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Chang L, Wang XL, Yu C, Liu CH, Zhang Q, Wu Y, Jia R, Ma Q, Pan G, Tong D, Wang X. Chronic kidney disease in a giant panda (Ailuropoda melanoleuca): a case report. BMC Vet Res 2023; 19:131. [PMID: 37612662 PMCID: PMC10464369 DOI: 10.1186/s12917-023-03663-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 07/18/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a common cause of morbidity and mortality in captive wildlife species. However, CKD has been rarely documented in giant pandas. CASE PRESENTATION The following report describes a case of an eight-year-old female giant panda showing clinical signs of epistaxis, bloody diarrhea, polyuria, azotemia and anemia. The animal died despite of supportive treatments. Necropsy was performed. Grossly, both kidneys were shrunken and scarred with pallor. Subcutis edema and petechia on the epicardium of the heart were observed. The tissue samples were made into paraffin sections and stained by H.E and special staining including Periodic Acid-Schiff (PAS), von Kossa, Masson's trichrome, Phosphotungstic acid-hematoxylin (PTAH), and Congo red. Histopathology examination revealed severe chronic tubulointerstitial nephritis with marked interstitial fibrosis, glomerulosclerosis, tubular atrophy and calcification in kidneys, and acute necrotizing hemorrhagic myocarditis with calcification in heart. Other lesions included intestinal hemorrhage, hepatic fatty degeneration and necrosis with hemosiderin, and splenic hemosiderin. CONCLUSIONS In summary, chronic kidney disease was finally diagnosed based on the association of clinical, gross, and histopathological findings. Heart failure secondary to CKD is the leading cause of death in this giant panda. The potential cause of CKD in this animal is possibly due to long term and uncontrolled hypertension. Blood pressure monitoring is essential in establishing the diagnosis and management of hypertension in giant panda.
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Affiliation(s)
- Lingling Chang
- College of Veterinary Medicine, Northwest A&F University, Yangling, China
| | - Xiangyang L Wang
- College of Veterinary Medicine, Northwest A&F University, Yangling, China
| | - Chenfei Yu
- College of Veterinary Medicine, Northwest A&F University, Yangling, China
| | - Chen-Hsuan Liu
- Graduate Institute of Molecular and Comparative Pathobiology, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
| | - Qiang Zhang
- Qinling Giant Panda Research Center, Xi'an, China
| | - Yaping Wu
- Qinling Giant Panda Research Center, Xi'an, China
| | - Ruoyi Jia
- Qinling Giant Panda Research Center, Xi'an, China
| | - Qingyi Ma
- Qinling Giant Panda Research Center, Xi'an, China
| | - Guanglin Pan
- Qinling Giant Panda Research Center, Xi'an, China.
| | - Dewen Tong
- College of Veterinary Medicine, Northwest A&F University, Yangling, China.
| | - Xinglong Wang
- College of Veterinary Medicine, Northwest A&F University, Yangling, China.
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Moretto L, Beckmann K, Günther C, Herzig R, Rampazzo A, Suter A, Steffen F, Glaus T. Manifestations of hypertensive encephalopathy in cats. J Feline Med Surg 2023; 25:1098612X231153357. [PMID: 36802953 PMCID: PMC10812077 DOI: 10.1177/1098612x231153357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVES Hypertensive encephalopathy in cats is an important entity but is underestimated in clinical practice. This could be explained, in part, by non-specific clinical signs. The objective of this study was to characterise the clinical manifestations of hypertensive encephalopathy in cats. METHODS Cats with systemic hypertension (SHT) recognised by routine screening, associated with underlying predisposing disease or a clinical presentation suggestive of SHT (neurological or non-neurological), were prospectively enrolled over a 2-year period. Confirmation of SHT was based on at least two sets of measurements of systolic blood pressure >160 mmHg by Doppler sphygmomanometry. RESULTS Fifty-six hypertensive cats with a median age of 16.5 years were identified; 31 had neurological signs. In 16/31 cats, neurological abnormalities were the primary complaint. The other 15 cats were first presented to the medicine or ophthalmology service, and neurological disease was recognised based on the cat's history. The most common neurological signs were ataxia, various manifestations of seizures and altered behaviour. Individual cats also showed paresis, pleurothotonus, cervical ventroflexion, stupor and facial nerve paralysis. In 28/30 cats, retinal lesions were detected. Of these 28 cats, six presented with a primary complaint of visual deficits, and neurological signs were not the primary complaint; nine presented with non-specific medical issues, without suspicion of SHT-induced organ damage; in 13 cats, neurological issues were the primary complaint and fundic abnormalities were detected subsequently. CONCLUSIONS AND RELEVANCE SHT is common in older cats and the brain is an important target organ; however, neurological deficits are commonly ignored in cats with SHT. Gait abnormalities, (partial) seizures and even mild behavioural changes should prompt clinicians to consider the presence of SHT. A fundic examination in cats with suspected hypertensive encephalopathy is a sensitive test to support the diagnosis.
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Affiliation(s)
- Laura Moretto
- Department of Cardiology, University of Zurich, Zürich, Switzerland
| | - Katrin Beckmann
- Department of Neurology, University of Zurich, Zürich, Switzerland
| | | | - Robert Herzig
- Department of Neurology, University of Zurich, Zürich, Switzerland
| | - Antonella Rampazzo
- Department of Ophthalmology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Anja Suter
- Department of Ophthalmology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Frank Steffen
- Department of Neurology, University of Zurich, Zürich, Switzerland
| | - Tony Glaus
- Department of Cardiology, University of Zurich, Zürich, Switzerland
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Navarro I, Summers S, Rishniw M, Quimby J. Cross-sectional survey of non-invasive indirect blood pressure measurement practices in cats by veterinarians. J Feline Med Surg 2022; 24:1195-1202. [PMID: 35109690 PMCID: PMC10812353 DOI: 10.1177/1098612x211067015] [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] [Accepted: 11/28/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This survey of small animal veterinarians endeavored to: (1) determine current methods of indirect blood pressure measurement; (2) detail techniques used to reduce situational hypertension; and (3) better understand the obstacles to performing blood pressure measurement in cats. METHODS An online survey was produced and circulated to members of the Veterinary Information Network. A total of 733 veterinarians who saw cats in their practice and had access to at least one indirect blood pressure device completed the entirety of the survey. RESULTS Ninety-six percent (703/733) of veterinarians who completed the survey reported measuring indirect blood pressure in cats in their practice, with veterinary technicians conducting most (600/703; 85.3%) of these measurements. Few veterinarians (30/733; 4.1%) did not measure blood pressure, with these veterinarians citing several obstacles including: difficulty interpreting results with the occurrence of fear, anxiety and stress in cats (20/30; 66.7%); difficulty performing measurements in cats (17/30; 56.7%); and technical staff being uncomfortable performing measurements (12/30; 40.0%). Most veterinarians (300/435; 69.0%) in this survey preferred an ultrasonic Doppler flow detector with sphygmomanometry, with many (272/300; 90.7%) perceiving that the results obtained with this device were more trustworthy compared with results obtained with oscillometry. Ninety percent (633/703) of veterinarians employed techniques to reduce situational hypertension in cats. Techniques perceived to be most helpful among veterinarians included: using a quiet location (454/633; 71.7%); minimizing restraint (316/633; 49.9%); performing blood pressure prior to other procedures (eg, phlebotomy, cystocentesis) (302/633; 47.7%); avoiding other animals (219/633; 34.6%); and allowing time for acclimation (167/633; 26.4%). CONCLUSIONS AND RELEVANCE This survey study of veterinarians helps clarify obstacles to routine blood pressure measurement in conscious cats. Veterinarians reported several strategies that they felt reduced situational hypertension in cats. The data inform modifications of techniques to increase the frequency and perceived reliability of blood pressure measurement in at-risk cats.
