Kayla M. Fowler, Timothy A. Bolton, John H. Rossmeisl, Avril U. Arendse, Karen M. Vernau, Ronald H. L. Li, Rell L. Parker
Background
Hemophilia A is an inherited X-linked coagulation disorder caused by factor VIII deficiency, leading to spontaneous or excessive bleeding. While common manifestations include subcutaneous or internal hemorrhage, bleeding within the vertebral canal is rare. This report describes three juvenile dogs presenting with acute paraspinal pain or neurologic deficits linked to vertebral canal hemorrhage secondary to hemophilia A, aiming to characterize clinical presentation and MRI findings.
Methods
This case series examined three juvenile male dogs that underwent clinical evaluation, bloodwork, coagulation testing, MRI imaging, and, in some cases, cerebrospinal fluid (CSF) sampling or surgical intervention. Diagnosis of hemophilia A was confirmed via coagulation panels measuring factor VIII levels. Clinical progression and outcomes were documented for each case.
Results
All dogs presented with acute hyperesthesia and/or neurologic deficits. MRI findings consistently revealed extradural material suggestive of hemorrhage, with variable signal characteristics depending on hemorrhage stage. Two dogs developed severe complications following CSF sampling, including hematomas and neurologic deterioration. All cases showed prolonged activated partial thromboplastin time (aPTT) with normal prothrombin time (PT), and factor VIII deficiency confirmed hemophilia A. Outcomes varied: one dog temporarily improved but was later euthanized due to gastrointestinal hemorrhage, one was euthanized after neurologic decline, and one improved following surgical decompression but lacked long-term follow-up.
Limitations
The study is limited by its small sample size (three cases), lack of long-term follow-up in one case, and variability in diagnostic procedures and imaging modalities. Additionally, the retrospective and descriptive nature of the report limits generalizability and prevents assessment of treatment efficacy.
Conclusions
Hemophilia A should be considered a differential diagnosis in young dogs, particularly males, presenting with acute spinal pain or neurologic deficits, especially when other signs of bleeding are present. MRI can aid in identifying hemorrhagic lesions, but coagulation testing is critical prior to invasive procedures such as CSF sampling due to the risk of severe hemorrhagic complications.
Cervical MRI in a 5-month-old 2.5 kg sexually intact male Yorkshire Terrier with an acute onset of cervical pain (case three). (A)—T2W sagittal image of the cervical spine with longitudinal T2 hyperintensity extending from C2-C6 (arrow). (B)—T2W transverse image at the level of C4 showing T2 hyperintense extradural material resulting in severe spinal cord compression (arrow). (C)—T1W pre-contrast transverse image at the level of C4 showing T1 iso- to hypointense extradural material resulting in severe spinal cord compression (arrow). (D)—T1W post-contrast image at the level of C4 showing minimal contrast enhancement along the rim of the extradural material (arrow). (E)—T2* image at the level of C4 with heterogenously hyperintense extradural material in the left dorsolateral vertebral canal. A susceptibility artifact is present (arrow).
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