Could early trauma be responsible for porencephaly?

Front Vet Science 2023

Tommaso Davini 1*, Chiara Mattei 1,2, Claudia La Rosa 1,Carlotta Remelli 1, Swan Specchi 1,2, Elena Lionello 3,Elena Dell’Era 1 and Marco Bernardini 1,3

Background
Porencephaly, a condition involving fluid-filled cavities in the brain, is commonly regarded as a congenital anomaly resulting from developmental or encephaloclastic processes. However, this study hypothesizes that postnatal trauma, especially in early life, might be a more prevalent cause of porencephaly in dogs and cats than previously recognized. The study aimed to evaluate MRI characteristics distinguishing congenital from acquired traumatic forms and assess the prevalence of seizure activity in affected animals.

Methods
A retrospective case series from two veterinary centers analyzed dogs and cats diagnosed with cerebral cavitary lesions via MRI between 2007 and 2023. Inclusion criteria required complete signalment and comprehensive brain MRI studies. Observers classified lesions as porencephaly based on location, communication with cerebrospinal fluid spaces, and other MRI features. Cases were categorized as presumed traumatic if musculoskeletal abnormalities (e.g., skull fractures) were associated.

Results
Population: 32 cases (23 dogs, 9 cats); median ages were 24 months for dogs and 21 months for cats.

Lesion Characteristics:
-Single porencephalic cavities were found in 78.1% of cases, with parietal lobe involvement being most common.
-Communication with both ventricular and subarachnoid spaces was observed in 50% of cases.
-Musculoskeletal changes (e.g., skull fractures, calvarium depression) were present in 43.8% of cases, supporting a traumatic origin.

Seizure Activity:
-Observed in 71.8% of cases, often as the primary clinical manifestation.
-Mean age at seizure onset was 26.1 months.

Traumatic Indicators:
-Among the 14 cases with fractures, a history of early-life trauma (e.g., falls, car accidents) was reported in half, while others lacked historical data due to adoption later in life.

Limitations
The study was retrospective, relying on existing MRI data, which might miss subtle trauma-related findings due to the use of low-field MRI in most cases. Lack of histopathological confirmation and incomplete histories for some animals limit definitive conclusions on trauma as a causative factor.

Conclusions
The study highlights the potential underestimation of postnatal trauma as a cause of porencephaly in dogs and cats. MRI findings of musculoskeletal abnormalities, especially skull fractures, can support a traumatic etiology. Seizures are a common clinical sign associated with porencephaly, even in animals diagnosed later in life. Further prospective studies are needed to clarify the etiological role of trauma and improve diagnostic accuracy.

Figure 2. Dorsal T1-weighted MR-images of the brain of a dog showing a porencephalic cavity in the right temporal lobe at level of the caudal collicoli (A) and a slice below (B). A temporal bone fracture (long arrow) associated with a mild depression of the overlying calvarium is appreciated. Abnormal signal of the right temporal muscle (fat infiltration) is also present (short arrow).

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