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A RETROSPECTIVE STUDY OF BRAIN LESIONS IN CAPTIVE NONDOMESTIC FELIDS. J Zoo Wildl Med 2021; 52:918-925. [PMID: 34687508 DOI: 10.1638/2021-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 11/21/2022] Open
Abstract
This retrospective study identified and characterized brain lesions in captive nondomestic felids from a large cat sanctuary. Necropsy reports from January 2002 through December 2018 were examined, and gross images and microscopic slides were reviewed from individual cats, where available. In total, 255 cats met the following inclusion criteria: complete necropsy report available, brain examined grossly or microscopically, and age of >1 mon. Of the 255 cats, 49 cats (19%) were determined to have brain lesions. Eleven different felid species, as well as one captive-bred hybrid (liger), were included in the study, with tigers (Panthera tigris) (55%) and lions (Panthera leo) (18%) being the most common species. Lesions were grouped into six etiologic categories: neoplastic (32%), vascular (26%), inflammatory or infectious (20%), congenital (9%), idiopathic (7%), and metabolic (6%). Not included in these categorized lesions were previously undescribed amphophilic globules in the cerebral cortex of many cats with and without other brain lesions; these were in 95% of lion and 93% of tiger brains where the cerebral cortex was available for histologic examination. These globules were not associated with clinical disease. The histopathologic and gross brain changes documented in this study provide insight into specific diseases and pathologic processes that affect the brains of captive large cat populations.
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Baka RD, Soubasis N, Oevermann A, Koutinas CK, Polizopoulou ZS. Severity of neurological signs in feline hypertensive encephalopathy may be reflected through brain histopathological lesions. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Rania D. Baka
- School of Veterinary Medicine Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
| | - Nektarios Soubasis
- School of Veterinary Medicine Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
| | - Anna Oevermann
- Department of Clinical Research and Veterinary Public Health Vetsuisse Faculty University of Bern Bern Switzerland
| | - Christos K. Koutinas
- School of Veterinary Medicine Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
| | - Zoe S. Polizopoulou
- School of Veterinary Medicine Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
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Kent M, Glass EN, Song RB, Warren JD, de Lahunta A. Pathology in Practice. J Am Vet Med Assoc 2021; 257:53-56. [PMID: 32538698 DOI: 10.2460/javma.257.1.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Hypertension is a common problem, particularly in older cats. Hypertension secondary to a concurrent disease is the most common form of hypertension in cats, particularly in association with chronic kidney disease or hyperthyroidism. However, idiopathic hypertension may account for up to 24% of cases. Any form of persistent hypertension risks target organ damage (TOD), therefore measurement of blood pressure is vital in at-risk cats to identify occult hypertension before TOD occurs. This article addresses when and how to perform blood pressure measurement in cats, TOD that has been documented in this species, and our evidence basis for treating hypertension.
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Affiliation(s)
- Rebecca F Geddes
- Queen Mother Hospital for Animals, Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire AL9 7TA, UK.
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Church ME, Turek BJ, Durham AC. Neuropathology of Spontaneous Hypertensive Encephalopathy in Cats. Vet Pathol 2019; 56:778-782. [PMID: 31113291 DOI: 10.1177/0300985819849500] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pathologic features of 12 cats with naturally acquired systemic hypertension and concomitant hypertensive encephalopathy were analyzed. All cats demonstrated acute onset of signs localized to the forebrain and/or brainstem, including stupor, coma, and seizures. All cats had systemic hypertension, ranging from 160 to 300 mm Hg. Gross lesions were identified in 4 of 12 cases, including caudal herniation of the cerebrum and cerebellum, sometimes with compression of the rostral colliculus and medulla. Histologically, all cases featured bilaterally symmetrical edema of the cerebral white matter. Associated vascular lesions, especially arteriolar hyalinosis, were also observed. Concurrent lesions were chronic tubulointerstitial nephritis (11/12 cases), adenomatous hyperplasia of the thyroid gland (4 cases), hypertensive choroidal arteriopathy (6 cases), and left ventricular hypertrophy (5 cases). This study demonstrates that the typical histologic manifestation of spontaneous hypertensive encephalopathy in cats is bilaterally symmetrical edema of the subcortical cerebral white matter.
