Vestibular Signs Research Articles

Neurologic symptoms due to cholesteatoma in a cat with lysis of the temporal and occipital bone demonstrated by computed tomography and magnetic resonance imaging

AbstractA 7‐year‐old cat was presented with vestibular signs. The cat had a history of a presumed aural polyp that had been removed via ventral bulla osteotomy 4 years prior to presentation, followed by bacterial otitis externa and media that had been treated medically and healed within 8 weeks. At representation, computed‐tomographic imaging and video‐otoscopy showed obstruction of the right tympanic bulla by a heterogeneous mass, severe lysis of the surrounding bones, and pale, friable material within the horizonal external ear canal, extruding from the middle ear. The bacterial culture was negative. Histopathologic examinations supported the diagnosis of cholesteatoma. Due to the rapid progression of the disease, the cat was humanely euthanased 2 months later. Before euthanasia, magnetic resonance imaging documented the worsening of the disease, with an increased size of the expansile lesion and progressive changes in the adjacent structures. Furthermore, additional signs of otitis interna were visible.

An Atypical Ramsay-Hunt Syndrome: Case Report

After the initial infection, which manifests as varicella, the varicella-zoster virus (VZV) remains dormant in the sensory nerve ganglia. It reactivates in elderly people or in immunocompromised patients. When this reactivation involves the geniculate ganglion, it typically causes the Ramsay-Hunt syndrome manifesting as shingles in the Hunt’s zone which includes the eardrum, the external auditory canal and the cavum conchae, as well as a peripheral facial nerve palsy, earache and sensitivity or sensorial disturbances of the nearby cranial ans spinal nerves. Our case describes a 40-year-old patient who developed an atypical Ramsay-Hunt syndrome associating only peripheral facial nerve paralysis and a herpetiform vesiculopustular rash in the retroauricular area, with no otologic, vestibular or sensory signs. In fact, there are anastomoses between the different cranial nerve fibers and ganglia with the spinal nerves and ganglia, which may explain the occurrence of herpes zoster in the C2 dermatome with peripheral facial nerve palsy.

A comatose vertebrobasilar occlusion patient recovering with bilateral hearing loss following full recanalization with mechanical thrombectomy.

Acute occlusion of vertebrobasilar artery mostly presents with severe neurologic impairment. Bilateral sensorineural hearing loss (SNHL) as the first clinical symptom on onset is a rare phenomenon. Clinical benefit of mechanical thrombectomy (MT) in terms of hearing loss in these cases is poorly understood. We describe a case of a patient with vertebrobasilar occlusion who presented with only sudden bilateral SNHL and recovered poorly in terms of hearing loss after full recanalization with MT. We describe a 52-year-old right-handed male patient with an unremarkable medical history. On admission, he was hypertensive to 200/102mm Hg; neurological examination was significant for mild right facial palsy and bilateral SNHL, later confirmed by an audiogram. diffusion-weighted imaging (DWI) showed infarction of bilateral anterior cerebellum, cerebellar peduncles, and pons with negative flair. Computed tomography angiography showed occlusion in the level of the vertebrobasilar junction. Patients' neurological status deteriorated within hours into a comatose status with anarthria and quadriplegia. He was treated with MT and stenting and full recanalization was achieved. All neurological examination findings have completely resolved, except for the bilateral SNHL. Acute onset of sudden bilateral deafness in isolation or accompanied by vestibular, cerebellar, and/or brainstem signs may indicate large vessel occlusion. Although rapid recanalization with MT helps improve the symptoms, the specific impact over SNHL varies between patients.

