Abstract
BackgroundOverdrainage and collapse of the hemispheres is a potential severe complication after surgical treatment of internal hydrocephalus using ventriculoperitoneal shunts. Here we describe a case of a spontaneous hemispheric ventricular collapse in an untreated dog with congenital hydrocephalus internus.Case presentationA twelve-week-old, male, intact Golden Retriever was presented with a history of peracute obtundation, impaired vision, and progressive gait abnormalities of all limbs for three days. Neurological examination revealed a dome shaped skull, a broad-based stance and a moderate cerebellar ataxia. The postural responses were markedly delayed in all limbs. Moderate ventro-lateral strabismus, vertical nystagmus and absent menace response were observed bilaterally. Clinical signs indicated multifocal localisation (forebrain, cerebellum). Magnetic resonance imaging (MRI) showed dilation of all cerebral ventricles, irregular thinning of the periventricular white and grey matter, consistent with internal hydrocephalus. In addition, the hemispheres were collapsed at the right temporal and left frontal lobe with haemorrhage filling the adjacent subarachnoid space. The dog underwent left frontal and right temporal craniotomy for removal of the haemorrhage. The dog improved on all neurological signs and was discharged after seven days. A repeat MRI three months postsurgical intervention showed reexpansion of the cerebral hemispheres. Subarachnoid haemorrhages were markedly reduced.ConclusionsCollapse of the hemispheres can occur spontaneously in dogs with hydrocephalus internus. Removal of the haemorrhage can improve clinical signs.
Highlights
Overdrainage and collapse of the hemispheres is a potential severe complication after surgical treatment of internal hydrocephalus using ventriculoperitoneal shunts
The development of subarachnoid haemorrhages and hematomas secondary to hemispheric ventricular collapse leads to acute progression of neurological signs and decompressive surgery is the first choice of treatment in human patients [12, 13] and animals [14]
Preanesthetic laboratory investigations comprising complete blood cell count (CBC), serum biochemistry panel and electrolytes were unremarkable with the exception of a mildly elevated creatine kinase (392 U/L; reference range, 10–143 U/L), alkaline phosphatase (371 U/L; reference range 0–130 U/L), calcium (1.59 mmol/L; reference range 1.23–1.43 mmol/L), and phosphate (2.85 mmol/L; reference range 0.79–2.1 mmol/L), attributed to the young age of the dog
Summary
Internal hydrocephalus, defined as an accumulation of the cerebrospinal fluid (CSF) within the ventricular system of the brain, is the most common congenital anomaly of the nervous system in dogs [1,2,3]. We report successful surgical treatment of subarachnoid haemorrhages secondary to spontaneous hemispheric ventricular collapse in a dog with congenital hydrocephalus internus. At the level of the left frontal lobe there was a marked, heterogenous, lobulated lesion in the subarachnoid space with a severe mass effect on the cortical surface causing medial displacement of the brain parenchyma. The hemispheres were collapsed at the right temporal and left frontal lobe with subacute and chronic haemorrhage filling the adjacent subarachnoid space as well as subtentorial and cerebellar herniation. The subarachnoid haemorrhages were significantly decreased in size, but still present Their signal intensity changed compared to previous exam, being characterized by severe heterogeneous mixed hypointense and hyperintense signal in T2W/FLAIR, isointense in T1W with moderate peripheral and internal contrast uptake (Fig. 2 a-d). The ventricular system was asymmetric and moderately distended, the mesencephalic aqueduct could not be delineated, which suggests aquaeductal stenosis as the underlying cause for the
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