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Affiliation(s)
- Molly E Church
- 1 Department of Pathobiology, Ryan Veterinary Hospital, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Amy C Durham
- 1 Department of Pathobiology, Ryan Veterinary Hospital, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Coleman AE, Brown SA, Traas AM, Bryson L, Zimmering T, Zimmerman A. Safety and efficacy of orally administered telmisartan for the treatment of systemic hypertension in cats: Results of a double-blind, placebo-controlled, randomized clinical trial. J Vet Intern Med 2019; 33:478-488. [PMID: 30851066 PMCID: PMC6430933 DOI: 10.1111/jvim.15429] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/16/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Information regarding the efficacy of telmisartan for feline systemic arterial hypertension is limited. OBJECTIVES To evaluate the safety and efficacy of PO administered telmisartan solution in hypertensive cats. ANIMALS Client-owned cats with indirect systolic arterial blood pressure (SBP) of 160-200 mm Hg, based on multiple measurements. METHODS This multicenter trial consisted a 28-day, prospective, randomized, double-blind, placebo-controlled, parallel group, efficacy phase and a 154-day extended-use telmisartan phase. Hypertensive cats were randomly assigned to receive 1.5 mg telmisartan/kg PO q12h for 14 days, followed by 2 mg telmisartan/kg PO q24h, or equivalent volume of placebo. Systolic blood pressure was measured on days 0, 14, and 28. Change in SBP compared to baseline was calculated for days 14 and 28. Telmisartan efficacy was defined as significant decrease in SBP at day 14 compared to placebo and a clinically relevant (>20 mm Hg) decrease in SBP at day 28. RESULTS Two-hundred twenty-one cats were included. On day 14, least squares mean (95% confidence interval) SBP decrease was significantly larger in telmisartan-treated (-23.3 mm Hg [-28.2 to -18.3]) versus placebo-treated (-7.5 mm Hg [-13.6 to -1.5]) cats (P = .0005). On day 28, telmisartan treatment resulted in a clinically relevant SBP decrease (-23.9 mm Hg [-27.8 to -20.0]), whereas placebo did not (-11.6 mm Hg [-17.4 to -5.9 mm Hg]). The decrease in SBP persisted over the 6-month trial in telmisartan-treated cats. CONCLUSIONS AND CLINICAL IMPORTANCE Telmisartan significantly decreased SBP to a clinically relevant extent and was well tolerated in hypertensive cats.
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Affiliation(s)
- Amanda E. Coleman
- Department of Small Animal Medicine and SurgeryUniversity of Georgia College of Veterinary MedicineAthensGeorgia
| | - Scott A. Brown
- Department of Small Animal Medicine and SurgeryUniversity of Georgia College of Veterinary MedicineAthensGeorgia
- Department of Physiology and PharmacologyUniversity of Georgia College of Veterinary MedicineAthensGeorgia
| | - Anne M. Traas
- Pharmaceutical Clinical Research and Development, Boehringer Ingelheim Vetmedica, Inc.St. JosephMissouri
| | - Lawrence Bryson
- Pharmaceutical Clinical Research and Development, Boehringer Ingelheim Vetmedica, Inc.St. JosephMissouri
| | - Tanja Zimmering
- Global PetVet Business Unit, Boehringer Ingelheim Vetmedica GmbHIngelheim am RheinGermany
| | - Alicia Zimmerman
- Pharmaceutical Clinical Research and Development, Boehringer Ingelheim Vetmedica, Inc.St. JosephMissouri
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Coleman AE, Brown SA, Stark M, Bryson L, Zimmerman A, Zimmering T, Traas AM. Evaluation of orally administered telmisartan for the reduction of indirect systolic arterial blood pressure in awake, clinically normal cats. J Feline Med Surg 2019; 21:109-114. [PMID: 29513155 PMCID: PMC10814602 DOI: 10.1177/1098612x18761439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to compare the effects of multiple once- or twice-daily oral dosage rates of the angiotensin II, type-1 receptor blocker, telmisartan (TEL), or placebo (PLA) on indirect systolic arterial blood pressure (SBP) in awake, clinically normal cats. METHODS Utilizing an incomplete crossover design and following a 14 day acclimation period, 28 healthy laboratory cats were randomized to undergo treatment with three of the following 14 day treatment protocols, each separated by a 1 week washout period: oral PLA q24h, oral TEL at a dosage of 1, 1.5, 2 or 3 mg/kg q24h, or oral TEL at a dosage of 1 or 1.5 mg/kg q12h. Using the Doppler ultrasound method, indirect SBP was measured daily during each treatment period, and daily during the first 5 days of each washout period, approximately 3 h after administration of the morning treatment. RESULTS Each treatment protocol was administered to a total of 12 cats. A statistically significant effect of treatment period was identified for the entire study; therefore, only data from the first treatment period (four cats per treatment group) were used for further analysis. Compared with PLA, during the first treatment period, SBP values were significantly lower in cats treated with TEL at all tested dosages by the second week of treatment. SBP remained significantly lower than in PLA-treated animals for 2 days following administration of the last dose in all TEL treatment groups. No clinical signs of hypotension were noted in any group. CONCLUSIONS AND RELEVANCE These results suggest that treatment with TEL at a total daily dose of 1-3 mg/kg - administered as a single dose, or split into two equal doses administered 12 h apart - results in a significant, relatively long-lasting reduction of SBP in clinically normal cats. TEL appears to be well tolerated by normal cats at the dosages tested.
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Affiliation(s)
- Amanda E Coleman
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA, USA
| | - Scott A Brown
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA, USA
- Department of Physiology and Pharmacology, University of Georgia College of Veterinary Medicine, Athens, GA, USA
| | - Marcus Stark
- Boehringer Ingelheim Animal Health, Rheinland-Pfalz, Germany
| | | | | | - Tanja Zimmering
- Boehringer Ingelheim Animal Health, Rheinland-Pfalz, Germany
| | - Anne M Traas
- Boehringer Ingelheim Vetmedica, St Joseph, MO, USA
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Parratt CA, Firth AM, Boag AK, Allison GF, Boysen SR. Retrospective characterization of coma and stupor in dogs and cats presenting to a multicenter out-of-hours service (2012-2015): 386 animals. J Vet Emerg Crit Care (San Antonio) 2018; 28:559-565. [PMID: 30325574 DOI: 10.1111/vec.12772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 09/03/2017] [Accepted: 11/01/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the signalment, etiology, and short-term outcome of dogs and cats presenting in a coma or stupor. DESIGN Retrospective study conducted between May 2012 and February 2015. SETTING Multicenter out-of-hours emergency service provider. ANIMALS Three hundred eighty-six patients presenting in a coma or stupor to a multicenter out-of-hours emergency care provider. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Records were reviewed to determine the most likely etiology of coma or stupor. Short-term outcomes were defined as deceased (died or euthanized) or transferred (case handed over to a daytime clinic or discharged). There were 168 dogs (coma n = 112, stupor n = 56) and 218 cats (coma n = 148, stupor n = 70) identified. Coma and stupor were more prevalent in cats compared to dogs, and Chihuahuas were over represented. Blood glucose concentrations were frequently outside established reference intervals. Excluding undetermined causes, the most common causes in dogs included traumatic brain injury (TBI) 16.0% (n = 27, deceased n = 22), hypoglycemia 10.7% (n = 18, deceased n = 8), shock 10.1% (n = 17, deceased n = 16), seizure 9.5% (n = 16, deceased n = 13), and renal or hepatic dysfunction 5.3% (n = 9, deceased n = 7). For cats, the most common causes included TBI 21.6% (n = 47, deceased n = 38), renal or hepatic dysfunction 13.3% (n = 29, deceased n = 25), intoxication 10.1% (n = 22, deceased n = 18), hypoglycemia 6.0% (n = 13, deceased n = 4), and shock 5.0% (n = 11, deceased n = 8). When treatment was attempted, 46.0% of dogs (n = 44/96) and 41.2% of cats (n = 35/85) survived to be transferred. Compared to all other etiologies, death was less likely when coma or stupor was attributed to hypoglycemia. CONCLUSION In cases where a cause was determined, TBI was the predominant etiology of coma and stupor for both species. With the exception of coma and stupor attributed to hypoglycemia, the overall short-term prognosis was poor.
