Presumptive Ischemic Brain Infarction in a Dog with Evans’ Syndrome

Abstract

A ten-year-old neutered female mixed breed dog was referred for pale mucous membrane and acute onset of right prosencephalic clinical signs. Brain magnetic resonance imaging was suggestive for right middle cerebral artery ischemic stroke. Based on cell blood count, serum biochemistry and serologic tests and flow cytometric detection of anti-platelets and anti-red blood cells antibodies, a diagnosis of immunomediated haemolytic anemia associated with thrombocytopenia of suspected immunomediated origin was done. Immunosuppresive therapy with prednisone was started and the dog clinically recovered. Two months later complete normalization of CBC and serum biochemistry was documented. The dog remained stable for 7 months without therapy; then she relapsed. CBC revealed mild regenerative anemia with spherocytosis and thrombocytopenia. A conclusive Evans’ syndrome diagnosis was done and prednisone and cyclosporine treatment led to normalization of physical and CBC parameters. The dog is still alive at the time the paper submitted. Possible thrombotic etiopathogenetic mechanisms are illustrated in the paper and the authors suggest introducing Evans’ syndrome in the differential diagnosis list for brain ischemic stroke in dogs.

QSM in canine model of acute cerebral ischemia: A pilot study

“…Cortical regions of interest (ROIs) corresponding to the MCA territory were manually drawn by a trained operator (N.S., blinded for review) on the magnitude images (generated through combination of all echoes using standard approach, that is, the final image M = √(), where is the magnitude of the i th echo, and n is the total number of acquired echoes), which are naturally coregistered to the QSM (Figure 1). The MCA territory was defined based on gyral derived from the literature, 39,53‐57 supplemented by the operator’s experience. Magnitude images provided the anatomic detail to manually draw the MCA territory.…”

“…, where M i is the magnitude of the ith echo, and n is the total number of acquired echoes), which are naturally coregistered to the QSM (Figure 1). The MCA territory was defined based on gyral derived from the literature, 39,[53][54][55][56][57] supplemented by the operator's experience. Magnitude images provided the anatomic detail to manually draw the MCA territory.…”

The utility of diagnostic tests for immune‐mediated hemolytic anemia

“…In humans, concurrent IMHA and IMT have been termed Evan's Syndrome. This disease process likely occurs in dogs; however, the presence of concurrent anti‐erythrocyte and anti‐platelet antibodies has rarely been documented in veterinary patients . In 38 dogs with both anemia and thrombocytopenia, 18 of 38 (47%) patients were positive by DAT for anti‐erythrocyte antibodies .…”

Central vestibular syndrome in a red fox (<i>Vulpes vulpes</i>) with presumptive right caudal cerebral artery ischemic infarct and prevalent midbrain involvement

“…Cerebral ischemic stroke is a sudden interruption of arterial blood flow in a limited area of the brain caused by vascular obstruction, impaired vasodilation or increased blood viscosity leading to neuronal injury and parenchymal necrosis (Garosi et al, 2006;Higgins et al, 2006;Hillock et al, 2006;Wessmann et al, 2009;Giannuzzi et al, 2014). Depending on the size of the involved vessel, cerebral infarcts are distinct in territorial infarcts, associated with disease of superficial, large diameter blood vessels and lacunar infarcts, deriving from disease of small, intraparenchymal, penetrating arteries (Garosi et al, 2006).…”

“…Clinical signs of focal ischemic encephalopathy are variable and ultimately related to the involved brain area (telencephalon; thalamus or midbrain; cerebellum; brainstem) (Hillock et al, 2006). Although a large percentage, more or less 40%, of ischemic strokes have an unknown etiology, several underlying causes have been recognized in dogs and cats including, hypertension, endocrine, kidney, heart, metastatic diseases, parasitic thromboembolism (Garosi, 2010) and Evans' syndrome (Giannuzzi et al, 2014). Focal ischemic encephalopathy is frequently diagnosed in companion animals and, in the last decade, it has been more commonly recognized likely because of both increased awareness of it as a potential neurologic disorder and increased availability of magnetic resonance imaging (MRI) and computed tomography (Dewey, 2003;Hillock et al, 2006).…”