Differentials for brain bleeds

Frontiers in Veterinary Science 2024

December 21, 2024

Koen M. Santifort, Simon Platt

Background
Hemorrhagic encephalopathies and myelopathies in dogs and cats are rare but potentially severe conditions involving bleeding within the central nervous system (CNS). While human medicine employs established etiological classification systems for such conditions, no similar systems exist in veterinary practice. This study reviews existing literature and proposes a classification framework for veterinary use.

Methods
The authors reviewed veterinary and human medical literature, focusing on CNS hemorrhagic conditions. They proposed a veterinary classification system based on the well-known "VITAMIN D" mnemonic, categorizing hemorrhages into primary, secondary, and traumatic causes, each with relevant subcategories.

Results
The proposed system includes:

Primary hemorrhagic encephalopathy: Vascular causes (e.g., cerebral amyloid angiopathy), hypertension-associated, idiopathic hemorrhagic stroke.

Secondary hemorrhagic encephalopathy: Includes vascular malformations, neoplasia, infections, and coagulopathies.

Traumatic hemorrhagic encephalopathy: Encompasses trauma-related CNS injuries. Each category is further subdivided to reflect specific underlying pathologies.

Limitations
The study highlights the absence of standardized diagnostic protocols and the limited availability of advanced imaging in veterinary practice, which may constrain classification accuracy. The proposed framework remains unvalidated in prospective studies.

Conclusions
The proposed classification system aims to improve diagnostic accuracy, guide treatment strategies, and facilitate research. Future studies are needed to validate and refine this system, potentially enhancing clinical outcomes for affected animals.

Figure 2. Transverse magnetic resonance images of the brain of a 14-year-old crossbreed dog with a primary hemorrhagic encephalopathy – hypertension-associated cerebral microbleeds. All images are at the level of the head of the caudate nuclei. Left is on the right of the images. (A): T2-weighted, (B): Susceptibility-weighted, (C): T1-weighted, (D): T1-weighted post-contrast, (E): photograph of hematoxylin and eosin stained brain tissue with an acute cerebral microbleed – courtesy of W. Bergman, Veterinary Pathology Diagnostic Center, Department of Biomedical Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.

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