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Affiliation(s)
| | | | | | | | - Søren R Boysen
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, Canada
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Newton PL, Fry DR. Successful treatment of Providencia rettgeri cholecystitis and neutrophilic cholangitis in a cat. JFMS Open Rep 2018; 4:2055116917750763. [PMID: 29399368 PMCID: PMC5788108 DOI: 10.1177/2055116917750763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Case summary A 15-year-old male neutered domestic shorthair cat was presented with a recent history of seizures, diarrhoea, lethargy, fever and jaundice. Marked elevation of liver enzyme activity was present and ultrasound examination was suggestive of cholecystitis and hepatitis. Neutrophilic cholangitis was confirmed on histopathology of liver biopsies. Bile culture identified a monomicrobial infection with Providencia rettgeri, which was resistant to multiple antimicrobial agents. The cat was treated with oral pradofloxacin for 4 weeks and remained well 4 months later. Relevance and novel information Providencia species are rarely reported in the veterinary literature and are an uncommon cause of disease in humans. The significance of this species in humans relates to the high prevalence of antimicrobial resistance. This is the first report of P rettgeri causing clinical illness in a cat and highlights the importance of bile cultures in hepatic disease.
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Affiliation(s)
| | - Darren R Fry
- Brisbane Veterinary Specialist Centre, Albany Creek, QLD, Australia
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14
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Ungvari Z, Tarantini S, Kirkpatrick AC, Csiszar A, Prodan CI. Cerebral microhemorrhages: mechanisms, consequences, and prevention. Am J Physiol Heart Circ Physiol 2017; 312:H1128-H1143. [PMID: 28314762 PMCID: PMC5495931 DOI: 10.1152/ajpheart.00780.2016] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/22/2017] [Accepted: 03/09/2017] [Indexed: 12/20/2022]
Abstract
The increasing prevalence of multifocal cerebral microhemorrhages (CMHs, also known as "cerebral microbleeds") is a significant, newly recognized problem in the aging population of the Western world. CMHs are associated with rupture of small intracerebral vessels and are thought to progressively impair neuronal function, potentially contributing to cognitive decline, geriatric psychiatric syndromes, and gait disorders. Clinical studies show that aging and hypertension significantly increase prevalence of CMHs. CMHs are also now recognized by the National Institutes of Health as a major factor in Alzheimer's disease pathology. Moreover, the presence of CMHs is an independent risk factor for subsequent larger intracerebral hemorrhages. In this article, we review the epidemiology, detection, risk factors, clinical significance, and pathogenesis of CMHs. The potential age-related cellular mechanisms underlying the development of CMHs are discussed, with a focus on the structural determinants of microvascular fragility, age-related alterations in cerebrovascular adaptation to hypertension, the role of oxidative stress and matrix metalloproteinase activation, and the deleterious effects of arterial stiffening, increased pulse pressure, and impaired myogenic autoregulatory protection on the brain microvasculature. Finally, we examine potential treatments for the prevention of CMHs based on the proposed model of aging- and hypertension-dependent activation of the reactive oxygen species-matrix metalloproteinases axis, and we discuss critical questions to be addressed by future studies.
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Affiliation(s)
- Zoltan Ungvari
- Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; .,Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Stefano Tarantini
- Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.,Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Angelia C Kirkpatrick
- Veterans Affairs Medical Center, Oklahoma City, Oklahoma.,Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and
| | - Anna Csiszar
- Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.,Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Calin I Prodan
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Taylor SS, Sparkes AH, Briscoe K, Carter J, Sala SC, Jepson RE, Reynolds BS, Scansen BA. ISFM Consensus Guidelines on the Diagnosis and Management of Hypertension in Cats. J Feline Med Surg 2017; 19:288-303. [PMID: 28245741 PMCID: PMC11119534 DOI: 10.1177/1098612x17693500] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Practical relevance: Feline hypertension is a common disease in older cats that is frequently diagnosed in association with other diseases such as chronic kidney disease and hyperthyroidism (so-called secondary hypertension), although some cases of apparent primary hypertension are also reported. The clinical consequences of hypertension can be severe, related to 'target organ damage' (eye, heart and vasculature, brain and kidneys), and early diagnosis followed by appropriate therapeutic management should help reduce the morbidity associated with this condition. Clinical challenges: Despite being a common disease, routine blood pressure (BP) monitoring is generally performed infrequently, probably leading to underdiagnosis of feline hypertension in clinical practice. There is a need to: (i) ensure BP is measured as accurately as possible with a reproducible technique; (ii) identify and monitor patients at risk of developing hypertension; (iii) establish appropriate criteria for therapeutic intervention; and (iv) establish appropriate therapeutic targets. Based on current data, amlodipine besylate is the treatment of choice to manage feline hypertension and is effective in the majority of cats, but the dose needed to successfully manage hypertension varies between individuals. Some cats require long-term adjuvant therapy and, occasionally, additional therapy is necessary for emergency management of hypertensive crises. Evidence base: These Guidelines from the International Society of Feline Medicine (ISFM) are based on a comprehensive review of the currently available literature, and are aimed at providing practical recommendations to address the challenges of feline hypertension for veterinarians. There are many areas where more data is required which, in the future, will serve to confirm or modify some of the recommendations in these Guidelines.
