CT-guided drainage of a brainstem abscess in a cat as an emergency treatment procedure

Case summary A 3-year-old male neutered domestic shorthair cat was presented with a 1-week progressive and rapidly deteriorating history of lethargy and abnormal behaviour. Neurolocalisation indicated multifocal intracranial lesions (right oculomotor nerve, brainstem [obtundation, non-ambulatory tetraparesis, vestibular dysfunction and intermittent decerebrate rigidity] and possibly the thalamus [left-sided pleurothotonus]), or more likely a single brainstem lesion with mass effect. MRI of the brain demonstrated a brainstem abscess causing severe dorsal displacement particularly affecting the pons and the medulla oblongata causing cerebellar vermis herniation through the foramen magnum. CT-guided free-hand technique drainage of the brain abscess was performed and broad spectrum antibiotics were started based on sensitivity results. The cat recovered uneventfully from anaesthesia displaying marked improvement immediately after the procedure. Antibiotics were continued for 8 months; repeat imaging prior to withdrawal found complete resolution of the brainstem abscess. Relevance and novel information Free-hand CT-guided drainage of a brainstem abscess is not without risk; however, in this case it led to significant clinical improvement and stabilisation likely owing to reduced intracranial pressure. It also provided a diagnostic sample that allowed successful medical treatment planning and outcome. To our knowledge, this is the first report describing the successful management of a brainstem abscess by CT-guided drainage in the veterinary literature. It suggests that stereotactic drainage followed by medical therapy can be considered a successful therapeutic alternative to brain surgery or medical treatment alone, providing an emergency treatment in cases of acute brainstem dysfunction.

GM1 gangliosidosis: Case report

Introduction. Gangliosidoses occur due to inhereted deficiency of human ? - galaktosidase,resulting in the accumulation of glicophyngolipides within the lisosomes. Clinical manifestations of lysosomal storage disorders are remarkably heterogeneous, they can appear at any age and each of them can vary from mild to severe conditions. Case report. We present a patient with an early, infintile type of GM1 gangliosidosis. The facial features were coarse: hypertelorismus, wide nose, depressed nasal bridge with lingual protrusion. From the very first months of life she had severe generalized hypotonic, delayed development and hapatosplenomegaly. Before she died, when she was 13 months old, she had not had any spontaneus movements, she was deaf and blind, dispnoic, with apnoiccrises, with amimic face, but without seizures and decerebrate rigidity, which often accompanies the terminal stage of this illness. Conclusion. The absence of ?-galaktosidase enzyme activaty at the skin fibroblasts confirmed the definitive diagnosis. There has been no successful treatment so far, but increasingly better results of the gene therapy for other lysosomal storage disorders can make us optimistic.

Neurological findings and outcome in adult cerebral malaria

The neurological findings of 100 patients of adult cerebral malaria were studied. The commonest neurological feature was symmetrical upper motor neuron lesion as evidenced by exaggerated tendon reflexes and bilateral planter extensor (61%). Twenty two percent had features of meningeal irritation and/or meningism. Abnormal posturing occurred decerebrate rigidity (6%) and decorticate rigidity (4%) with or without opisthotonus, focal neurological deficit was noted in 5% cases. Pupillary size and reaction were normal in 86%, poor in 14%. Corneal reflexes were absent in 4% cases. Fundoscopy showed retinal hemorrhage in 16%, papilloedema is 3% and exudates in 1%. Majority of the patients recovered (80%) without any persistent neurological sequelae at the time of discharge from hospital and death rate was 20%. Â Patients having focal neurological deficit, disconjugate gaze, poor pupillary reaction, absent corneal reflex and papilloedema were more susceptible to death. Delay in hospitalization and deep coma were also associated with increased mortality, whereas early hospitalization and proper nursing care could reduce mortality. Keywords: Cerebral malaria; Neurological; BangladeshOnline: 21 May 2009 DOI: 10.3329/bmrcb.v35i1.2313Bangladesh Med Res Counc Bull 2009; 35: 15-17