grapes NJ, De Decker S, Gutierrez-Quintana R, Abouzeid J, Freeman P, Faller KME, Stein VM, Maiolini A. Otitis media and interna with or without polyps in cats: association between meningeal enhancement on postcontrast MRI, cerebrospinal fluid abnormalities, and clinician treatment choice and outcome. J Feline Med Surg 2022; 24:e481-e489. [PMID: 36409551 PMCID: PMC10812352 DOI: 10.1177/1098612x221125573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the association between meningeal enhancement (MgE) and cerebrospinal fluid (CSF) analysis results, their individual association with bacteriology results from affected ear samples and whether these test results influenced clinicians' therapeutic choice in cats with otitis media and interna (OMI). METHODS This was a multicentre retrospective study carried out over an 8-year period. Cats diagnosed with OMI, with or without a nasopharyngeal polyp, leading to peripheral vestibular signs were included. Only cats for which MRI with postcontrast T1-weighted sequences and CSF analyses available were included. Cats with intra-axial MRI lesions or empyema were excluded. RESULTS Fifty-eight cats met the inclusion criteria. MgE was reported in 26/58 cases, of which nine had an abnormal CSF result (increased total nucleated cell count [TNCC] or total protein); 32/58 cases had no MgE, of which 10 showed abnormal CSF results. There was no association between bacteriology results (external ear canal or bulla) and MgE or abnormal CSF results. CSF abnormalities were statistically significantly more common in acute cases (n = 16/37) than in chronic cases (n = 3/21; Fischer's test P = 0.04). Prednisolone was prescribed in 10/16 cases with increased TNCC. Among the 42 cases with normal TNCC, 15 received prednisolone and 13 received non-steroidal anti-inflammatory drugs. Various antimicrobial drugs were prescribed in 53/58 cats. Duration of antimicrobial treatment was similar, regardless of positive bacterial culture (5.58 vs 4.22 weeks), abnormal CSF (5.83 vs 4.76 weeks) or MgE (5.33 vs 4.90 weeks). CONCLUSIONS AND RELEVANCE No association was found between the CSF and MgE results. Furthermore, no association was found between MgE, CSF or bacteriology findings. In addition, abnormal CSF results might lead the clinician to treat with corticosteroids, but they did not have any impact on duration of antimicrobial treatment. CSF abnormalities were seen significantly less frequently in chronic cases. The outcome tended to be poorer when MgE was detected on MRI.
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Affiliation(s)
- Guillaume F Dutil
- Division of Clinical Neurology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Julien Guevar
- Division of Small Animal Surgery, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Daniela Schweizer
- Division of Radiology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Petra Roosje
- Division of Dermatology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Filip Kajin
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany
| | - Holger A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany
| | - Nick J Grapes
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | | | - Jad Abouzeid
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Paul Freeman
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Kiterie ME Faller
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, UK
| | - Veronika M Stein
- Division of Clinical Neurology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Arianna Maiolini
- Division of Clinical Neurology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Bancroft S, Heinrich N, Wolf C. Otogenic intracranial abscessation secondary to an inflammatory polyp with chronic otitis media/interna in a cat. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Sara Bancroft
- McKeever Dermatology Clinics Eden Prairie Minnesota USA
| | | | - Christina Wolf
- Blue Pearl Veterinary Partners Eden Prairie Minnesota USA
