Spontaneous thoracolumbar hematomyelia secondary to hemophilia B in a cat

Surgical treatment and outcome of haematomyelia with a traumatic cause in a dog and a cat

Two surgically treated haematomyelia cases were documented. One dog and one cat were presented for acute progressive paraplegia following a fall from height incident. Neurological examinations suggested a L4-S3 myelopathy in both cases. Radiography and magnetic resonance imaging in both cases revealed no fracture or subluxation of the spine, but well-defined intramedullary mass lesions in lower lumbar regions compatible with haemorrhage and haematoma formation. Exploratory surgeries were performed over the lesions. Dark-red friable masses were removed via myelotomy. Histopathological examinations revealed organizing haematomas at the acute to subacute stage. Postoperatively, both cases improved and regained ambulation. The dog walked normally but remained urinary and faecal incontinent 9 months after the surgery. The cat was continent and ambulatory with a paraparetic gait 5 months after the surgery. In both cases, the outcomes and the patients' quality of life were considered satisfactory by the owners.

Presumptive Haematomyelia Secondary to Warfarin Toxicosis in a Dog

A 3-year-old male entire Boxer was presented for a 6-day history of progressive symmetric nonambulatory tetraparesis with diffuse spinal hyperesthesia. Eight days prior to admission, the dog ingested warfarin accidentally, exhibiting systemic clinical signs of intoxication 2 days later. Upon referral, the dog was nonambulatory with paretic thoracic limbs and plegia with absent nociception on pelvic limbs, spinal reflexes were decreased to absent in all four limbs, and urinary and faecal incontinence were noticed. Magnetic resonance imaging (MRI) of the cervical, thoracic, and lumbar regions of the vertebral column revealed intramedullary lesions extending from the first cervical segments to the conus medullaris consistent with extensive intramedullary haemorrhages. Despite management with vitamin K1 and physiotherapy, 6 weeks later, improvement was limited to thoracic limb motor function, and euthanasia was elected. This case reports an extensive presumptive haematomyelia with severe neurological deficits suspected to be secondary to warfarin intoxication in a dog.

Haematomyelia and myelomalacia following an inadvertent thoracic intraspinal injection in a cat

Case summary

A 4-month-old cat was presented with acute paraplegia after the referring veterinarian performed a subcutaneous injection (cefovecin and dexamethasone) in the caudodorsal thoracic area, during which the cat suddenly became uncooperative. A complete neurological examination performed 1 day after the injection revealed paraplegia without deep pain perception and reduced segmental spinal reflexes in the pelvic limbs. Findings were consistent with either an L4–S3 myelopathy or a T3–L3 myelopathy with subsequent spinal shock. MRI showed swelling of the spinal cord from T1 to L1 with heterogeneous T2-weighted intramedullary hyperintensity and no contrast enhancement. A centrally located intraspinal signal void was visible in T2*-weighted images. These changes were compatible with a suspected traumatic intraspinal injection. Despite intensive supportive care over 4 days, neurological status did not improve and the cat was euthanased. Gross pathology findings revealed severe intramedullary haemorrhage and myelomalacia in the T10–L1 spinal cord segments. Histopathology of the spinal cord after haematoxylin and eosin staining revealed a severe intramedullary space-occupying haemorrhage with focal malacia. A trajectory-like, optically empty cavity containing some eosinophilic droplets at the edges was detected. Although no further evidence of trauma was noted in the surrounding structures, the spinal cord changes were compatible with a perforating trauma.

Relevance and novel information

To our knowledge, this is the first report of thoracic intraspinal injection causing myelomalacia defined by an ante-mortem MRI and confirmed post mortem by histopathology. The traumatic myelopathy appeared to be most compatible with an intraspinal injection causing vascular rupture.