Spontaneous thoracolumbar hematomyelia secondary to hemophilia B in a cat

Abstract

Case summaryA 10-year-old neutered male domestic shorthair cat presented for evaluation of acute onset of paraplegia with loss of nociception and thoracolumbar spine hyperesthesia and no history of trauma. Activated partial thromboplastin time (aPTT) was markedly prolonged, and specific coagulation factor testing revealed a factor IX level of 4% of normal activity, confirming the presence of mild hemophilia B. Prior abnormal bleeding had occurred at the time of castration as a kitten, as well as with laceration to a toe. Advanced imaging, including computed tomography (CT) and magnetic resonance imaging (MRI) of the thoracolumbar spine, confirmed the presence of multifocal intradural and intramedullary spinal cord hemorrhage through demonstration of focal ring enhancement on CT and multifocal areas of signal void on gradient echo T2* images on MRI. Despite factor IX supplementation through the use of fresh frozen plasma transfusions and normalization of the aPTT time, the cat’s neurological status did not improve. Owing to repeated urinary tract infections, with increasing resistance to antibiotic therapy, the cat was ultimately euthanized. Post-mortem examination showed no evidence of another underlying primary pathology for the hematomyelia.Relevance and novel informationTo our knowledge, this case demonstrates the first reported occurrence of spontaneous hematomyelia secondary to hemophilia B in a cat.

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

“…In the absence of trauma, conditions described to be associated with intramedullary spinal cord haemorrhage include neoplasia, vasculitis, 9 parasite infection 10 and haemophilia. 11 In the present case, intramedullary haemorrhage developed <24 h after trauma and this correlates well with the description of rapidly developing parenchymal haemorrhages after experimental SCI. Indeed, in rats, two studies focused on MRI findings after SCI, 12 and these found a good correlation between MRI and histopathological findings.…”

“…In the absence of trauma, conditions described to be associated with intramedullary spinal cord haemorrhage include neoplasia, vasculitis, 9 parasite infection 10 and haemophilia. 11 …”

Presumptive Haematomyelia Secondary to Warfarin Toxicosis in a Dog

“…As in the case described here, hyperesthesia together with neurological deficits has also been reported in all the previous cases of haematomyelia described in veterinary medicine with hemophilia A and B, in two of the four cases with Angiostrongylus Vasorum, in a case of juvenile polyarteritis syndrome, and other cases of unknown origin [ 5 , 7 – 9 ]. Haematomyelia has been described in human medicine as an abrupt spinal syndrome, with intense local or radicular pain related to motor and sensory deficits, which in time and depending on its location [ 10 ] could be accompanied by urinary and/or faecal sphincter atony.…”

“…Haematomyelia, and in particular nontraumatic haematomyelia, is rarely reported in veterinary medicine [ 1 – 3 ]. Previously reported underlying causes for nontraumatic haematomyelia include vascular malformations [ 3 ], spinal tumors [ 4 ], parasites such as Angiostrongylus vasorum [ 5 ] and Leishmania infantum [ 6 ], and also related to juvenile polyarteritis syndrome [ 7 ] and congenital coagulopathies such as Von Willebrand disease or hemophilia A and B [ 8 , 9 ]. Recently, a case of suspected primary haematomyelia has also been described in a French Bulldog with no identified underlying cause [ 1 ].…”

“…Intramedullary haemorrhage (haematomyelia) is rarely reported in veterinary medicine [ 1 ], with most cases secondary to spinal cord trauma [ 2 , 3 ]. Nontraumatic causes have been described as a result of vascular malformations [ 3 ], spinal tumors [ 4 ], parasitic diseases such as Angiostrongylus vasorum [ 5 ] and Leishmania infantum [ 6 ], juvenile polyarteritis syndrome [ 7 ], and congenital coagulopathies such as Von Willebrand disease and hemophilia A and B [ 8 , 9 ]. This case reports an extensive presumptive haematomyelia with severe neurological deficits suspected to be secondary to warfarin intoxication in a dog.…”