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Case 32
Primary clinician: Brad
Gavaghan, DVM
Supervising clinician: Mark D. Kittleson,
DVM, PhD,
DipACVIM (Cardiology)
 | Eight-year-old Blue Point Siamese male neutered cat weighing 4.4
kg ("Mickey") |
| Blind and progressive vestibular disease -
presenting to the Neurology Service |
| Mickey is presented to the VMTH with a 2-month
history of progressive vestibular dysfunction and loss of vision OU. |
| The owner
first noticed him being clumsy when jumping on and off obstacles. |
|
Four to six weeks ago, he
became gradually more unstable on his front limbs and would bunny hop when
attempting to climb stairs. |
| Three weeks ago the
referring veterinarian noticed cataracts OU and he
remarked that this cat
came from a known litter of amyloid sufferers.
Thoracic radiographs revealed slight cardiomegaly. |
| Mickey has mydriasis and
limited vision OU. |
| A urinalysis showed +++ protein.
T4 was normal at 1.4. Hematocrit was high at 48%. Albumin was
mildly elevated at 3.95g/dl, BUN was high at
39.5mg/dl, and glucose was high at 224.4mg/dl (possibly stress induced). Rest
of blood work was unremarkable. |
| Today, Mickey is initially circling a lot, predominantly to the right;
he loses his balance occasionally and falls to the right as well. He
will also fall on his left side occasionally. He is
very curious yet cautious, and he turns his head from side to side constantly.
|
| Mickey eats baked chicken breast, chicken baby food,
and Iams dry food. He is a finicky eater. |
| BARH, nervous, cautious. BCS: 5/9. T=101.0, P=244, R=32. |
| INTEGUMENT: NSF |
| EENT: Eyes -
mydriasis OU; poor to unresponsive
pupillary light responses (PLRs)
both direct and consensual bilaterally; mucoid discharge OU;
Mouth - moderate dental
calculus |
| MUSCULOSKELETAL: lean musculature, no atrophy |
| CV: no murmur ausculted at this point, a soft
gallop rhythm was noted. Mm's pink; CRT<1second;
no edema; strong femoral pulses. |
| GI: NSF |
| GU: small soft bladder |
| LN: WNL |
| NEUROLOGICAL EXAM: MENTATION: nervous, constantly pacing the room.
GAIT: insecure, moving head in wide excursions from side to side; holds head
high when walking on the floor and low when carried on arm. CRANIAL NERVES:
direct and consensual PLRs nearly non-existent OU; rest of cranial nerve exam
normal. POSTURAL RESPONSES: tactile placing is present, while visual placing
is absent. Hopping: slow but purposeful hopping. SPINAL REFLEXES: present.
MUSCLE TONE: normal. SENSATION/PAIN: normal. |
| Problem 1: see physical exam. Added: S/O: Mickey is very nervous and
scared. He does not want to eat, and he hides in his box. He vocalizes when we
attempt to make contact. According to the function test of the cranial
reflexes, it appears that nerves III to VII and IX and X are intact.
A: The
blindness and decreased PLRs are consistent with a problem situated
at the level of the retina, optic disc or optic nerve; however, brain disease
must also be considered. Rule outs include: (1) Extracranial abnormalities:
metabolic, toxic or nutritional diseases; and (2)Intracranial causes:
infectious/inflammatory disease; degenerative disease; vascular/ischemic
incident; trauma; neoplasia. P: Ophthalmology and
cardiology consults today. Tomorrow we will perform
an MRI and a CSF tap if consults and bloodwork are
normal. |
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