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HIDROCEFALIA EN PERROS (2ª PARTE). DIAGNÓSTICO Y TRATAMIENTO

This is the second article of a series of two, in which we tell you from Ane Uriarte, what is hydrocephalus in dogs, causes of its development, how it presents itself as well as the diagnosis and clinical treatment to be performed.

Author: Ane Uriarte 

Dip ECVN, DVM, MRCVS, RCVS Recognized specialist in Neurology, EBVS, European Specialist in Veterinary Neurology Veterinary Veterinaria

Diagnosis of hydrocephalus in dogs

The most reliable and extensive method for the diagnosis of hydrocephalus in dogs and its cause is magnetic resonance imaging (MRI)..

A tomodensitometric (TM) examination will allow us to observe the dilated ventricular system without being able to provide much information regarding the reason for the dilatation or the cortical state. We must remember that many of these animals present more than one cerebral/cervical congenital malformation, and MRI is the most exhaustive way to study these.

Resonancia Magnética de Cavalier King
Magnetic Resonance of Cavalier King 1.5T MRI. Sagittal T2WI image of a Cavalier King Charles Spaniel. Hydrocephalus with Chiari-like syndrome and syringomyelia. Note the dilatation of the ventricular system with herniation of the cerebellum through the formen magnum.
Resonancia Magnética 2
Magnetic Resonance Imaging 2 1.5T MRI. Sagittal T2WI image of congenital hydrocephalus where the entire ventricular system is dilated.

Treatment of hydrocephalus in dogs

The definitive treatment of hydrocephalus in dogs is surgery. The problem we face is to choose the best time to bring a relevant clinical improvement to the patient, since certain animals can develop a comfortable life with little or no clinical signs or evolution.

  1. Medical treatment: The medical treatments available to reduce CSF production are few and their use does not usually improve clinical symptoms significantly: corticosteroids (anti-inflammatory doses) and diuretics. In case of seizures, antiepileptic treatment should be instituted immediately.
  2. Surgical treatment: The medical treatments available to reduce CSF production are few and their use does not usually improve clinical symptoms significantly: corticosteroids (anti-inflammatory doses) and diuretics. In case of seizures, antiepileptic treatment should be instituted immediately.
Imagen perioperatoria e imagen por tomo-densitometría
Perioperative imaging and tomo-densitometry imaging Perioperative image and computed tomo-densitometry image after ventriculo-peritoneal shunt position. Note the correct presence of the valve in the lateral ventricle.

Prognosis of hydrocephalus in dogs

In animals that are not severely affected, and only present clinical symptoms (usually seizures) at an advanced age (several years) the prognosis is generally good. These animals usually respond to antiepileptic treatment and generally do not need a ventricular shunt.

In cases of rapid progressive hypertensive hydrocephalus, surgery is the only option, but in most cases the results are highly satisfactory. The problem in these cases is rather economic: the valves are expensive and will probably need revision at some point.

Shunt subcutáneo
Note the subcutaneous shunt and the extra conduit that allows the dog to grow.

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Bibliography

Dewey, C. W. (2002). External hydrocephalus in a dog with suspected bacterial meningoencephalitis. Journal of the American Animal Hospital Association38(6), 563-567.

Thomas, W. B. (2010). Hydrocephalus in dogs and cats. Veterinary Clinics: Small Animal Practice40(1), 143-159.

Levine, D. N. (2008). Intracranial pressure and ventricular expansion in hydrocephalus: have we been asking the wrong question?. Journal of the neurological sciences269(1-2), 1-11.

Estey, C. M. (2016). Congenital hydrocephalus. Vet Clin North Am Small Anim Pract46(2), 217-29.

Girod, M., Allerton, F., Gommeren, K., Tutunaru, A. C., De Marchin, J., Van Soens, I., … & Peeters, D. (2016). Evaluation of the effect of oral omeprazole on canine cerebrospinal fluid production: a pilot study. The Veterinary Journal209, 119-124.

Laubner, S., Ondreka, N., Failing, K., Kramer, M., & Schmidt, M. J. (2015). Magnetic resonance imaging signs of high intraventricular pressure-comparison of findings in dogs with clinically relevant internal hydrocephalus and asymptomatic dogs with ventriculomegaly. BMC veterinary research11(1), 1-11.

Schmidt, M. J., Rummel, C., Hauer, J., Kolecka, M., Ondreka, N., McClure, V., & Roth, J. (2016). Increased CSF aquaporin-4, and interleukin-6 levels in dogs with idiopathic communicating internal hydrocephalus and a decrease after ventriculo-peritoneal shunting. Fluids and Barriers of the CNS13(1), 1-11.