Hope or Hurdles? Predicting Recovery in Pets with Brain Injury

JVIM 2023

Abbe Harper Crawford, Elsa Beltran, Cecilia-Gabriella Danciu, Dylan Yaffy

Background
Global hypoxic-ischemic brain injury (GHIBI) results from decreased cerebral perfusion, commonly due to cardiopulmonary arrest or anesthesia-related complications. The study highlights the need for better prognostic tools in veterinary medicine, as GHIBI presents with variable neurological outcomes. Drawing parallels from human medicine, where poor outcomes follow out-of-hospital arrests, the authors aim to identify indicators of functional recovery in animals.

Methods
A retrospective case series was conducted by reviewing medical records from 2010 to 2022 at the Royal Veterinary College. Inclusion criteria required new-onset neurological deficits post-hypoxic-ischemic events with detailed serial neurological exams. Ten animals (8 dogs, 2 cats) met criteria. Data collected included neurological signs, diagnostics, treatments, and outcomes. A four-point scale was used to classify long-term outcomes, and short-term outcomes were defined by survival at 72 hours.

Results
Of the 10 animals, 8 suffered in-hospital arrests, mostly related to anesthesia, and received immediate resuscitation. Seven of these showed neurological improvement within 72 hours; 4 achieved full recovery, 3 had residual deficits. Two dogs experienced out-of-hospital arrests; both had severe deficits, and one died, the other was euthanized due to poor quality of life. MRI findings of diffuse cortical swelling and brainstem compression, and lack of early neurological improvement, were associated with poor outcomes. Only 3 animals received advanced diagnostics such as MRI or EEG.

Limitations
The study's small sample size and retrospective design limited statistical power. Diagnostic evaluations varied across cases, and many lacked detailed anesthetic or resuscitation records. Follow-up times were inconsistent, and histopathological confirmation was available in only two cases. Cases not referred to the institution may represent a more severe or milder spectrum of GHIBI, limiting generalizability.

Conclusions
Despite severe initial neurological deficits, positive long-term outcomes are possible, particularly with prompt resuscitation and early neurological improvement. Key prognostic indicators may include duration of the hypoxic event, brainstem involvement, and imaging findings. Serial neurological exams, possibly quantified with validated tools like the Modified Glasgow Coma Scale, could support prognosis. Further studies are needed to validate the use of imaging, EEG, and biomarkers in prognosticating GHIBI in veterinary patients.

Magnetic resonance images of the head of a 2.5-year-old intact male spaniel crossbreed dog that presented after cardiopulmonary
arrest and successful resuscitation at the referring veterinary surgeon's hospital. T2-weighted sagittal (A) and transverse images at the level of the
head of the caudate nuclei (B) and rostral colliculi (C) show a diffusely swollen brain with almost complete obliteration of the cerebral sulci
(arrowheads) and ventricular compression. There is diffuse bilateral subtle to moderate loss of gray and white matter differentiation. These
changes are more severe dorsally within the parietal and occipital lobes. There is caudal transtentorial herniation (asterisk) with compression and
caudal displacement of the rostral cerebellum. Additionally, the cerebellum is protruding into the foramen magnum (arrow) with severe
compression of the underlying medulla oblongata. The cervical spinal cord is swollen with obliteration of the surrounding cerebrospinal fluid
signal. The caudal aspect of the nasal cavity, nasopharynx, caudal aspect of the oral cavity and frontal sinuses contains T2W hyperintense
material (likely compatible with regurgitation of gastric contents). Hyperintensities are reported relative to normal gray matter.

How did we do?

Login or Subscribe to participate in polls.

Disclaimer: The summary generated in this email was created by an AI large language model. Therefore errors may occur. Reading the article is the best way to understand the scholarly work. The figure presented here remains the property of the publisher or author and subject to the applicable copyright agreement. It is reproduced here as an educational work. If you have any questions or concerns about the work presented here, reply to this email.