The phenotypic spectrum of CEP250 gene variants

ABSTRACT Introduction Classically, Usher syndrome is characterized by the association of sensorineural hearing loss (SNHL), retinitis pigmentosa (RP) and possible vestibular dysfunction. Pathogenic bi-allelic variants in CEP250 cause atypical autosomal recessive Usher syndrome, which is associated with SNHL and photoreceptors 20 dysfunction without vestibular signs. To date, only 19 scattered descriptions have been reported. In this study, we present detailed clinical and genetic description of 7 unrelated individuals with CEP250 related disease, along with a literature review to provide new insight on the severity and course of the disease. Methods We retrospectively recruited 7 unrelated individuals who underwent genetic testing (targeted gene panel or whole genome sequencing) and were found to carry CEP250 pathogenic variants. Results Most patients (5/7) 25 exhibit both retinal dystrophy and SNHL. Two patients appear to present either isolated hearing loss or visual impairment, but further investigations are needed to confirm a possible non-syndromic presentation. All patients harbored isolated truncating variants. Discussion CEP250 pathogenic variants are associated with post-lingual SNHL, and most often progressive photoreceptor dysfunction. The disease may begin with ocular features or hearing loss. We strongly recommend genetic analysis of classical and atypical Usher 30 related-genes, in patients with isolated retinal dystrophy or SNHL. We also recommend ophthalmological evaluation and follow-up in patients with isolated SNHL, and conversely. The coexistence of loss- and gain-of-function effects may exist, complicating the development of gene therapy.

Acute vestibular syndrome accompanying middle cerebral artery infarctions: a single-center study

Objectives: Acute vestibular syndrome (AVS) is a disease and disorder usually manifest with a single episode of sudden onset vestibular symptoms and signs, and may occur at any point along the vestibular pathway from the peripheral labyrinth to the vestibular cortex. This study presents the characteristics of the involved cortical area and clinical course in middle cerebral artery (MCA) territory infarction patients with central vestibular disorder. Methods: Files of patients diagnosed with acute ischemic stroke in the MCA territory were reviewed retrospectively between December 2020 and March 2022. All the patients were categorized into two groups (with or without AVS) and analyzed for comorbidities as well as smoking and drinking habits, and their data pertaining to the neurological examination, bedside neuro-otological examination, and laboratory and computerized tomography angiography findings were collected. Results: Seven hundred and sixty-eight patients with MCA territory infarction were included in the study. AVS incidence was calculated to be 13.3%. There was no statistically significant difference in the distribution of age and sex between patients with and without AVS. The involvement of the right side was significantly more prevalent in AVS patients. Distribution of patients with right-sided infarction: 11 with posterior superior temporal gyrus 17 with parieto-insular cortex, 16 with insular cortex and temporoparietal junction together, and 18 with more than one millimetric infarction in all three areas. Conclusions: Patients with acute vestibular syndrome, may have infarctions in the anterior circulation and most of them had no pathological neuro-otologic test findings.

Phaeohyphomycosis caused by Trematosphaeria grisea in an immunocompromised English springer spaniel

AbstractA 10‐year‐old, male, farm‐based springer spaniel that presented with subacute progressive left‐sided central vestibular signs was diagnosed with meningoencephalitis of unknown origin. The patient received prednisolone (2 mg/kg/day orally), ciclosporin (5 mg/kg orally twice a day) and a single infusion of cytarabine (200 mg/m2). Six weeks later, neurological signs had resolved, but multiple cutaneous nodules developed on the limbs, trunk and face. Lesions discharged a dark purulent material without tissue grains. A ‘filamentous fungus’ was isolated, but discarded without identification. Aspirates from nodules showed pigmented, septate fungal hyphae, and culture of aspirates yielded Trematosphaeria grisea. Itraconazole (5 mg/kg once a day) and gradual tapering of immunosuppressive drugs led to resolution of nodular lesions over 4 months without neurological relapse. A fungal granuloma developed transiently 8 months after starting itraconazole. Immunosuppressive drugs were stopped 15 months after introduction without neurological relapse. Itraconazole was withdrawn 8 weeks later, 5 months after last relapse of skin disease.

