Magnetic resonance imaging signs of presumed elevated intracranial pressure in dogs

Bittermann, Sophie; Lang, Johann; Henke, Diana; Howard, Judith; Gorgas, Daniela

doi:10.1016/j.tvjl.2014.04.020

Cited by 36 publications

(71 citation statements)

References 49 publications

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“…Despite the widespread use of MRI to diagnose intracranial disease and the general suggestion that brain herniation carries a poor prognosis, the clinical implications of finding CTH or FMH on advanced imaging have not been investigated extensively . Indeed, lack of specific survival information makes it difficult to advise owners at the time of identifying herniation on MRI.…”

Section: Discussionmentioning

confidence: 99%

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Clinical and Diagnostic Imaging Features of Brain Herniation in Dogs and Cats

Lewis

Olby

Early

et al. 2016

Veterinary Internal Medicne

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BackgroundQuantification of brain herniation on MRI and its immediate clinical implications are poorly described.ObjectivesDefine the normal position of caudal fossa structures on brain MRIs in dogs and cats utilizing morphometry, compare this to dogs and cats with caudal transtentorial herniation (CTH), foramen magnum herniation (FMH) or both identified on MRI, and investigate associations between herniation severity, clinical signs, and 24‐hour outcome.AnimalsNinety‐two controls (66 dogs, 26 cats), 119 cases with herniation (88 dogs, 31 cats).MethodsRetrospective case series. The MRI database was searched for controls with normal brain anatomy and cases with brain herniation. Morphometry in controls established TTX (transtentorial to rostroventral cerebellum) to quantify CTH and FMX (caudoventral cerebellum to foramen magnum) to quantify FMH. Measurements were compared between cases and controls. Correlations with specific clinical variables and outcome were investigated.ResultsMeasurements in medium/large control dogs versus small dog and cat controls were significantly different (P < .001, TTX: −0.46, −0.305, −0.3, FMX: 0.695, 0.27, 0.25, respectively). 119/1564 (7.6%) cases that underwent brain imaging had brain herniation. TTX and FMX were significantly different between controls and cases with CTH or FMH (P < .001). 67/89 (75%) cases with supratentorial lesions had no signs directly attributable to herniation. 71/119 (60%) had a normal anesthetic recovery. TTX was significantly associated with 24‐hour survival (P < .001).Conclusions and clinical importanceBrain herniation can be quantified on MRI. Clinical signs directly attributable to brain herniation commonly are absent, and more severe CTH based on TTX is associated with a worse short‐term outcome.

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Section: Discussionmentioning

confidence: 99%

“…Clinical signs classically associated with brain herniation include altered consciousness accompanied by changes in pupil size and responsiveness to light (CTH), and altered cardiorespiratory patterns (FMH) . Clinical signs supportive of herniation, however, might not consistently be present or be difficult to differentiate from primary brainstem disease …”

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confidence: 99%

Clinical and Diagnostic Imaging Features of Brain Herniation in Dogs and Cats

Lewis

Olby

Early

et al. 2016

Veterinary Internal Medicne

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“…A tentative diagnosis of ICH was based on history, neurologic examination (performed by a board-certified neurologist) and/or magnetic resonance or computed tomographic imaging studies (evaluated by a board-certified radiologist or neurologist). Criteria to substantiate suspicion of ICH were a forebrain or multifocal localization with severely reduced consciousness and miotic pupils on neurological exam, Cushing triad (irregular respiration, bradycardia, and systolic hypertension), brain herniation or other shifts of brain parenchyma on MRI or CT [20], an elevated resistive index [21], and deterioration of modified Glasgow coma scale scores [22]. The decision to administer osmotherapy was at the clinicians’ discretion.…”

Section: Methodsmentioning

confidence: 99%

Comparison of the effects of 7.2% hypertonic saline and 20% mannitol on whole blood coagulation and platelet function in dogs with suspected intracranial hypertension - a pilot study

