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La Fiera

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OK,
I'm an ER attending (human doctor!) and have a problem with my family dog (living with my mom) who is a 5 year old pug with a history of seizures (on potassium bromide). She's also deaf and I think has some congenital defects (she was the runt of the litter, and is very small for a pug).
Anyway, my mom took her to to vet a several weeks ago because she was limping (back right leg) and they gave her an injection of "something" which didn't really help. Anyway, 5 days ago, she was very lethargic and bumping in to things, and seemed depressed (tail not in it's normal curl) and didn't want to eat anything. So my mom took her to the on call vet, and they empirically treated her for meningitis as she had a
temp of 100.3, (she had a WBC of 19.3 (nl range 4-15.5), with an absolute neutrophil count of 16, 598 (nl range 660- 10600) with absolute bands of 386 (nl high <300)
The vet then referred her to the neurologist in a city an hour a way. Today, my mom took the dog to the neurologist and they told her that the pug needs an MRI, an LP, and a electroretinogram!


Here is a copy of the Neuro Consult:

History:
Bandit presented to the Neurology Service with the chief complaint of left eye blindness, lethargy, and anorexia that started about 1 week ago. Bandit was taken to her referring veterinarian on 12/9/2010, where blood work and radiographs were performed. In addition, Bandit was prescribed dexamethasone SP, doxycycline, Convenia, and famotidine. The next day, some of Bandit's vision returned as she stopped bumping into objects and her appetite and activity improved. Bandit was diagnosed with seizures (epilepsy) when she was around 3 years old and has been on potassium bromide which has controlled her seizures.
Physical Exam:
On physical examination, Bandit was intermittently dull, but responsive. Her temperature was normal. But, her heart rate was a little slower than would be expected. On thoracic auscultation normal heart and lung sounds were heard in all fields. In addition, Bandit's patellas (knee caps) were bilaterally luxated.
Neuroanatomical Diagnosis and Assessment:
Bandit showed decreased placing responses on all four limbs (right slight worse than left side). All of her myotatic reflexes were normal. Her mentation was depressed. On cranial nerve examination, the only abnormality found was absent menace of the left eye (non to poorly visual), with a dilated pupil poorly responsive to bright light stimulation. Based on Bandit's clinical signs and neurologic exam we believe that she has an intracranial (brain) lesion that may also be affecting the optic nerve. A lesion of the optic nerve would explain the blindness and a lesion in the brain could explain Bandit's unsteadiness and depression. Additional diagnostics including MRI with spinal tap are needed to determine whether the lesions are inflammatory, infectious, or neoplastic. Although, Bandit appears to be stable (and perhaps improving) the MRI is highly recommended as we cannot predict the progression or prognosis of Bandit's condition without additional testing.
Based on fundic (ocular) examination we also cannot rule out retinal degeneration as the cause of Bandit's blindness. Our ophthalmology team performed a fundic exam today and recommend an electroretinogram (ERG) &#8211; this test is needed to rule out retinal degeneration as a cause of her blindness. However, even if retinal degeneration is the cause of Bandit's blindness we would still recommend the MRI as a brain lesion would be suspected as the cause of Bandit's proprioceptive deficits and depression.

They recommended the following:
Discontinue dexamethasone and doxycycline if you would like to pursue additional diagnostics return on Wednesday (2 days) for -
MRI with spinal tap
Electroretinogram
Abdominal ultrasound


SO, I am not a vet, but since we are all animals anyway, I couldn't help but try to evaluate our dog, and get her the best treatment.
I was hoping to get some thoughts and recommendations about what to do.
- I am worried about not continuing to treat her for meningitis by waiting to do an LP and stopping antibiotics in the meantime. I would think that the LP wouldn't be accurate anyway (after 4 days already of doxy as well as Dex). On top of that, if she has an intracranial mass with edema, I worry that an LP would cause brainstem herniation and then she'd die much quicker than the mass would kill her.
- I don't think getting an ERG is going to be worthwhile at all because she seems to have lost her vision suddenly, and even if she did have retinal degeneration, there's no treatment anyway
- Why on earth do they want an abdominal ultrasound??? The only thought I had was that on her chem panel the "Lipa" was 2371 (nl range 200-1800) I'm assuming "lipa" is Lipase?! and they are looking for pancreatitis? However, I would have though that 1 diagnosis would suffice, and a neurological dx is a big diagnosis, and usually there aren't 2 separate entities!
-What might the diagnosis be? I thought it was most likely to be a brain abscess or meningitis because she has an elevated WBC, and so far she responded to antibiotics pretty well, but would meningitis cause blindness? Maybe an abscess sitting on the optic nerve? SHe has always sounded congested, and manybe she got sinusitis that seeded to the brain causing meningitis/abscess?

Anyway, any recommendations/thoughts would be helpful!
Thanks
 
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Nexx

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Sorry to hear about the pup.

Unfortunately we cannot answer the question for you (against ToS). Your best bet is to have your mom contact the veterinarians she is dealing with and authorize you to get information/ask questions about her dog. Then set up either an appointment to go in, or a phone consult appointment to discuss the findings you just posted here and the questions and concerns you have.

Good luck!
 

squeegee

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sorry to hear about your mother's dog, and I agree that we're not allowed to help on these boards but just out of curiosity (and I hope I won't get in trouble for asking this!) where are you getting your normal ranges from? are those human ranges? because those ranges are much higher than the normals we've been learning....

good luck!
 

alliecat44

KSU CVM Class of '11
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Talk to the neurologist yourself. Medical advice is against the terms of service of SDN.

Closing thread. Good luck with the dog.
 
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