Case Studies In Small Animal

Cardiovascular Medicine

Home Up 1    Pleural Fluid 2              Cough 3   Heart Murmur 4           Syncope 5       Tachypnea 6           Cyanosis 7   Heart Murmur 8   Heart Murmur 9              Cough 10    Heart Failure 11              Ascites 12    Pleural Fluid 13           Syncope 14     Bradycardia 15     Tachycardia 16                Blind 17   Heart Murmur 18   Resp. Distress 19        Collapsing 20    Heart Failure 21          Paralysis 22    New Murmur 23              Cough 24          Vomiting 25       Tachypnea 26   Heart Murmur 27      Hemoptysis 28  Limb Swelling 29  Heart Murmur 30 Acute Collapse 31 Enlarged Heart 32               Blind 33             Cough 34         Collapse 35         Collapse 36 Thromboembolus 37  Heart Murmur 38  Heart Murmur

Radiographs Ophthalmology Echocardiograms Diagnosis

Case 32

Primary clinician: Brad Gavaghan, DVM

Supervising clinician: Mark D. Kittleson, DVM, PhD, DipACVIM (Cardiology)

Signalment

bulletEight-year-old Blue Point Siamese male neutered cat weighing 4.4 kg ("Mickey")

Presenting Complaints

bulletBlind and progressive vestibular disease - presenting to the Neurology Service

Pertinent History

bulletMickey is presented to the VMTH with a 2-month history of progressive vestibular dysfunction and loss of vision OU.
bulletThe owner first noticed him being clumsy when jumping on and off obstacles.
bullet Four to six weeks ago, he became gradually more unstable on his front limbs and would bunny hop when attempting to climb stairs.
bullet Three weeks ago the referring veterinarian noticed cataracts OU and he remarked that this cat came from a known litter of amyloid sufferers. Thoracic radiographs revealed slight cardiomegaly.
bulletMickey has mydriasis and limited vision OU.
bullet A urinalysis showed +++ protein. T4 was normal at 1.4. Hematocrit was high at 48%. Albumin was mildly elevated at 3.95g/dl, BUN was high at 39.5mg/dl, and glucose was high at 224.4mg/dl (possibly stress induced). Rest of blood work was unremarkable.
bulletToday, Mickey is initially circling a lot, predominantly to the right; he loses his balance occasionally and falls to the right as well. He will also fall on his left side occasionally. He is very curious yet cautious, and he turns his head from side to side constantly.
bulletMickey eats baked chicken breast, chicken baby food, and Iams dry food. He is a finicky eater.

Physical Examination

bulletBARH, nervous, cautious. BCS: 5/9. T=101.0, P=244, R=32.
bulletINTEGUMENT: NSF
bulletEENT: Eyes - mydriasis OU; poor to unresponsive pupillary light responses (PLRs) both direct and consensual bilaterally; mucoid discharge OU; Mouth - moderate dental calculus
bulletMUSCULOSKELETAL: lean musculature, no atrophy
bulletCV: no murmur ausculted at this point, a soft gallop rhythm was noted. Mm's pink; CRT<1second; no edema; strong femoral pulses.
bulletGI: NSF
bulletGU: small soft bladder
bulletLN: WNL
bulletNEUROLOGICAL EXAM: MENTATION: nervous, constantly pacing the room. GAIT: insecure, moving head in wide excursions from side to side; holds head high when walking on the floor and low when carried on arm. CRANIAL NERVES: direct and consensual PLRs nearly non-existent OU; rest of cranial nerve exam normal. POSTURAL RESPONSES: tactile placing is present, while visual placing is absent. Hopping: slow but purposeful hopping. SPINAL REFLEXES: present. MUSCLE TONE: normal. SENSATION/PAIN: normal.

Plans and Progress Notes

bulletProblem 1: see physical exam. Added: S/O: Mickey is very nervous and scared. He does not want to eat, and he hides in his box. He vocalizes when we attempt to make contact. According to the function test of the cranial reflexes, it appears that nerves III to VII and IX and X are intact. A: The blindness and decreased PLRs are consistent with a problem situated at the level of the retina, optic disc or optic nerve; however, brain disease must also be considered. Rule outs include: (1) Extracranial abnormalities: metabolic, toxic or nutritional diseases; and (2)Intracranial causes: infectious/inflammatory disease; degenerative disease; vascular/ischemic incident; trauma; neoplasia. P: Ophthalmology and cardiology consults today. Tomorrow we will perform an MRI and a CSF tap if consults and bloodwork are normal.

Mark D. Kittleson, D.V.M., Ph.D. All rights reserved.