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Mascarenhas MB. Nonpolyp‐associated otitis media in cats: The little we know. Vet Med Sci 2022; 8:1853-1854. [PMID: 35689834 PMCID: PMC9514504 DOI: 10.1002/vms3.850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Grapes NJ, Taylor-Brown FE, Volk HA, De Decker S. Clinical reasoning in feline vestibular syndrome: which presenting features are the most important? J Feline Med Surg 2021; 23:669-678. [PMID: 33176542 PMCID: PMC10812200 DOI: 10.1177/1098612x20970869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate whether clinical variables from the history, clinical presentation, and physical and neurological examinations of cats with vestibular syndrome were statistically predictive of the underlying diagnosis. METHODS In total, 174 cats presenting with vestibular syndrome between January 2010 and May 2019 were investigated. Univariate statistical analysis of clinical variables was performed and those statistically associated with a diagnosis were retained for multivariable binary logistic regression modelling. RESULTS The seven most prevalent diagnoses represented 95% of vestibular presentations, which included: otitis media/interna (n = 48), idiopathic vestibular syndrome (n = 39), intracranial neoplasia (n = 24), middle ear polyp (n = 17), feline infectious peritonitis (n = 13), thiamine deficiency (n = 13) and intracranial empyema (n = 11). Idiopathic vestibular syndrome was commonly associated with non-purebred cats and had 17.8 times the odds of an improving clinical progression (95% confidence interval [CI] 1.3-250.0; P = 0.03). Intracranial neoplasia was associated with older age and chronic onset of clinical signs, and was significantly more likely to have a central vestibular neuroanatomical localisation (95% CI 8.5-344,349,142.0; P = 0.015) with postural deficits on neurological examination. Thiamine deficiency was more common in female cats, with 52.6 times the odds of a waxing and waning clinical progression (95% CI 1.2-1000; P = 0.038) and 6.8 times the odds of presenting with bilateral vestibular signs (95% CI 1.0-45.7; P = 0.047) and wide excursions of the head (95% CI 1.0-45.7; P = 0.047). Middle ear polyps were associated with 8.8 times the odds of presenting with Horner syndrome (95% CI 1.5-50.0; P = 0.015). CONCLUSIONS AND RELEVANCE Although it may be difficult to identify the underlying diagnosis in cats with vestibular syndrome from the presenting features alone, there are instances in which discrete clinical features may help to guide clinical reasoning when evaluating cats with vestibular presentations.
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Affiliation(s)
- Nicholas J Grapes
- Department of Clinical Science and Services, Royal Veterinary College, North Mymms, Hatfield, UK
| | | | - Holger A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary College, North Mymms, Hatfield, UK
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Brame B, Cain C. Chronic Otitis in Cats: Clinical management of primary, predisposing and perpetuating factors. J Feline Med Surg 2021; 23:433-446. [PMID: 33896249 PMCID: PMC10741284 DOI: 10.1177/1098612x211007072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PRACTICAL RELEVANCE Chronic otitis can be one of the most frustrating diseases to manage for a small animal practitioner. While it occurs less commonly in the cat than the dog, it is no less challenging. The purpose of this review is to discuss the common and uncommon causes of chronic otitis in the cat within the clinical framework used for diagnosis and treatment. The focus is on diseases that affect the ear canal, rather than those restricted to the pinnae. CLINICAL CHALLENGES Otitis is multifactorial, which complicates management. A common clinical mistake is to focus solely on treating the infection present. Only by addressing all factors will a clinician successfully control chronic otitis. For the purposes of this review, the authors have adopted the established model of separating primary, predisposing and perpetuating causes of otitis. Primary factors are those that directly cause otitis (inflammation); predisposing factors are those that put the patient at risk for development of otitis; and perpetuating factors are those that result in ongoing clinical signs of otitis or that prevent clinical resolution. AUDIENCE This review is aimed at veterinarians who treat cats and particularly those with an interest in feline dermatology and otology. EQUIPMENT While many practitioners rely on a hand-held otoscope, a video-otoscope can be very helpful for the diagnosis and treatment of chronic otitis. EVIDENCE BASE This review presents up-to-date information regarding the diagnosis and treatment of chronic otitis in cats, with emphasis on the most recent peer-reviewed literature.