Cervical and ocular vestibular-evoked myogenic potentials test results and its relation to vestibular signs and symptoms in individuals with vestibular migraine

ObjectiveThe objective of the present study was to characterize the response rate, latency, and amplitude parameters of the cervical and ocular vestibular evoked myogenic potentials in individuals with vestibular migraine. The objective was also to describe the signs and symptoms exhibited by individuals with vestibular migraine and find out an association with VEMP results.MethodThirty individuals with a diagnosis of vestibular migraine and thirty healthy individuals participated in the study. The diagnosis of the vestibular migraine was made based on the diagnosis criteria given by the Barany Society and the International Headache Society. Cervical and ocular vestibular evoked myogenic potentials were recorded using 500 Hz tone burst stimulus for all the participants in both groups.ResultsThe latency was prolonged, and the amplitude was reduced for both the cervical and ocular vestibular evoked myogenic potentials in individuals with vestibular migraine compared with healthy individuals. There was no association between signs and symptoms exhibited by vestibular migraine individuals and VEMP results.ConclusionsBoth the sacullocollic and otolith ocular pathways are affected in vestibular migraine. Hence, there is a necessity for vestibular evaluation in all patients with vestibular migraine to understand the spectrum of the pathology.

Otitis media/interna and encephalitozoonosis are the most common causes of head tilt in pet rabbits in the UK: 73 cases (2009‒2020).

There are limited studies that identify diseases associated with head tilt in pet rabbits. This was an observational, retrospective, single-centre study of rabbits with head tilt presented between 2009 and 2020. Descriptive statistics were performed for all cases, whereas univariate and multivariate analyses were only performed for the 36 cases with a final diagnosis. Seventy-three rabbits met the inclusion criteria. The final diagnoses included Encephalitozoon cuniculi meningoencephalomyelitis (EC) (15/36; 41.7%), otitis media/interna (OMI) (8/36; 22.2%) and concurrent EC and OMI (13/38; 36.1%). Subacute-to-chronic onset was more common in rabbits with OMI than in those with EC (p = 0.018). Previous middle ear surgery (p = 0.046) and a diagnosis of otitis externa (p = 0.004) significantly increased the risk of OMI. Meloxicam was associated with improvement of clinical signs(p = 0.007). Upright ears (p = 0.013), recumbency (p = 0.037) and impaired mentation (p = 0.001) were associated with a higher risk of death/euthanasia. The proportions of residual head tilt (66.7%) and relapse of vestibular signs (42.1%) were high. This was a retrospective study with cases varying in their investigation and conclusive final diagnoses. OMI and EC were the most common aetiologies of head tilt in pet rabbits in the UK. Meloxicam might be associated with a favourable outcome in affected rabbits. Paired EC serology and a CT scan of the head should be the baseline investigation for head tilt in rabbits.

Canine glioma in the first year of life: 5 cases.

Most canine gliomas occur in adult and aged dogs, and reports in puppies < 12-mo-old are exceedingly rare. Here we describe the occurrence of gliomas in 5 dogs ≤ 12-mo-old. The affected patients (4 males, 1 female) were 3-12-mo-old (x̄ = 6.6-mo-old). None of the dogs were brachycephalic. Clinical signs consisted of dullness (2 cases), seizures (2 cases), vestibular signs, and deafness (1 case each). All patients were euthanized. Grossly, neoplasms were pale-tan or red, soft masses in the telencephalon (4 cases) or gelatinous leptomeningeal thickening in the brain and spinal cord (1 case). Neoplasms were classified as astrocytomas (3 cases) and oligodendrogliomas (2 cases) based on histology or histology and IHC. Our findings confirm that, while exceptionally rare, canine gliomas occur in the first year of life, and are clinically, morphologically, and immunohistochemically similar to gliomas in adult and aged dogs.

Development of a clinical investigation protocol for occupational auditory health.