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Affiliation(s)
| | | | - Katherine Briscoe
- Animal Referral Hospital, 250 Parramatta Road, Homebush, Sydney, NSW 2140, Australia
| | - Jenny Carter
- PO Box 128209, Remuera, Auckland 1541, New Zealand
| | | | - Rosanne E Jepson
- Clinical Sciences and Services, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK
| | | | - Brian A Scansen
- Associate Professor, Department of Clinical Sciences, Colorado State University, Campus Delivery 1678, Fort Collins, CO 80523, USA
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Kohnken R, Scansen BA, Premanandan C. Vasa Vasorum Arteriopathy: Relationship With Systemic Arterial Hypertension and Other Vascular Lesions in Cats. Vet Pathol 2016; 54:475-483. [DOI: 10.1177/0300985816685137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The vasa vasorum is a delicate network of small arterioles that supplies nutrients to the adventitia and outer media of large arteries. In humans, dysfunction of the vasa vasorum contributes to the pathogenesis of aortic dissection and atherosclerosis. Twenty-four cats from 1 to 18 years of age were prospectively evaluated. Cases were divided into 3 cohorts—with systemic hypertension, without systemic hypertension, and uncertain. Histologic sections of the aorta and main pulmonary artery, as well as sections of kidney and lung, were blindly examined by 2 pathologists. The severity of vasa vasorum arteriopathy was compared to the presence of renal arteriosclerosis, aortic medial degeneration, subintimal fibroplasia of the main pulmonary artery, and blood pressure. We found that vasa vasorum arteriopathy correlated strongly with hypertensive status, degree of renal arteriosclerosis, and lesions in the great vessels. The positive predictive value of a severe vasa vasorum score for systemic hypertension was 84.6%. Lesions of vasa vasorum arteriopathy were predictive of renal arteriosclerosis with 100% sensitivity and 64.7% specificity. The positive predictive value of a severe vasa vasorum score for the presence of aortic lesions was 69.2% vs 91.6% for lesions in the main pulmonary artery. The vasa vasorum appears to be an important responder to systemic hypertension in cats, and arteriopathy of this vascular bed has significant implications for the integrity of the great vessels.
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Affiliation(s)
- R. Kohnken
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - B. A. Scansen
- Department of Clinical Sciences, College of Veterinary Medicine, Colorado State University, Fort Collins, CO, USA
| | - C. Premanandan
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
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17
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Payne JR, Brodbelt DC, Luis Fuentes V. Blood Pressure Measurements in 780 Apparently Healthy Cats. J Vet Intern Med 2016; 31:15-21. [PMID: 27906477 PMCID: PMC5259628 DOI: 10.1111/jvim.14625] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 10/05/2016] [Accepted: 11/02/2016] [Indexed: 11/30/2022] Open
Abstract
Background Mean systolic blood pressure in apparently healthy cats has been reported as approximately 125 mmHg using direct assessment, but there is greater variability in reported values using indirect assessment. Increasing age and the white‐coat effect are associated with increased systolic blood pressure. Hypothesis/Objectives To report Doppler‐derived blood pressure measurements from a large population of apparently healthy cats and to assess epidemiologic factors associated with recorded blood pressures. Animals A total of 780 cats in rehoming centers enrolled in a screening program for heart murmurs and cardiac disease. Methods Cats were considered healthy based on history and physical examination. Cats with known hypertension, hyperthyroidism, or clinical signs of systemic disease and pregnant or nursing queens were excluded. After an acclimatization period, systolic blood pressure was measured using the Doppler sphygmomanometry method following the recommendations of the ACVIM Consensus Statement. General linear model analysis was performed to identify factors associated with variation in systolic blood pressure. Results Median (interquartile range, IQR) systolic blood pressure for the group was 120.6 (110.4–132.4) mmHg. Factors significantly associated with higher systolic blood pressure in a general linear model were increased age, increased nervousness, male sex, neutering, or history of being a stray. The model explained 29.2% of the variation in systolic blood pressure. Conclusions and Clinical Importance The age, demeanor, sex, neuter status and history of being a stray should be taken into account when assessing systolic blood pressure in apparently healthy cats.
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Affiliation(s)
- J R Payne
- Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
| | - D C Brodbelt
- Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
| | - V Luis Fuentes
- Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
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18
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Ferreira A, Sottiaux J, Mandara MT, Motta L. Ascending haemorrhagic myelomalacia associated with systemic hypertension in a hyperthyroid cat. JFMS Open Rep 2015; 1:2055116915589840. [PMID: 28491365 PMCID: PMC5362925 DOI: 10.1177/2055116915589840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2015] [Indexed: 12/30/2022] Open
Abstract
CASE SUMMARY An 8-year-old domestic shorthair neutered male cat was presented with acute onset of paraplegia, absent nociception on the pelvic limbs, tail and perianal area, and a previous history of uncontrolled hyperthyroidism (even after thyroidectomy) and chronic hypertension. The magnetic resonance findings (heterogeneous intramedullary ill-defined area, isointense on T1-weighted and hyperintense on short tau inversion recovery and T2-weighted scans between T12 and L5 spinal cord segments) were consistent with ascending haemorrhagic myelomalacia, which was confirmed by histopathology. It also revealed myelomalacia associated with diffuse arteriolar hyalinosis, similar to the reports found with hypertensive encephalopathy. RELEVANCE AND NOVEL INFORMATION Myelomalacia should be considered as a possible outcome in cats with hypertension. Considering that hypertension is a common consequence of hyperthyroidism, emphasis should be given to blood pressure monitoring, especially after treatment of this condition. We describe the histopathological changes occurring in the spinal cord associated with a state of hypertension.
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Affiliation(s)
| | - Jacques Sottiaux
- Cardiology Department, Grange Pierre, Saint Andre de Corcy, France
| | | | - Luca Motta
- ChesterGates Veterinary Specialists, Neurology Department, Chester, UK
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19
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Bowman CA, Witham A, Tyrrell D, Long SN. Magnetic resonance imaging appearance of hypertensive encephalopathy in a dog. Ir Vet J 2015; 68:5. [PMID: 25949801 PMCID: PMC4422606 DOI: 10.1186/s13620-015-0033-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/31/2015] [Indexed: 11/12/2022] Open
Abstract
A 16-year-old female spayed English Staffordshire terrier was presented for evaluation of a 10-month history of intermittent myoclonic episodes, and a one weeks history of short episodes of altered mentation, ataxia and collapse. Magnetic resonance imaging identified subcortical oedema, predominately in the parietal and temporal lobes and multiple cerebral microbleeds. Serum biochemistry, indirect blood pressure measurements and magnetic resonance imaging abnormalities were consistent with hypertensive encephalopathy secondary to chronic kidney disease.
