datlas
i have a crazy case
7 yr old German Shepherd dog who I worked up for cluster seizures 3 weeks ago. Found hemorrhagic mass right temporal lobe, thought to be a brain tumor.
Spinal fluid, clotting times, platelet function, liver function, chest rads, and abdominal ultrasound all normal. He developed neurogenic pulmonary edema from his seizures but got over that fine.
Only other significant finding was hypothyroidism, and the dog is the poster child clinical appearance for hypothyroidism.
Discharged on prednisone, Keppra, and levo thyroxine.
Poorly controlled seizures since, I’ve increased his keppra several times. Today owners called he’d had multiple focal seizures, so I saw him back. Had a generalized tonic clonic seizure while we were putting an IV catheter in. Give IV midazolam followed IV phenobarbital and no more seizures.
Then a few hours later, one of the ICU nurses comes to find me. He now has profuse existaxis from his left nostril. Get that stopped with epinephrine, repeat all his clotting stuff plus his CBC and chemistry. All normal essentially. Total white count is high, a mature neutrophilia. I check a buccal mucosal bleeding time which is normal. Sometimes Von Willibrand disease, although inherited, can become symptomatic in middle age in dogs associated with hypothyroidism.
WTF? I’m going to CT his nose tomorrow to look for a tumor, fungal infection etc. And call the Coag Lab at the vet school at Cornell, who I’m told can be very helpful for specific tests to pursue for unusual cases of hemophilia. Which would be very weird because this dog was neutered without incident and we’d have expected bleeding at surgery if he was a hemophiliac.
Weirdness, I don’t know what to make of it all.