Intra-parenchymal brainstem haemorrhage secondary to iatrogenic needle injury after a parenteral injection in a cat

Abstract

Case summaryA 6-month-old female domestic shorthair cat was presented with acute onset non-ambulatory right hemiparesis and horizontal nystagmus following an injection attempt in the neck, during which the cat did not cooperate. Magnetic resonance imaging (MRI) revealed a well-defined intra-axial lesion on the right side of the myelencephalon. The lesion was T2-weighted hypointense and T1-weighted hypointense to isointense to grey matter, non-contrast enhancing, with perilesional oedema and signal void on T2*-weighted images. A linear hyperintense lesion in the muscles of the right dorsolateral aspect of the neck on short tau inversion recovery images was also observed. These MRI findings were consistent with iatrogenic brainstem haemorrhage and a muscle needle tract. The cat made a good recovery with just mild residual neurological deficits 6 weeks after the injury.Relevance and novel informationTo our knowledge, this is the first report of an iatrogenic brainstem needle injury in a cat and the first report of a central nervous system iatrogenic trauma after a parenteral injection. Care should be taken with neck parenteral injections, especially in the cranial cervical area.

Haematomyelia and myelomalacia following an inadvertent thoracic intraspinal injection in a cat

“…25 MRI features of needle-associated CNS injuries, without injection, have been previously described in four dogs and one cat, respectively. 3,5 MRI, performed between 8 h and 5 days after the incident, succeeded to demonstrate the needle trajectory either in the brainstem or in the paraspinal musculature in all cases. 3,5 In one dog, the findings were confirmed histopathologically.…”

“…3,5 MRI, performed between 8 h and 5 days after the incident, succeeded to demonstrate the needle trajectory either in the brainstem or in the paraspinal musculature in all cases. 3,5 In one dog, the findings were confirmed histopathologically. 5 The lack of visible needle trajectory on MRI in the present case can be related to the small size of the cat (body weight 1.9 kg) or a smaller needle compared with other cases.…”

“…5 However, the outcome was good for a brainstem injury in a young cat. 3 The authors could not find any report of intraspinal injection in human medicine. Only inadvertent intrathecal injections are rarely described and outcomes vary from no neurological signs to death.…”

“…Iatrogenic needle injuries to the central nervous system (CNS) without injection have been previously reported in the veterinary literature following CSF collection attempts in dogs, 5 , 6 microchip implantation in a dog 7 and a cat, 8 and after attempted IM injection in one cat. 3 Iatrogenic injection into the CNS has been described after attempted IM injection in a lamb and an alpaca. 22 In human patients, myelopathies secondary to various needle-associated injuries have been occasionally described, including intramedullary contrast injection, 23 CNS migration of a broken acupuncture needle 24 and spinal cord infarction following a self-inflicted needle-stick injury.…”

“…Parenteral injections are routinely performed in small animal veterinary medicine. 1 Although these procedures are usually safe, there have been reports of accidental damage to the nervous system, such as lesions of the sciatic nerve 2 and of the caudal brainstem, 3 caused by inappropriate routes of administration. This case report describes a detrimental spinal cord injury (SCI) in a cat following an intended subcutaneous (SC) injection in the thoracolumbar paravertebral area.…”