Acidentes vasculares cerebrais: estudo retrospetivo em enfartes cerebrais isquémicos em cães
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2017-10-25
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O historial clínico de 17 cães com sinais neurológicos de apresentação aguda não progressiva, sugestiva de enfarte cerebral, e que realizaram ressonância magnética na clínica veterinária Referência Veterinária, foi revisto. Todos eles dispunham de exame físico e neuro-lógico, hemograma completo, bioquímica hepática e renal e ressonância magnética do neuro-crânio com sequências ponderação T1 (T1W) pré e pós-contraste, ponderação T2 (T2W) e Fluid-Attenuated Inversion Recovery (FLAIR) em plano dorsal, transversal e sagital. Outras informações foram recolhidas pelo contacto direto com os centros de atendimento médico-ve-terinário que referenciaram os animais, nomeadamente exames complementares para pesquisa de doenças concorrentes e a sua evolução. Os Acidentes Vasculares Cerebrais (AVC) foram classificados como isquémicos ou hemorrágicos, quanto ao tipo (territorial ou lacunar) e loca-lização anatómica (telencéfalo (5/17), cerebelo (4/17), tálamo (2/17), tronco cerebral (3/17) e múltiplos (3/17)) e território vascular. Os enfartes do telencéfalo ocorreram no território vascu-lar da artéria cerebral média, do cerebelo na artéria cerebelar rostral e do tálamo e mesencéfalo nas artérias perfurantes. Todos os AVC eram isquémicos pálidos, hipointensos em T1W e hi-perintensos em T2W e FLAIR. Em média, o tempo entre o início dos sinais clínicos e a reali-zação da ressonância magnética foi de 12.9 dias. Destes, apenas um não apresentava intensifi-cação após contraste e os restantes a intensificação era leve na periferia da lesão, mesmo na-queles em que os proprietários indicaram só aperceberem dos défices neurológicos há menos de 3 dias. Dois tinham adicionalmente lesões encefálicas compatíveis com enfartes cerebrais antigos e três otite média. Os sinais clínicos foram compatíveis com as áreas afetadas, mas também associados a défices persistentes de enfartes antigos e por otites médias. Mais de me-tade tinha doenças concorrentes, alguns diversas simultaneamente, sendo hipotiroidismo (5/17), hiperadrenocorticismo (2/17) e mastocitomas (2/17) as mais encontradas. Nove faleceram, mas 6 devido à doença concorrente e apenas 3 por não melhoria dos défices neurológicos ou suspeita de novos AVC, com confirmação histológica em 3/2. Nestes as causas foram aterosclerose e êmbolos neoplásicos (tumor primário de origem mesenquimatosa). Dos 8 que sobreviveram 2 recuperaram totalmente e 6 evoluíram favoravelmente, permanecendo com alguns sinais neu-rológicos como convulsões, cabeça inclinada e hipermetria. O prognóstico de AVC foi, em geral favorável, indo de encontro à restante literatura. Relativamente à região afetada, a maioria dos estudos indicam o cerebelo como a área mais frequente, não se concluindo aqui o mesmo, eventualmente pela reduzida dimensão da amostra.