Considering that noise is present in different work environments, occupational health regulations have been created that advocate for the care of employees' auditory system in these environments. Occupational hearing assessment should be performed by audiologists through audiological examinations, otoscopy, as well as an interview to assess possible risk factors for the development of hearing loss. However, up to the present moment, a standardized set of updated questions for this interview has not been defined. To develop a clinical investigation instrument for occupational auditory health that provides support for clinical decision-making and differential diagnosis. The study was conducted using Design Thinking as a methodological approach in its stages of inspiration (problem identification), ideation (theoretical foundation and protocol design), and prototyping (protocol construction). This study was conducted with the objective of providing support for clinical decision-making and differential diagnosis of the auditory aspects of the assisted population. The Protocolo de Investigação Clínica da Saúde Auditiva Ocupacional was developed, consisting of six main sections that address medical history, lifestyle habits, exposure to non-occupational noise, work history, extra-auditory symptoms, and auditory and vestibular signs and symptoms, aimed at investigating workers' auditory health and related aspects. The developed instrument can be used for data collection and assist audiologists in the occupational health teams in diagnosis and decision-making processes.

Case report: Acute audiovestibular presentation following hemi-pontine infarction

Posterior circulation stroke is an uncommon cause of sudden-onset sensorineural hearing loss (SSNHL). Anterior inferior cerebellar artery occlusion results in ipsilateral peripheral audiovestibular dysfunction. Few reports describe posterior circulation stroke presenting with contralateral SSNHL and acute vestibular and focal neurological signs. We present a case of contralateral SSNHL and isolated acute central vestibular dysfunction in the absence of other central focal neurological deficits. To the best of our knowledge, this has not been described to date. The patient was identified to have asymmetrical SSNHL, subtle skew deviation with left head tilt, and significant refixation saccades on video head impulse test despite bilaterally normal vestibulo-ocular reflex gains. Left pontine infarct was suspected and confirmed on magnetic resonance imaging. The patient was treated with an appropriate antiplatelet regimen. We highlight the importance of a thorough clinical diagnostic work-up as posterior circulation strokes with isolated audiovestibular deficits can be easily missed if other significant neurological deficits are absent.

Do monosymptomatic stroke patients with dizziness present a vestibular syndrome without nystagmus? An underestimated entity.

Vestibular symptoms are common in emergency department (ED) patients and have various causes, including stroke. Accurate identification of stroke in patients with vestibular symptoms is crucial for timely management. We conducted a prospective cross-sectional study from 2015 to 2019 to determine stroke prevalence and associated symptoms in ED patients with vestibular symptoms, aiming to improve diagnosis and outcomes. As part of the DETECT project, we screened 1647 ED patients with acute vestibular symptoms. Following a retrospective analysis of 961 head and neck magnetic resonance imaging (MRI) scans, we included 122 confirmed stroke cases and assessed them for vestibular signs and symptoms. Stroke prevalence in dizzy patients was 13% (122/961 MRI scans). Most patients (95%) presented with acute vestibular symptoms with or without nystagmus, whereas 5% had episodic vestibular syndrome (EVS). Nystagmus was present in 50% of stroke patients. Eighty percent had a purely posterior circulation stroke, and nystagmus was absent in 46% of these patients. Seven patients (6%) had lesions in both the anterior and posterior circulation. Vertigo was experienced by 52% regardless of territory. A stroke was identified in 13% of ED patients presenting with acute vestibular symptoms. In 5%, it was EVS. Most strokes were in the posterior circulation territory; vertigo occurred with similar frequency in anterior and posterior circulation stroke, and absence of nystagmus was common in both.

Pneumocephalus and meningoencephalitis as a complication of otitis media in a dog

AbstractA 3‐year‐old Maltese dog presented with vestibular signs that worsened after a grass seed was removed from the right external ear canal. Neurological examination was suggestive of a brainstem lesion. Magnetic resonance imaging of the head was performed, and findings were consistent with infectious meningoencephalitis and otogenic pneumocephalus secondary to intracranial extension of right otitis media. A culture of the right middle ear effusion yielded Staphylococcus epidermidis. The dog was euthanased under general anaesthesia due to worsening of the cardiovascular and respiratory parameters. Pneumocephalus in dogs has been described secondary to surgery, trauma, meningocele and meningoencephalocele. To the authors' knowledge, this is the first case report describing otogenic pneumocephalus in a dog.

