Computed tomographic findings in dogs with head trauma and development of a novel prognostic computed tomography–based scoring system

Abstract

OBJECTIVE To characterize CT findings and outcomes in dogs with head trauma and design a prognostic scale. ANIMALS 27 dogs admitted to the Koret School Veterinary Teaching Hospital within 72 hours after traumatic head injury that underwent CT imaging of the head. PROCEDURES Data were extracted from medical records regarding dog signalment, history, physical and neurologic examination findings, and modified Glasgow coma scale scores. All CT images were retrospectively evaluated by a radiologist unaware of dog status. Short-term (10 days after trauma) and long-term (≥ 6 months after trauma) outcomes were determined, and CT findings and other variables were analyzed for associations with outcome. A prognostic CT-based scale was developed on the basis of the results. RESULTS Cranial vault fractures, parenchymal abnormalities, or both were identified via CT in 24 of 27 (89%) dogs. Three (11%) dogs had only facial bone fractures. Intracranial hemorrhage was identified in 16 (59%) dogs, cranial vault fractures in 15 (56%), midline shift in 14 (52%), lateral ventricle asymmetry in 12 (44%), and hydrocephalus in 7 (26%). Hemorrhage and ventricular asymmetry were significantly and negatively associated with short- and long-term survival, respectively. The developed 7-point prognostic scale included points for hemorrhage, midline shift or lateral ventricle asymmetry, cranial vault fracture, and depressed fracture (1 point each) and infratentorial lesion (3 points). CONCLUSIONS AND CLINICAL RELEVANCE The findings reported here may assist in determining prognoses for other dogs with head trauma. The developed scale may be useful for outcome assessment of dogs with head trauma; however, it must be validated before clinical application.

Early CT in dogs following traumatic brain injury has limited value in predicting short‐term prognosis

“…Early CT of canine TBI patients proved to be a valuable tool in the detection of structural abnormalities including midline shift, brain herniation, and skull fractures. The majority of cases (87.5%) had abnormalities detected; this is consistent with previous studies 10–12 . Skull fractures were the most commonly identified imaging feature and of those cases, 72.4% involved the neurocranium.…”

“…Availability of post contrast images was not an inclusion criterion. A time frame of up to 72 h posttrauma was chosen for consistency with other studies 11 . Dogs that died during the course of treatment where death was obviously unrelated to TBI, or where medical records or imaging studies were incomplete or unavailable for review, were excluded from the study.…”

“…Computed tomography has previously been suggested as a valuable tool in all cases of canine head trauma 10 ; however, extensive veterinary literature regarding CT in canine TBI patients is currently lacking. Only one study exists that proposes a scoring system in order to assess prognosis; this study was limited to 27 cases and is yet to be validated in a clinical setting 11 . Imaging evaluation criteria for purposes of prognostication have previously been applied to MRI studies of canine TBI cases and were found to have a significant association with outcome 12,13 .…”

Global brain ischemia in a dog with concurrent multiorgan dysfunction syndrome after bite wound trauma

“…In humans, the incidence rate of ventricular dilation occurring after a severe traumatic head injury is known to be about 39–44%, and increased ventricular size was found to be evident 4 weeks after sustaining an injury [23]. One report showed that the prevalence of hydrocephalus among dogs with head trauma was 26% (7/27), which was concluded to be an incidental finding [24]. There is no report on acquired hydrocephalus following the development of GBI in both humans and dogs.…”

Traumatic skull fractures in dogs and cats: A comparative analysis of neurological and computed tomographic features

“…In addition, other intracranial changes such as brain edema or intra-axial or extra-axial hemorrhage were almost exclusively found in patients with this region affected. Previous studies have reported several aspects of TBI both on MRI and CT. 8,23 The main aim of these studies was to develop prognostic scores for dogs after suffering head trauma with brain involvement. In both studies, significant associations were found between MRI and CT findings and prognosis in dogs with TBI.…”