Medical records of 17 dogs with acute non-progressive neurological dysfunctions, suggestive of cerebral infarction, including magnetic resonance imaging (MRI) performed at the veterinary clinic Referência Veterinária, were reviewed. All of them had physical and neu-rological examinations, complete blood count, liver and renal biochemistry and MRI of the neurocranium with pre and post-contrast T1-weighted (T1WI), T2-weighted (T2WI) and Fluid-Attenuated Inversion Recovery (FLAIR) in dorsal, transverse and sagittal image planes. Other information was collected by direct contacts with the clinics referring the animals, namely com-plementary tests for research of concurrent diseases and the evolution of post presumptive di-agnosis. The strokes were classified as ischaemic or haemorrhagic (territorial or lacunar), ac-cording to the anatomic location (telencephalon (5/17), cerebellum (4/17), thalamus (2/17), brainstem (3/17) and multiple (3/17)) and vascular territory. The telencephalon infarcts were within the vascular territory of the middle cerebral artery, the cerebellum on the rostral cerebel-lar artery and the thalamus and midbrain on the perforating arteries. All strokes were ischemic non-haemorrhagic, hypointense on T1WI and hyperintense on T2WI and FLAIR. On average, the time between the onset of the clinical signs and the performance of MRI was 12.9 days. Of these, only one did not show contrast uptake, and on the other dogs the uptake was mild at the periphery of the lesion, even in those where the owners only perceived neurological deficits in less than 3 days. Additionally, two animals had brain lesions compatible with old cerebral in-farcts and three had concurrent otitis media. The clinical signs were compatible with the af-fected areas, but also related with persistent deficits of old infarcts and otitis media. More than half had concurrent diseases, some of them with more than one, being hypothyroidism (5/17), hyperadrenocorticism (2/17), and mastocytomas (2/17) the most frequently found. Nine died, but 6 due to the severity of concurrent diseases and only 3 for lack of improvement of their neurological deficits or suspicion of new strokes. 2/3 were histologically confirmed. In these cases, the causes of the strokes were atherosclerosis and neoplastic emboli (primary tumour with mesenchimal origin). Of the 8 that survived 2 recovered completely and 6 evolved favour-ably, remaining with some neurological signs like convulsions, head tilt and hypermetric gait. The prognosis of stroke was, in general, favourable, and according to the literature. Regarding the affected region, most of the studies indicated the cerebellum as the most frequent anatomic site, a result which was not confirmed in this thesis, possibly due to the small sample size.
Medical records of 17 dogs with acute non-progressive neurological dysfunctions, suggestive of cerebral infarction, including magnetic resonance imaging (MRI) performed at the veterinary clinic Referência Veterinária, were reviewed. All of them had physical and neu-rological examinations, complete blood count, liver and renal biochemistry and MRI of the neurocranium with pre and post-contrast T1-weighted (T1WI), T2-weighted (T2WI) and Fluid-Attenuated Inversion Recovery (FLAIR) in dorsal, transverse and sagittal image planes. Other information was collected by direct contacts with the clinics referring the animals, namely com-plementary tests for research of concurrent diseases and the evolution of post presumptive di-agnosis. The strokes were classified as ischaemic or haemorrhagic (territorial or lacunar), ac-cording to the anatomic location (telencephalon (5/17), cerebellum (4/17), thalamus (2/17), brainstem (3/17) and multiple (3/17)) and vascular territory. The telencephalon infarcts were within the vascular territory of the middle cerebral artery, the cerebellum on the rostral cerebel-lar artery and the thalamus and midbrain on the perforating arteries. All strokes were ischemic non-haemorrhagic, hypointense on T1WI and hyperintense on T2WI and FLAIR. On average, the time between the onset of the clinical signs and the performance of MRI was 12.9 days. Of these, only one did not show contrast uptake, and on the other dogs the uptake was mild at the periphery of the lesion, even in those where the owners only perceived neurological deficits in less than 3 days. Additionally, two animals had brain lesions compatible with old cerebral in-farcts and three had concurrent otitis media. The clinical signs were compatible with the af-fected areas, but also related with persistent deficits of old infarcts and otitis media. More than half had concurrent diseases, some of them with more than one, being hypothyroidism (5/17), hyperadrenocorticism (2/17), and mastocytomas (2/17) the most frequently found. Nine died, but 6 due to the severity of concurrent diseases and only 3 for lack of improvement of their neurological deficits or suspicion of new strokes. 2/3 were histologically confirmed. In these cases, the causes of the strokes were atherosclerosis and neoplastic emboli (primary tumour with mesenchimal origin). Of the 8 that survived 2 recovered completely and 6 evolved favour-ably, remaining with some neurological signs like convulsions, head tilt and hypermetric gait. The prognosis of stroke was, in general, favourable, and according to the literature. Regarding the affected region, most of the studies indicated the cerebellum as the most frequent anatomic site, a result which was not confirmed in this thesis, possibly due to the small sample size.
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Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Acidente vascular cerebral , Isquemia encefálica , Espectroscopia de ressonância magnética , Cão