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Case of the month September 2006

Case of the month September 2006. Norwich Terrier, m, 7.5 y. History. For several weeks movement to the left. On day before presentation stress situation due to confrontation with a foreign dog; this was followed by sudden onset of circling to the right and ambulating. Neurological exam.

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Case of the month September 2006

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  1. Case of the month September 2006 Norwich Terrier, m, 7.5 y

  2. History For several weeks movement to the left. On day before presentation stress situation due to confrontation with a foreign dog; this was followed by sudden onset of circling to the right and ambulating.

  3. Neurological exam ambulating and circling to the right unwillingness to stand, laying down on left side desorientation, questionable blindness palpebral reflex: reduced on left side menace response: bilaterally severely reduced proprioception: reduced at left hindlimb extensor postural thrust reaction: reduced at left hindlimb Localisation: multifocal: left brainstem; right forebrain Differentials meningoencephalitis; neoplasia; vascular pathology

  4. dor r T2-weighting transverse

  5. dor r T2-weighting transverse

  6. dor r T2-weighting transverse

  7. dor r T2-weighting transverse

  8. dor dor r r dor dor r r T2-weighting transverse findings ?

  9. dor dor r r dor dor r r T2-weighting transverse findings Between the right frontal and occipital lobe there is a hyperintense (white, arrows) lesion affecting mainly the gray matter. The volume of the affected areas is slightly increased. Additionally there is a moderate midline shift towards the left side (arrow head).

  10. dor dor r r plain contrast enhanced T1-weighting transverse

  11. dor r T1-weighting transverse findings dor r contrast enhanced

  12. dor dor dor r r r +KM iv contrast enhanced T1-weighting transverse findings The lesion is hypointense in the plain sequence (arrows). It does not take up contrast; but there is increased meningeal enhancement on the surface of the brain (arrowheads). The increased delineation of the lesion in the contrast enhanced series is due to its reduced contrast uptake in comparison to normal parenchyma.

  13. rostral r FLAIR dorsal sequence The FLAIR (cerebrospinal fluid suppression) is a special sequence, which suppresses the signal from CSF whereas pathological fluids still give high signal intensity. This increases the conspicuity and delineation of lesions near the lateral ventricles and other CSF-spaces.

  14. rostral r FLAIR dorsal sequence The whole extension of the lesion is depicted clearly. Temporally also the white matter is affected. The right lateral ventricle (asterisk) is slightly deformed; this is a sign for a space occupying effect and confirms the suspected swelling of the affected tissue.

  15. Interpretation The MRI shows a diffuse edema mainly of the gray matter of the right hemisphere, which is diffusely swollen. Therefore the right lateral ventricle is slightly compressed and there is a moderate midline-shift to the right. The lesion shows reduced, the adjacent meningeal vessels show increased contrast uptake. Diagnosis: anemic infarct of the right Art. cerebri media. Comment Stroke is a disease which sporadically also occurs in dogs. Magnetic resonance imaging allows diagnosis, localisation and identification of the affected feeding vessel. The extension and grade of brain damage can be assessed and a prognosis regarding possible recovery of the patient can be given.

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