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Affiliation(s)
- Chloe A Bowman
- Neurology Department, University of Melbourne Veterinary Clinic and Hospital, 250 Princes Highway, Werribee, Melbourne, 3030 Australia
| | - Adrian Witham
- Internal Medicine Department, University of Melbourne Veterinary Clinic and Hospital, 250 Princes Highway, Werribee, Melbourne, 3030 Australia
| | - Dayle Tyrrell
- Diagnostic Imaging Department, University of Melbourne Veterinary Clinic and Hospital, 250 Princes Highway, Werribee, Melbourne, 3030 Australia
| | - Sam N Long
- Neurology Department, University of Melbourne Veterinary Clinic and Hospital, 250 Princes Highway, Werribee, Melbourne, 3030 Australia
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20
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Rylander H, Eminaga S, Palus V, Steinberg H, Caine A, Summers BA, Gehrke J, West C, Fox PR, Donovan T, Cherubini GB. Feline ischemic myelopathy and encephalopathy secondary to hyaline arteriopathy in five cats. J Feline Med Surg 2014; 16:832-9. [PMID: 24518252 PMCID: PMC11112216 DOI: 10.1177/1098612x14520810] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Five cats presented with acute-onset neurological signs. Magnetic resonance imaging in four cats showed a T2-weighted hyperintense spinal cord lesion that was mildly contrast-enhancing in three cats. Owing to inflammatory cerebrospinal fluid changes three cats were treated with immunosuppression. One cat was treated with antibiotics. All cats improved initially, but were eventually euthanased owing to the recurrence of neurological signs. Histopathology in all cats showed hyaline degeneration of the ventral spinal artery, basilar artery or associated branches with aneurysmal dilation, thrombosis and ischemic degeneration and necrosis of the spinal cord and brain. Two cats also had similar vascular changes in meningeal vessels. Vascular hyaline degeneration resulting in vascular aneurysmal dilation and thrombosis should be a differential diagnosis in cats presenting with acute central nervous system signs.
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Affiliation(s)
- Helena Rylander
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | | | | | - Howard Steinberg
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Brian A Summers
- Department of Pathology and Infectious Diseases, Royal Veterinary College, London, UK
| | | | - Chad West
- Animal Medical Center, New York, NY, USA
| | | | - Taryn Donovan
- Department of Anatomic Pathology, Animal Medical Center, New York, NY, USA
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21
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Niemuth JN, De Voe RS, Jennings SH, Loomis MR, Troan BV. Malignant hypertension and retinopathy in a western lowland gorilla (Gorilla gorilla gorilla
). J Med Primatol 2014; 43:276-9. [DOI: 10.1111/jmp.12114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Jennifer N. Niemuth
- College of Veterinary Medicine; North Carolina State University; Raleigh NC USA
| | - Ryan S. De Voe
- College of Veterinary Medicine; North Carolina State University; Raleigh NC USA
- The North Carolina Zoological Park; Asheboro NC USA
| | - Samuel H. Jennings
- College of Veterinary Medicine; North Carolina State University; Raleigh NC USA
- Cummings School of Veterinary Medicine; Tufts University; North Grafton MA USA
| | - Michael R. Loomis
- College of Veterinary Medicine; North Carolina State University; Raleigh NC USA
- The North Carolina Zoological Park; Asheboro NC USA
| | - Brigid V. Troan
- College of Veterinary Medicine; North Carolina State University; Raleigh NC USA
- The North Carolina Zoological Park; Asheboro NC USA
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22
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O'Neill J, Kent M, Glass EN, Platt SR. Clinicopathologic and MRI Characteristics of Presumptive Hypertensive Encephalopathy in Two Cats and Two Dogs. J Am Anim Hosp Assoc 2013; 49:412-20. [DOI: 10.5326/jaaha-ms-5942] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Two dogs and two cats were evaluated for the acute-onset of abnormal mentation, recumbency, and blindness. All cases had systemic hypertension, ranging from 180 mm Hg to 260 mm Hg. MRI of the brain disclosed noncontrast-enhancing, ill-defined, T2-weighted (T2W) hyperintensities in the white matter of the cerebrum in the areas of the frontal, parietal, temporal, and occipital lobes. Lesions were also observed in the caudate nuclei and thalamus (n = 1 in each). Intracranial hemorrhage was observed in one animal. Diffusion-weighted imaging (DWI) was consistent with vasogenic edema in two animals. Retinal lesions were observed in three animals. Hypertension was secondary to renal disease in three animals. A primary underlying disorder was not identified in one animal. Normalization of blood pressure was achieved with amlodipine either alone or in combination with enalapril. In one cat, hypertension spontaneously resolved. In three cases, neurologic improvement occurred within 24–48 hr of normalization of blood pressure. The presumptive diagnosis of hypertensive encephalopathy was supported by the MRI findings and neurologic dysfunction coincident with systemic hypertension in which the neurologic dysfunction improved with treatment of hypertension. The prognosis appears good for the resolution of neurologic deficits with normalization of blood pressure in animals with hypertensive encephalopathy.
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Affiliation(s)
- Jeremy O'Neill
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA (J.O., M.K., S.P.); and the Section of Neurology/Neurosurgery, Red Bank Veterinary Hospital, Tinton Falls, NJ (E.G.)
| | - Marc Kent
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA (J.O., M.K., S.P.); and the Section of Neurology/Neurosurgery, Red Bank Veterinary Hospital, Tinton Falls, NJ (E.G.)
| | - Eric N. Glass
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA (J.O., M.K., S.P.); and the Section of Neurology/Neurosurgery, Red Bank Veterinary Hospital, Tinton Falls, NJ (E.G.)
| | - Simon R. Platt
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA (J.O., M.K., S.P.); and the Section of Neurology/Neurosurgery, Red Bank Veterinary Hospital, Tinton Falls, NJ (E.G.)
