Debreuque Maud, Ducerveau Marie-Noelle, Valin Isabelle, de Fornel Pauline, Manassero Mathieu, Thibaud Jean-Laurent
MICEN VET, Créteil, France.
Internal Medicine Service, University of Toulouse, ENVT, Toulouse, France.
JFMS Open Rep. 2020 Jun 18;6(1):2055116920930181. doi: 10.1177/2055116920930181. eCollection 2020 Jan-Jun.
A 1.5-year-old male neutered Persian cat was referred for acute deterioration of chronic left head tilt and ataxia. A lateral intraventricular cystic lesion, closely associated with the left choroid plexus, was identified on MRI. The intralesional signal intensity and cytological analysis of the fluid revealed a liquid similar to cerebrospinal fluid. After trepanation, an endoscopic-assisted fenestration and aspiration of the cyst were performed to temporally relieve the high intracranial pressure while waiting for surgical cystoperitoneal shunt placement. Three weeks after surgery, clinical relapse and recurrence of the lesion were noted on the pre-cystoperitoneal shunting MRI. During anaesthesia, the cat arrested. Cardiac resuscitation was successfully performed and cystoperitoneal shunting was postponed. Global brain ischaemia was then suspected, based on major forebrain clinical signs and MRI abnormalities. During a 6-month recovery period, a further three fine-needle CT-guided aspirations of the lesion were required, owing to clinical recurrence and increased cyst size. Cystoperitoneal shunting was eventually performed, allowing persistent reduction of the lesion and long-term improvement of the cat's neurological status.
This is the first report of a symptomatic lateral intraventricular cystic lesion in a cat. A left lateral intraventricular choroid plexus cyst was suspected based on the MRI features. Our case suggests that endoscopic fenestration and CT-guided aspiration are not adequate treatments for long-term management. Cystoperitoneal shunting may be a safe procedure, allowing significant and stable reduction of the cystic lesion, associated with improvement in the cat's neurological status by preventing high intracranial pressure.
一只1.5岁已绝育的雄性波斯猫因慢性左侧头部倾斜和共济失调急性恶化而前来就诊。MRI检查发现一个与左侧脉络丛紧密相关的侧脑室内囊性病变。病变内信号强度及液体的细胞学分析显示为一种类似于脑脊液的液体。在颅骨钻孔后，进行了内镜辅助下囊肿开窗和抽吸术，以暂时缓解高颅内压，同时等待进行手术性囊肿-腹腔分流术。手术后三周，在进行囊肿-腹腔分流术前的MRI检查中发现病变临床复发。在麻醉过程中，猫心跳骤停。成功进行了心脏复苏，囊肿-腹腔分流术推迟。基于大脑前叶的主要临床症状和MRI异常，怀疑出现了全脑缺血。在6个月的恢复期内，由于临床复发和囊肿增大，又进行了三次CT引导下病变细针抽吸。最终进行了囊肿-腹腔分流术，使病变持续缩小，猫的神经状态得到长期改善。
这是关于猫有症状的侧脑室内囊性病变的首例报告。根据MRI特征怀疑为左侧侧脑室内脉络丛囊肿。我们的病例表明，内镜开窗和CT引导下抽吸术并非长期治疗的充分手段。囊肿-腹腔分流术可能是一种安全的手术，可使囊性病变显著且稳定地缩小，通过预防高颅内压改善猫的神经状态。