Intracranial embryonal neoplasm in an alpaca.

An 11-y-old hembra alpaca was admitted because of cerebellar and vestibular signs, dysphagia, and aspiration pneumonia; without clinical improvement following empirical therapy, the patient was euthanized. On autopsy, a neoplasm was found incorporating the right vestibulocochlear nerve at the level of the acoustic meatus. Histologically, the mass was composed of a multiphasic primitive cell population associated with a dense fibrous stroma and enveloping a remnant ganglion and nerve bundles. Patterns included dense ribbons and cords of embryonal neuroepithelial cells admixed with loosely defined interlacing spindle cells. The embryonal cells had angular cell profiles with variable amounts of lightly basophilic cytoplasm, ovoid-to-irregular nuclei, and an open chromatin pattern with a typically inapparent nucleolus. Necrosis was not evident, and there was 1 mitotic figure per 2.37 mm2. The entire mass was infiltrated by small numbers of lymphocytes and plasma cells. Immunohistochemistry (IHC) revealed strong and diffuse cytoplasmic immunolabeling for vimentin, microtubule-associated protein-2, protein gene product 9.5, and synaptophysin; ~50% immunolabeling for cytokeratin AE1/3; sporadic OLIG2 and S100 immunolabeling; and absent glial fibrillary acidic protein immunolabeling. Based on the histologic pattern and the IHC results, our diagnosis was a poorly differentiated embryonal tumor with ependymal differentiation associated with the vestibulocochlear nerve.

Minor’s syndrome. A case report

Dehiscence syndrome of the anterior or superior semicircular canal, also known as Minor syndrome, is a rare entity, characterized by vestibular signs secondary to sound trauma and pressure changes, as well as deafness transmission or mixed type. CT of the ears is the diagnostic modality of choice and the treatment is mainly surgical, as well as a well-conducted vestibular rehabilitation. We report the case of a 36 yrs patient, a soldier, presenting to the emergency ward for repeated dizziness attacks, triggered during shooting sessions. After clinical examination, the CT scan of the ears revealed a dehiscence of the upper semicircular canal of the right ear (Minor syndrome). Surgical treatment was not performed because of a favorable evolution under medical treatment.

Bacterial meningitis secondary to otogenic infection in 10 French bulldogs: A retrospective case series.

There is limited published information to guide the clinical management of bacterial meningitis/encephalitis in dogs. This was a retrospective case series comprising 10 French bulldogs from two referral centres. The cases were diagnosed with bacterial meningitis/encephalitis suspected secondary to otogenic infection based on detection of abnormal fluid/soft tissue opacity within the middle/inner ear, associated meningeal/intracranial involvement through MRI, the findings of cerebro-spinal fluid (CSF) analysis suggestive of sepsis and/or clinical improvement following antibiosis. Ten dogs were included (three female and seven male), with a median age of 60 months. Dogs presented with acute onset (median 2 days), progressive history of vestibular signs and/or intra-oral or cervical pain. Five dogs had gross signs of concurrent otitis externa. Common MRI findings included material within the tympanic bulla with adjacent meningeal enhancement. Analysis of CSF documented pleocytosis in all eight dogs, intracellular bacteria seen in three with positive bacteriological culture in two dogs. One dog was euthanised following diagnosis. Nine remaining dogs received antimicrobial therapy and six underwent surgical management. Three dogs treated surgically were neurologically normal within 2 weeks and the remaining three improved. Two dogs treated medically improved and one had complete resolution reported within a 4-week follow-up period. Study limitations include its retrospective nature and small sample size with minimal longer term follow-up. Bacterial meningitis/encephalitis in French bulldogs can require both medical and surgical treatment to achieve a favourable outcome.