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23
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Leblanc NL, Stepien RL, Bentley E. Ocular lesions associated with systemic hypertension in dogs: 65 cases (2005-2007). J Am Vet Med Assoc 2011; 238:915-21. [PMID: 21453181 DOI: 10.2460/javma.238.7.915] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize ocular findings in hypertensive dogs, determine prevalence of hypertension in dogs with ocular disease suggestive of hypertension, and examine possible relationships between degree of hypertension and ocular disease. DESIGN Retrospective case series. ANIMALS 65 dogs initially referred for blood pressure measurement (n = 22), ophthalmic examination (25), or both (18). PROCEDURES Medical records were reviewed to identify dogs examined at the teaching hospital that underwent a complete ophthalmic examination and blood pressure measurement within a 24-hour period between January 1, 2005, and December 31, 2007. Signalment, history, blood pressure measurements, ophthalmic examination findings, and any vasoactive drug treatments were recorded. Ocular lesions considered likely to be associated with systemic hypertension included retinal hemorrhage, retinal detachment, hyphema, tortuous vessels, and subretinal edema. RESULTS Of the 65 dogs, 42 were hypertensive (systolic blood pressure ≥ 160 mm Hg) and 23 were normotensive. Sixty-two percent (26/42) of hypertensive dogs had ≥ 1 type of ocular lesion identified. Retinal hemorrhage was the most common ocular lesion in hypertensive dogs (17/42 [40%]). The presence of ≥ 1 type of ocular lesion had moderate sensitivity and specificity of 62% and 61 %, respectively, for identification of hypertension. Fifteen of the 25 (60%) dogs referred for blood pressure measurement after initial ophthalmic examination were found to be hypertensive. CONCLUSIONS AND CLINICAL RELEVANCE Ocular lesions are common in dogs with systemic hypertension. Dogs with hypertension or diseases associated with hypertension should be monitored carefully for evidence of ocular target organ damage, and hypertension should be systematically ruled out in dogs with characteristic ocular lesions.
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Affiliation(s)
- Nicole L Leblanc
- Department of Medical Sciences, University of Wisconsin, Madison, WI 53706, USA
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24
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Altay UM, Skerritt GC, Hilbe M, Ehrensperger F, Steffen F. Feline Cerebrovascular Disease: Clinical and Histopathologic Findings in 16 Cats. J Am Anim Hosp Assoc 2011; 47:89-97. [DOI: 10.5326/jaaha-ms-5480] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sixteen cats with cerebrovascular disease confirmed via histology to be of nontraumatic and nonneoplastic origins are described. In addition, the anatomy of the arterial supply of the cat's brain is reviewed. It is suggested that this unique arterial design may influence the incidence of cerebrovascular accidents in this species. Of the 16 cats reviewed, seven cats had ischemic infarctions, five had hemorrhagic infarctions, and four were diagnosed with intracranial hemorrhage. The median age was 8 yr and 9.5 yr in cats with infarctions and intracranial hemorrhages, respectively. Clinical signs were severe, acute, consistent with the localization of the cerebrovascular lesion, and influenced by underlying pathology. Four cats with infarction showed lateralized neurologic signs. Four cats with infarctions were diagnosed with pulmonary disease antemortem and three cats had hyperthyroidism. Cerebrospinal fluid analysis and computed tomography scans were available in two cats. None of the infarctions were grossly visible. All cats with hemorrhagic infarcts had severe liver pathology and nephritis was identified in four cats. Hypoxia was a feature in four cats and one cat suffered cardiac failure. In conclusion, the clinical picture is influenced by the type of cerebrovascular disease, the localization of the intracranial lesions, and any underlying pathology.
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Affiliation(s)
- Ulrike Michal Altay
- Department of Small Animals, Clinic of Small Animal Surgery/Neurology (U.M.A., F.S.) and the Institute of Veterinary Pathology (F.E., M.H.), Vetsuisse Faculty University of Zurich, Zurich, Switzerland; and ChesterGates Referral Hospital, Chester, UK (U.M.A., G.S.)
| | - Geoff C. Skerritt
- Department of Small Animals, Clinic of Small Animal Surgery/Neurology (U.M.A., F.S.) and the Institute of Veterinary Pathology (F.E., M.H.), Vetsuisse Faculty University of Zurich, Zurich, Switzerland; and ChesterGates Referral Hospital, Chester, UK (U.M.A., G.S.)
| | - Monika Hilbe
- Department of Small Animals, Clinic of Small Animal Surgery/Neurology (U.M.A., F.S.) and the Institute of Veterinary Pathology (F.E., M.H.), Vetsuisse Faculty University of Zurich, Zurich, Switzerland; and ChesterGates Referral Hospital, Chester, UK (U.M.A., G.S.)
| | - Felix Ehrensperger
- Department of Small Animals, Clinic of Small Animal Surgery/Neurology (U.M.A., F.S.) and the Institute of Veterinary Pathology (F.E., M.H.), Vetsuisse Faculty University of Zurich, Zurich, Switzerland; and ChesterGates Referral Hospital, Chester, UK (U.M.A., G.S.)
| | - Frank Steffen
- Department of Small Animals, Clinic of Small Animal Surgery/Neurology (U.M.A., F.S.) and the Institute of Veterinary Pathology (F.E., M.H.), Vetsuisse Faculty University of Zurich, Zurich, Switzerland; and ChesterGates Referral Hospital, Chester, UK (U.M.A., G.S.)
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25
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Abstract
Practical relevance The increased availability of indirect blood pressure monitoring devices in clinical practice over the past decade has highlighted the significance of systemic hypertension in the feline population. Without routine monitoring and appropriate intervention, cats with undiagnosed systemic hypertension may first be presented with sudden-onset blindness as a consequence of either hyphaema or retinal detachment. Clinical challenges The primary aim in the early diagnosis and treatment of systemic hypertension is prevention of hypertensive target organ damage (with respect to the eye, kidney, cardiovascular and central nervous systems, in particular). A prerequisite is a knowledge of the pathophysiological mechanisms and disease conditions that may contribute to the development of hypertension. This allows the clinician to determine those cases in which blood pressure assessment and longitudinal monitoring is essential and can assist in determining appropriate therapeutic strategies for control of blood pressure. Recent studies have also begun to explore the relationship that systemic hypertension may have with proteinuria and the progression of kidney disease. Patient group The geriatric cat appears most susceptible to the development of systemic hypertension, and monitoring of systolic blood pressure is often advocated as part of a routine health screen in cats over 9–12 years old. Consideration must also be given to cats suspected of having an underlying disease such as chronic kidney disease or hyperthyroidism, or which are receiving therapeutic agents, irrespective of their age. Evidence base Much of our understanding of the pathogenesis of feline hypertension is extrapolated from studies performed in experimental animal models or in human patients, and interspecies differences are often poorly understood.