et al. 2017

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BackgroundHyperosmolar therapy with either mannitol or hypertonic saline (HTS) is commonly used in the treatment of intracranial hypertension (ICH). In vitro data indicate that both mannitol and HTS affect coagulation and platelet function in dogs. The aim of this study was to compare the effects of 20% mannitol and 7.2% HTS on whole blood coagulation using rotational thromboelastometry (ROTEM®) and platelet function using a platelet function analyzer (PFA®) in dogs with suspected ICH. Thirty client-owned dogs with suspected ICH needing osmotherapy were randomized to receive either 20% mannitol (5 ml/kg IV over 15 min) or 7.2% HTS (4 ml/kg IV over 5 min). ROTEM® (EXTEM® and FIBTEM® assays) and PFA® analyses (collagen/ADP cartridges) were performed before (T0), as well as 5 (T5), 60 (T60) and 120 (T120) minutes after administration of HTS or mannitol. Data at T5, T60 and T120 were analyzed as a percentage of values at T0 for comparison between groups, and as absolute values for comparison between time points, respectively.ResultsNo significant difference was found between the groups for the percentage change of any parameter at any time point except for FIBTEM® clotting time. Within each group, no significant difference was found between time points for any parameter except for FIBTEM® clotting time in the HTS group, and EXTEM® and FIBTEM® maximum clot firmness in the mannitol group. Median ROTEM® values lay within institutional reference intervals in both groups at all time points, whereas median PFA® values were above the reference intervals at T5 (both groups) and T60 (HTS group).ConclusionsUsing currently recommended doses, mannitol and HTS do not differ in their effects on whole blood coagulation and platelet function in dogs with suspected ICH. Moreover, no relevant impairment of whole blood coagulation was found following treatment with either solution, whereas a short-lived impairment of platelet function was found after both solutions.

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“…The MRI findings were reviewed by an experienced veterinarian (HO) who was unaware of the TCD variables. The MRI findings indicative of intracranial hypertension were recorded according to the following criteria: (1) effacement of the cerebral sulci, (2) brain herniation (foramen magnum, transtentorial, subfalcine), (3) compression of CSF space (third ventricle, fourth ventricle), and (4) displacement of the lamina quadrigemina . Dogs were suspected of having intracranial hypertension if any ≥2 of the above‐mentioned MRI findings were identified …”

Section: Methodsmentioning

confidence: 99%

“…Magnetic resonance imaging (MRI) findings are good indicators of intracranial hypertension, but these findings are also nonspecific . Previously reported MRI findings indicative of intracranial hypertension include effacement of cerebral sulci, brain herniation, compression of the cerebrospinal fluid (CSF) space, and brain shifting …”

mentioning

confidence: 99%

Transcranial Doppler Ultrasound Examination in Dogs with Suspected Intracranial Hypertension Caused by Neurologic Diseases

Sasaoka

Nakamura

Osuga

et al. 2017

Veterinary Internal Medicne

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BackgroundTranscranial Doppler ultrasound examination (TCD) is a rapid, noninvasive technique used to evaluate cerebral blood flow and is useful for the detection of intracranial hypertension in humans. However, the clinical usefulness of TCD in diagnosing intracranial hypertension has not been demonstrated for intracranial diseases in dogs.ObjectivesTo determine the association between the TCD variables and intracranial hypertension in dogs with intracranial diseases.AnimalsFifty client‐owned dogs with neurologic signs.MethodsCross‐sectional study. All dogs underwent TCD of the basilar artery under isoflurane anesthesia after magnetic resonance imaging (MRI). Dogs were classified into 3 groups based on MRI findings: no structural diseases (group I), structural disease without MRI evidence of intracranial hypertension (group II), and structural disease with MRI evidence of intracranial hypertension (group III). The TCD vascular resistance variables (resistive index [RI], pulsatility index [PI], and the ratio of systolic to diastolic mean velocity [Sm/Dm]) were measured.ResultsFifteen, 22, and 13 dogs were classified into groups I, II, and III, respectively. Dogs in group III had significantly higher Sm/Dm (median, 1.78; range, 1.44–2.58) than those in group I (median, 1.63; range, 1.43–1.75) and group II (median, 1.62; range, 1.27–2.10). No significant differences in RI and PI were identified among groups.Conclusions and Clinical ImportanceOur findings suggest that increased Sm/Dm is associated with MRI findings of suspected intracranial hypertension in dogs with intracranial diseases and that TCD could be a useful tool to help to diagnose intracranial hypertension.

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Magnetic resonance imaging signs of presumed elevated intracranial pressure in dogs

Cited by 36 publications

References 49 publications

Clinical and Diagnostic Imaging Features of Brain Herniation in Dogs and Cats

Clinical and Diagnostic Imaging Features of Brain Herniation in Dogs and Cats

Comparison of the effects of 7.2% hypertonic saline and 20% mannitol on whole blood coagulation and platelet function in dogs with suspected intracranial hypertension - a pilot study

Transcranial Doppler Ultrasound Examination in Dogs with Suspected Intracranial Hypertension Caused by Neurologic Diseases

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