Sudden Bilateral Sensorineural Hearing Loss due to Basilar Artery Occlusion (P3-5.027)

<h3>Objective:</h3> We describe a case of a patient with occlusion of the basilar artery and bilateral anterior inferior cerebellar arteries (AICAs) who presented with a chief complaint of sudden bilateral sensorineural hearing loss (SNHL). <h3>Background:</h3> Sudden bilateral SNHL, defined as SNHL developing in less than 72 hours, is a rare phenomenon representing less than 5% of all acute SNHL cases. Whereas more frequent unilateral presentation is relatively benign, sudden bilateral SNHL represents a medical emergency and warrants immediate evaluation for life-threatening and/or reversible causes. <h3>Design/Methods:</h3> NA <h3>Results:</h3> A 56-year-old right-handed African American woman with personal medical history of hypertension, hyperlipidemia, chronic obstructive pulmonary disease, stroke, tobacco abuse, and obesity presented with sudden onset bilateral hearing loss preceded by one week of persistent vertigo and nausea. On admission she was hypertensive to 240/122 mm Hg, physical examination was significant for saccadic pursuit with spontaneous bilateral horizontal and vertical down-beating nystagmus, truncal ataxia, and bilateral SNHL confirmed by audiogram. CT of head alongside CT angiography showed occlusion of V4 segment of right vertebral artery extending through most of the basilar artery, and near-occlusion of bilateral AICAs. MRI showed late acute/early subacute ischemic infarcts in bilateral anterior cerebellum, cerebellar peduncles, and pons. Patient was out of time window for thrombolysis with rt-PA, mechanical thrombectomy was deferred due to &gt;24h from symptom onset and stable neurological examination throughout hospital admission. Blood pressure was gradually lowered and antiplatelet therapy with aspirin was initiated prior to discharge to rehabilitation facility. <h3>Conclusions:</h3> Sudden bilateral SNHL in isolation or accompanied by vestibular, cerebellar and/or brainstem signs particularly in patients with significant risk factors for cerebrovascular disease should alarm a clinician of a possibility of vertebrobasilar occlusion and prompt appropriate and timely medical management as delay in optimal medical treatment is associated with increased morbidity and mortality in this patient population. <b>Disclosure:</b> Dr. Buciuc has nothing to disclose. Dr. Gonzalez has nothing to disclose. Dr. Ali has nothing to disclose. Dr. Nankee has nothing to disclose. Dr. Holmstedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astrazeneca. The institution of Dr. Holmstedt has received research support from NIH. The institution of Dr. Holmstedt has received research support from Patient-Centered Outcomes Research Institute. The institution of Dr. Holmstedt has received research support from CSPC Pharmaceuticals . Dr. Holmstedt has received personal compensation in the range of $5,000-$9,999 for serving as a Study Adjudicator with Ischemia Care.

Adolescents With More Oculomotor and Vestibular Signs of Sport-Related Concussion Benefit from Aerobic Exercise: An Exploratory Analysis.

Abstract Early targeted heart rate (HR) aerobic exercise has been shown to reduce the duration of recovery from sport-related concussion (SRC) as well as the incidence of persistent post-concussive symptoms (PPCS). It is not known, however, if more severe oculomotor and vestibular presentations of SRC benefit from a prescription of aerobic exercise. The current study is an exploratory analysis of two published randomized controlled trials that compared aerobic exercise within 10 days of injury with a placebo-like stretching intervention. Combining the two studies yielded a larger sample size to stratify severity of concussion based on the number of abnormal physical examination signs present at the initial office evaluation, which were confirmed with self-reported symptoms and recovery outcomes. The most discriminant cut-off was between those who had ≤3 oculomotor and vestibular signs and those who had >3 signs. Aerobic exercise (hazard ratio = 0.621 [0.412, 0.936], p = 0.023) reduced recovery times even when controlling for site (hazard ratio = 0.461 [0.303, 0.701], p < 0.001), severity (hazard ratio = 0.528 [0.325, 0.858], p = 0.010) and the interaction term of intervention and severity (hazard ratio = 0.972 [0.495, 1.909], p = 0.935). Adolescents who presented with >3 signs and were assigned to the placebo-like stretching group had a PPCS incidence of 38%, which was the highest of all subgroups (aerobic exercise and ≤3 findings: 8%; stretching and ≤3 findings: 11%; aerobic exercise and >3 findings: 21%). This exploratory study provides pilot evidence that prescribed sub-symptom threshold aerobic exercise treatment early after SRC may be effective for adolescents with more oculomotor and vestibular physical examination signs and should be validated in future adequately powered trials.