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26
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Lavoué R, van der Lugt J, Day M, Georges M, Busoni V, Merveille A, Poujade A, Peeters D. Progressive Juvenile Glomerulonephropathy in 16 Related French Mastiff (Bordeaux) Dogs. J Vet Intern Med 2010; 24:314-22. [DOI: 10.1111/j.1939-1676.2010.0474.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Schmiedt CW, Mercurio AD, Glassman MM, McAnulty JF, Brown CA, Brown SA. Effects of renal autograft ischemia and reperfusion associated with renal transplantation on arterial blood pressure variables in clinically normal cats. Am J Vet Res 2009; 70:1426-32. [DOI: 10.2460/ajvr.70.11.1426] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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28
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Kagan RA, Kinsel M, Gloor K, Mylniczenko ND, Langan JN, Farina LL, Terio KA. Morphologic evidence suggestive of hypertension in western gray kangaroos (Macropus fuliginosus). Vet Pathol 2009; 46:977-84. [PMID: 19429991 DOI: 10.1354/vp.08-vp-0246-k-fl] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Marked renal vascular changes, suggestive of hypertension, were present in adult western gray kangaroos (Macropus fuliginosus) from a single facility over a 14-year period. A subset of these kangaroos also had vague clinical nervous system deficits, including blindness. To characterize the vascular lesions, determine prevalence, and document other changes, case histories and archival tissue sections from 21 adult kangaroos (8 male, 13 female) that died or were euthanatized between 1994 and 2008 were reviewed. Relevant lesions included increased thickness of the renal arteriolar tunica media with smooth muscle hypertrophy and/or hyperplasia, accumulation of extracellular matrix within arterioles, increased vascular tortuosity, and varying degrees of juxtaglomerular hyperplasia. Renal tissue from two more severely affected animals was further examined by transmission electron microscopy, highlighting arteriolar endothelial cell hypertrophy and disruption of the medial architecture. Hypertrophy of arteries and arterioles in other organ systems was also present (3/21), including vessels in the brain and spinal cord of one animal with clinical neurologic signs. Four kangaroos had antemortem retinal detachment, a potential sequel of hypertension in humans and domestic mammals. The cause of these vascular lesions in this mob is uncertain. Lesions were not associated with an infectious disease process, age, underlying renal disease, or thyroid abnormalities. In the absence of other causes, hypertension was a differential. Further investigation into clinical significance and predisposing factors, such as genetics and diet, is warranted.
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Affiliation(s)
- R A Kagan
- University of Illinois Zoological Pathology Program, Loyola University, Maywood, IL, USA.
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29
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Kent M. The cat with neurological manifestations of systemic disease. Key conditions impacting on the CNS. J Feline Med Surg 2009; 11:395-407. [PMID: 19389639 PMCID: PMC7128452 DOI: 10.1016/j.jfms.2009.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PRACTICAL RELEVANCE A number of systemic diseases are associated with neurological deficits. Most systemic diseases that impact on the nervous system result in multifocal neurological signs; however, isolated deficits can also be observed. This article reviews the clinical signs, pathophysiology, diagnosis, treatment and prognosis of four important systemic diseases with neurological consequences: feline infectious peritonitis, toxoplasmosis, hypertension and hepatic encephalopathy. CLINICAL CHALLENGES Early recognition of systemic signs of illness in conjunction with neurological deficits will allow for prompt diagnosis and treatment. While neurological examination of the feline patient can undoubtedly be challenging, hopefully the accompanying articles in this special issue will enable the clinician to approach these cases with more confidence. EVIDENCE BASE The veterinary literature contains numerous reports detailing the impact of systemic disease on the nervous system. Unfortunately, very few references provide detailed descriptions of large cohorts of affected cats. This review summarises the literature underpinning the four key diseases under discussion.
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Affiliation(s)
- Marc Kent
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA 30602, USA.
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30
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Schriefl S, Steinberg TA, Matiasek K, Ossig A, Fenske N, Fischer A. Etiologic classification of seizures, signalment, clinical signs, and outcome in cats with seizure disorders: 91 cases (2000–2004). J Am Vet Med Assoc 2008; 233:1591-7. [DOI: 10.2460/javma.233.10.1591] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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31
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Uechi M, Tanaka Y, Aramaki Y, Hori Y, Ishikawa Y, Ebisawa T, Yamano S. Evaluation of the renin-angiotensin system in cardiac tissues of cats with pressure-overload cardiac hypertrophy. Am J Vet Res 2008; 69:343-8. [PMID: 18312132 DOI: 10.2460/ajvr.69.3.343] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To clarify regulation of the renin-angiotensin (RA) system in cardiac tissues by measuring angiotensin-converting enzyme (ACE) and chymase activities in cats with pressure-overload cardiac hypertrophy. ANIMALS 13 adult cats. PROCEDURES Pressure-overload cardiac hypertrophy was induced by coarctation of the base of the ascending aorta in 6 cats, and 7 cats served as untreated control animals. Cats were examined before and 3 months and 2 years after surgery. Two years after surgery, cardiac hypertrophy was confirmed by echocardiography, and the blood pressure gradient was measured at the site of constriction. Cats were euthanized, and ACE and chymase activities were measured in cardiac tissues. RESULTS Mean +/- SD pressure gradient across the aortic constriction was 63 +/- 6 mm Hg. Chymase activity predominated (75% to 85%) in the RA system of the cardiac tissues of cats. Fibrosis in the wall of the left ventricle was detected in cats with hypertrophy, and fibrosis of the papillary muscle was particularly evident. CONCLUSIONS AND CLINICAL RELEVANCE Chronic pressure overload on the heart of cats can activate the RA system in cardiac tissues. A local increase in angiotensin II was one of the factors that sustained myocardial remodeling.
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Affiliation(s)
- Masami Uechi
- Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Kameino 1866, Fujisawa, Kanagawa 252-8510, Japan
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Brown S, Atkins C, Bagley R, Carr A, Cowgill L, Davidson M, Egner B, Elliott J, Henik R, Labato M, Littman M, Polzin D, Ross L, Snyder P, Stepien R. Guidelines for the Identification, Evaluation, and Management of Systemic Hypertension in Dogs and Cats. J Vet Intern Med 2007. [DOI: 10.1111/j.1939-1676.2007.tb03005.x] [Citation(s) in RCA: 486] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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33
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Jepson RE, Elliott J, Brodbelt D, Syme HM. Effect of Control of Systolic Blood Pressure on Survival in Cats with Systemic Hypertension. J Vet Intern Med 2007. [DOI: 10.1111/j.1939-1676.2007.tb02982.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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