Clinical Features, Imaging Characteristics, and Long-term Outcome of Dogs with Cranial Meningocele or Meningoencephalocele

Background

The term meningoencephalocele (MEC) describes a herniation of cerebral tissue and meninges through a defect in the cranium, whereas a meningocele (MC) is a herniation of the meninges alone.

Hypothesis/Objectives

To describe the clinical features, magnetic resonance imaging (MRI) characteristics, and outcomes of dogs with cranial MC and MEC.

Animals

Twenty‐two client‐owned dogs diagnosed with cranial MC or MEC.

Methods

Multicentric retrospective descriptive study. Clinical records of 13 institutions were reviewed. Signalment, clinical history, neurologic findings and MRI characteristics as well as treatment and outcome were recorded and evaluated.

Results

Most affected dogs were presented at a young age (median, 6.5 months; range, 1 month – 8 years). The most common presenting complaints were seizures and behavioral abnormalities. Intranasal MEC was more common than parietal MC. Magnetic resonance imaging identified meningeal enhancement of the protruded tissue in 77% of the cases. Porencephaly was seen in all cases with parietal MC. Cerebrospinal fluid (CSF) analysis identified mild abnormalities in 4 of 11 cases. Surgery was not performed in any affected dog. Seventeen patients were treated medically, and seizures were adequately controlled with anti‐epileptic drugs in 10 dogs. Dogs with intranasal MEC and mild neurologic signs had a fair prognosis with medical treatment.

Conclusion and clinical importance

Although uncommon, MC and MEC should be considered as a differential diagnosis in young dogs presenting with seizures or alterations in behavior. Medical treatment is a valid option with a fair prognosis when the neurologic signs are mild.

Patient doses in abdominal aortogram and aorta femoral runoff examinations

Radiation doses to adult male patients from abdominal aortogram and aorta femoral runoff examinations in a medical center were determined with the help of a dose-area product meter. The abdominal aortogram and aorta femoral runoff examination consisted of scout radiographs, fluoroscopy (to position a catheter near the area of interest), and serial films (to record the flow of contrast media). Measurements were converted to effective doses with the help of published results from Monte Carlo simulation calculations. Data from 19 male adult patients weighing 53 to 86 kg were analyzed. The resulting total effective dose had a value of 14.0 +/- 4A mSv (mean and standard deviation). The percent contribution by fluoroscopy was 18.5 +/- 9.9%. The fluoroscopy effective dose had a stronger correlation with the dose-area product (correlation coefficient of 0.97) than with duration of exposure (correlation coefficient of 0.84). Most of the radiation exposure in the observed abdominal aortogram and aorta femoral runoff examination was attributed to radiography.

Epidural blood patch improves postdural puncture headache in a patient with benign intracranial hypertension

Benign intracranial hypertension (BIH) is a disorder of elevated resting intracranial pressure without associated intracranial abnormality. When medical therapy fails to halt visual impairments or recalcitrant headaches progress, lumbar dural puncture and cerebral spinal fluid (CSF) drainage procedures are instituted. The authors report on a patient with BIH in whom a severe postdural puncture headache (low CSF pressure syndrome) paradoxically developed after therapeutic CSF drainage. This postdural puncture headache was successfully treated with an epidural blood patch without complicating the patient's underlying BIH condition.

Transjugular intrahepatic portosystemic shunt (TIPS): a promising nonsurgical treatment for bleeding gastroesophageal varices

Transjugular intrahepatic portosystemic shunts (TIPS) is a relatively new procedure for variceal decompression and alleviation of variceal bleeding. A central connection is made transjugularly between the right hepatic vein and portal vein confluence. The shunt is then buttressed with metallic stents. Between March and August 1992, nine patients with cirrhosis and recurrent variceal hemorrhage have undergone the TIPS procedure at Oklahoma Memorial Hospital. The procedure was successfully performed in all patients. The mean initial direct portosystemic gradient of 22.4 mm Hg was reduced to 9.7 mm Hg. All patients have survived to date with no evidence of recurrent variceal hemorrhage following discharge or transfer. Initial results from our institution and internationally suggest that the TIPS procedure will become an attractive alternative to operative portosystemic shunts.

Isolation and partial characterization of a low molecular weight trypsin inhibitor from human urine

A low molecular weight glycoprotein which completely inhibited trypsin at a 1 : 1 molar ratio was isolated from human urine. It was generated from a precursor molecule which in turn derived from plasma inter-alpha-trypsin inhibitor. It had one polypeptide chain with a molecular weight of about 20 000 and a high content of half-cystine residues. Its amino-terminal amino-acid sequence was Val-Thr-Glu-Val-Thr-X-Leu-Glu-Asp-.