Ocular Lateral Deviation as a Vestibular Sign to Improve Detection of Posterior Circulation Strokes: A Review of the Literature

BackgroundPosterior circulation stroke can present with dizziness/vertigo without other general neurological symptoms or signs, making it difficult to detect, and missed stroke can deteriorate. Therefore, a sign that can be easily identified during an examination would be helpful to improve the detection of this type of stroke. ObjectiveThe objective of this review is to highlight an ocular sign that is seen in posterior circulation strokes called ocular lateral deviation (OLD). OLD is mostly seen in dorsolateral medullary strokes, and it is also seen in pontine and cerebellar strokes. OLD is detected by asking a patient to look straight ahead and then briefly close their eyes. Upon re-opening their eyes, the examiner will see that the eyes have deviated to one side; the patient's eyes will then make corrective saccade(s) to return to looking straight ahead. Complete eye deviation is a central sign of posterior circulation stroke. DiscussionOLD is an under-recognized vestibular ocular sign of central vestibulopathies including posterior circulation stroke. The most common location is in the dorsolateral medulla, where one-third of such strokes have complete OLD. Eye deviation can also be appreciated on computed tomography or magnetic resonance imaging. OLD can be detected up to 6 months after a posterior circulation stroke. ConclusionsChecking for the sign of complete eye deviation in patients with dizziness/vertigo could be a simple, quick method for detecting posterior circulation stroke, and a means to improving the patients’ outcome.

Neurological Disorders in Pug Dogs: a Retrospective Study of 285 Cases (2013 – 2020) from a Single Referral Hospital in the United Kingdom

Pugs are commonly affected by neurological disorders and this retrospective observational study aims to describe what pathologies were more commonly diagnosed, their diagnostic approach and clinical features. This study was performed in a single referral hospital in the United Kingdom (UK). Medical records of pugs referred to the Neurology &amp; Neurosurgery department from 2013 to 2020 were retrieved. Signalment, presenting complaint, presence of pain at neurological examination and diagnostic tests were recorded. Final diagnosis was classified as: encephalopathies, myelopathies or peripheral nervous system (PNS) disease. Descriptive and univariate statistical analysis were performed. A total of 285 records were included in the study. The most common presenting complaints were: ambulatory paraparesis (27.6%), seizures (20.3%), ataxia (16.4%), spinal pain (10.1%) and vestibular signs (5.6%). Myelopathies were diagnosed in 64.7% of pugs, while encephalopathies and PNS disease in 29.7% and 5.3% of pugs respectively. Different types of intervertebral disc diseases (IVDDs; 44.3%), spinal arachnoid diverticulum (SAD; 22.2%) and vertebral malformations (VMs; 18.9%) were the most prevalent myelopathies. Idiopathic epilepsy (IE; 44.7%) and meningoencephalitis of unknown aetiology (MUA; 29.4%) were the most common encephalopathies. Peripheral vestibular syndrome (60%) and masticatory muscle myositis (20%) were the most prevalent PNS diseases. Pugs with IVDDs were more likely to be painful than pugs diagnosed with SAD and VMs. In this study, IVDDs, SAD and VMs were the most represented myelopathies, while IE and MUA the most prevalent encephalopathies. SAD and VMs were found to be non-painful myelopathies, as opposed to IVDDs being painful. These results may be used as a guide reflecting the prevalence of neurological diseases in a larger population of pugs.