Austin Veterinary Emergency & Specialty (AVES)

Overview

Signalment: 7-year-old neutered male Pomeranian

Presenting Complaint: The patient was attacked by another dog and initially stabilized at an outside emergency hospital. He was transferred to AVES for continued evaluation due to persistent nonambulatory tetraparesis.

Medical History:

• Vaccinations: Up to date

• Travel history: None

• Concurrent medical conditions: None

Medications at Presentation:

• Gabapentin

• Meloxicam

• Clavamox

Physical Examination

• Temperature: 100.9°F

• Heart Rate: 100 bpm

• Respiratory Rate: 34 breaths/min

• Weight: 4.13 kg

A puncture wound with scab formation was present on the dorsum of the cranium, which had been shaved at the referring hospital. No other significant abnormalities were noted on physical examination.

Neurologic Examination

• Mentation: Appropriate

• Gait/Posture: Nonambulatory tetraparesis, more severe in the hind limbs and on the left side

• Cranial Nerve Function: Normal

• Postural Reactions: Absent in both left limbs; normal in both right limbs

• Spinal Reflexes: Normal in all limbs

• Epaxial Palpation: No discomfort noted

• Nociception: Not assessed (motor function present in all limbs)

Diagnostics

MRI (Brain and Cervical Spine):

1. Prominent depressed skull fracture affecting the right dorsal aspect of the cerebrum, with associated right cerebral hemorrhage and edema. Mild leftward deviation of the falx cerebri was noted.

2. Multifocal T2-weighted hyperintensity within the cervical and thoracic spinal cord. Differential considerations included spinal cord contusion, fibrocartilaginous embolism, and/or edema.

Treatment and Management

Given the depressed nature of the skull fracture, surgical decompression with excision of the fracture fragment was recommended. The potential impact of the spinal cord hyperintensities on neurologic recovery was discussed with the owner. Despite these concerns, the owner elected to proceed with surgery.

Procedure Performed: Right frontal bone depressed fracture excisional debridement and decompression.

Postoperative Progress

One day postoperatively, the patient demonstrated marked neurologic improvement. Although still requiring assistance to ambulate, he showed significantly stronger motor function in all limbs compared to his preoperative status.