Neurology Case of the Month (Dec 2012): Hemiparesis & ataxia in a catWritten on December 03, 2012 by Mark T. Troxel, DVM, DACVIM (Neurology) Hospital: Massachusetts Veterinary Referral Hospital

Signalment: 5yr MC DSH

History: Acute onset of right-sided weakness this morning. Pidgeon-toed in right thoracic limb and lifting right pelvic limb off ground higher than normal. He does not appear painful. No known trauma. He is an indoor/outdoor cat that is supervised in the back yard when he’s outside. No prior symptoms like this. Good appetite. No weight loss. No C/S/OND/V/D/PU/PD

Case Video:

What is your neurolocalization? What are the top differential diagnoses? (SCROLL DOWN TO SEE NEURO EXAM DETAILS AND ANSWERS)

 

 

 

 

 

 

 

 

Neurological exam:

Mental status: QAR
Gait/posture: Vestibular ataxia – frequently stumbles & falls, right-sided hypermetria (not observed on video)
Cranial nerves: WNL
Postural reactions:
Normal x 4
Spinal reflexes: WNL x 4
Spinal pain: None
Muscle tone: Normal x 4
Muscle atrophy: None
Pain sensation: Normal x 4
Cutaneous trunci: WNL bilaterally

 

Neurolocalization = Right cerebellum

 

 

Differential diagnoses

  • Encephalitis
  • Neoplasia
  • Trauma
  • Infarct

 

Diagnostics

  • CBC/biochemical profile: Unremarkable
  • Whole body radiographs: WNL
  • Blood pressure: 170
  • MRI: See image below. On T2-weighted images (top row), there is a hyperintense wedge-shaped intra-axial lesion of the right cerebellum that is mildy hypointense on pre-contrast T1-weighted images (lower left) and does not contrast enhance (lower right)
  • CSF: WNL
  • Urinalysis: WNL, no proteinuria
  • T4: 2.3
  • AUS: WNL

 

Diagnosis
Cerebellar infarct

 

Treatment
Physical therapy and supportive care

 

Prognosis
The prognosis for cerebellar infarction is usually good to excellent. Most patients will recover if given enough time and supportive care.

 

Outcome
The patient was brought in for a recheck examination 2 weeks later and the neurological exam was within normal limits.

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