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Affiliation(s)
- Bailey Brame
- Department of Clinical Sciences and Advanced
Medicine, University of Pennsylvania, School of Veterinary Medicine, 3900 Spruce
Street, Philadelphia, PA 19104, USA
| | - Christine Cain
- Department of Clinical Sciences and Advanced
Medicine, University of Pennsylvania, School of Veterinary Medicine, 3900 Spruce
Street, Philadelphia, PA 19104, USA
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Bersan E, Maddox T, Walmsley G, Piviani M, Burrow R. CT-guided drainage of a brainstem abscess in a cat as an emergency treatment procedure. JFMS Open Rep 2020; 6:2055116919896111. [PMID: 32095257 PMCID: PMC7011327 DOI: 10.1177/2055116919896111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Case summary A 3-year-old male neutered domestic shorthair cat was presented with a 1-week
progressive and rapidly deteriorating history of lethargy and abnormal
behaviour. Neurolocalisation indicated multifocal intracranial lesions
(right oculomotor nerve, brainstem [obtundation, non-ambulatory
tetraparesis, vestibular dysfunction and intermittent decerebrate rigidity]
and possibly the thalamus [left-sided pleurothotonus]), or more likely a
single brainstem lesion with mass effect. MRI of the brain demonstrated a
brainstem abscess causing severe dorsal displacement particularly affecting
the pons and the medulla oblongata causing cerebellar vermis herniation
through the foramen magnum. CT-guided free-hand technique drainage of the
brain abscess was performed and broad spectrum antibiotics were started
based on sensitivity results. The cat recovered uneventfully from
anaesthesia displaying marked improvement immediately after the procedure.
Antibiotics were continued for 8 months; repeat imaging prior to withdrawal
found complete resolution of the brainstem abscess. Relevance and novel information Free-hand CT-guided drainage of a brainstem abscess is not without risk;
however, in this case it led to significant clinical improvement and
stabilisation likely owing to reduced intracranial pressure. It also
provided a diagnostic sample that allowed successful medical treatment
planning and outcome. To our knowledge, this is the first report describing
the successful management of a brainstem abscess by CT-guided drainage in
the veterinary literature. It suggests that stereotactic drainage followed
by medical therapy can be considered a successful therapeutic alternative to
brain surgery or medical treatment alone, providing an emergency treatment
in cases of acute brainstem dysfunction.
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Affiliation(s)
- Erika Bersan
- Small Animal Teaching Hospital, Institute of Veterinary Sciences, University of Liverpool, Neston, UK.,Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Thomas Maddox
- Small Animal Teaching Hospital, Institute of Veterinary Sciences, University of Liverpool, Neston, UK.,Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Gemma Walmsley
- Small Animal Teaching Hospital, Institute of Veterinary Sciences, University of Liverpool, Neston, UK.,Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Martina Piviani
- Small Animal Teaching Hospital, Institute of Veterinary Sciences, University of Liverpool, Neston, UK
| | - Rachel Burrow
- Small Animal Teaching Hospital, Institute of Veterinary Sciences, University of Liverpool, Neston, UK
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Martin S, Drees R, Szladovits B, Beltran E. Comparison of medical and/or surgical management of 23 cats with intracranial empyema or abscessation. J Feline Med Surg 2019; 21:566-574. [PMID: 30106317 PMCID: PMC10814531 DOI: 10.1177/1098612x18792657] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
OBJECTIVES Feline intracranial abscessation or empyema is infrequently reported in the veterinary literature. To date, the largest study is based on a population of 19 cats with otogenic infection. The aim of this study was to review a larger population of cats with intracranial empyema from multiple aetiologies and document their signalment, imaging findings, treatment protocols (including medical and/or surgical management) and to compare outcomes. METHODS Cases presenting to a single referral centre over a 10 year period with compatible history, neurological signs and imaging findings consistent with intracranial abscessation and empyema were reviewed retrospectively. RESULTS Twenty-three cats met the inclusion criteria. Advanced imaging (CT and/or MRI) was performed in 22/23 cats; one case was diagnosed via ultrasound. Ten cases underwent medical and surgical management combined, 10 underwent solely medical management and three were euthanased at the time of diagnosis. Short-term outcome showed that 90% of surgically managed and 80% of medically managed cats were alive at 48 h post-diagnosis. Long-term survival showed that surgically managed cases and medically managed cases had a median survival time of 730 days (range 1-3802 days) and 183 days (range 1-1216 days), respectively. No statistical significance in short- or long-term survival ( P >0.05) was found between medically and surgically managed groups. CONCLUSIONS AND RELEVANCE Feline intracranial abscessation and empyema are uncommon conditions that have historically been treated with combined surgical and medical management. This study documents that, in some cases, intracranial abscessation and empyema can also be successfully treated with medical management alone.
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Affiliation(s)
- Sophie Martin
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | - Randi Drees
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | - Balazs Szladovits
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, UK
| | - Elsa Beltran
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
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