Cardy Thomas J A, Lam Richard, Peters Laureen M, McLaren Philippa J, Matas Riera Màrian, De Decker Steven
Departments of Clinical Science and Services.
The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hertfordshire, United Kingdom.
J Vet Emerg Crit Care (San Antonio). 2017 Mar;27(2):238-242. doi: 10.1111/vec.12566. Epub 2017 Jan 12.
To describe a case of successful medical management of subdural intracranial empyema and multifocal pneumonia in a domestic longhaired cat.
A 7-year-and-8-month-old male neutered domestic longhair cat presented with tachypnea, respiratory compromise, vestibular ataxia, obtundation, left-sided head tilt, and multiple cranial nerve deficits. Neuroanatomical localization was multifocal with central vestibular involvement. Magnetic resonance imaging of the head indicated diffuse subdural empyema, mainly affecting the middle cranial fossa and the right cerebrum. Analysis of cerebrospinal fluid revealed degenerate neutrophils with a mixed population of intracellular bacilli. Computed tomography (CT) of the thorax was suggestive for multifocal pneumonia. Aggressive medical management with IV fluids, oxygen supplementation, mannitol boluses, dexamethasone, and broad-spectrum antimicrobials was initiated. The cat demonstrated gradual improvement within 24 hours following initiation of treatment. General physical and neurological examinations, 9 weeks after initiating treatment, did not reveal any abnormalities. A CT examination performed at this time revealed resolution of the cat's pulmonary lesions. The cat was still free of clinical signs, 9 months after treatment was started.
Subdural empyema is infrequently reported in cats and has high mortality rates even following surgical treatment. To the authors' knowledge, this is the first reported case of successful medical management of a cat with subdural empyema and suggests that aggressive medical management should be attempted in cats that are not considered surgical candidates.
描述一例对家养长毛猫硬膜下颅内积脓和多灶性肺炎进行成功药物治疗的病例。
一只7岁8个月大的已绝育家养长毛雄性猫，出现呼吸急促、呼吸功能不全、前庭性共济失调、意识迟钝、左侧头部倾斜以及多条脑神经功能缺损。神经解剖定位为多灶性且累及中枢前庭。头部磁共振成像显示弥漫性硬膜下积脓，主要影响中颅窝和右侧大脑。脑脊液分析显示有退化的中性粒细胞以及细胞内杆菌的混合菌群。胸部计算机断层扫描（CT）提示多灶性肺炎。开始采用静脉输液、吸氧、甘露醇推注、地塞米松和广谱抗菌药物进行积极的药物治疗。治疗开始后24小时内，这只猫病情逐渐好转。治疗开始9周后，全身体格检查和神经学检查未发现任何异常。此时进行的CT检查显示猫的肺部病变已消退。开始治疗9个月后，这只猫仍无临床症状。
硬膜下积脓在猫中鲜有报道，即使经过手术治疗死亡率也很高。据作者所知，这是首例成功药物治疗猫硬膜下积脓的报道，表明对于不被认为适合手术的猫应尝试积极的药物治疗。
