Apoplexy:
- It is also known as cerebrovascular accident (CVA) or stroke.
- It is medical condition in which poor blood flow to brain causes cell death.
- It can occur in various species and characterized by sudden loss of blood supply to part of brain, leading to neurological dysfunction.
Etiology:
- Thrombosis or embolism: Blood clots (thrombi) and emboli (clumps of material such as fat, bacteria or tumor cells) causes blockage of blood vessel, leading to reduced blood flow to brain.
- Hemorrhage: It occurs due to rupture of blood vessel in brain, often due to hypertension or head trauma
- Vascular disease: Conditions like atherosclerosis leads to narrowing or blockage of blood vessels, increasing risk of apoplexy
- In rare cases, infection in around brain also causes apoplexy
- Tumors: Brain tumors can compress blood vessels or invade brain tissue, increasing risk of apoplexy.
Types of Apoplexy:
- Two types of apoplexy occur in animals:
- Pituitary apoplexy: bleeding into pituitary gland which results in neurological impairment.
- Adrenal apoplexy: Bleeding into adrenal gland.
Clinical Findings:
- Sudden weakness or paralysis, often on one side of body
- Loss of balance and coordination
- Altered mental state, including confusion or stupor
- Seizures
- Loss of consciousness
- Abnormal eye movements
- Head tilt or circling
- Difficulty swallowing or drooling
- Specific symptoms vary depending on location and extent of brain injury
Diagnosis:
- Based on clinical findings
- Neurological examination of animals such as mental status, reflexes, muscle coordination, strength and cranial nerve function.
- Imaging studies such as CT scan, MRI helps visualize lesion in brain, hemorrhage or other abnormalities
- Blood test: It is performed to rule out underlying medical conditions that contribute to stroke, such as hypertension or clotting disorders
- CSF analysis: CSF fluid are obtained through tapping CSF or lumbar puncture to rule out infectious causes.
Treatment:
- Animals with apoplexy requires immediate stabilization which includes oxygen therapy, intravenous fluid, and medications to control seizures
- ABC care is important in traumatic injury. Airway, breathing and cardiovascular dysfunction should be corrected immediately
- Anticoagulant or antiplatelet medications may be administered to prevent further clot formation. Aspirin and clopidogrel are most commonly used in veterinary medicine. Aspirin @0.5-10 mg/kg, PO, q24 h in dogs. In cats it is given @ 81 mg, PO, q72h
- Clopidogrel @ 1.1-3 mg/kg, PO, q24h in dogs and 18.75 mg/cat, PO, q24h in cats
- In dogs, tissue plasminogen activator (alteplase) is used to dissolve intraocular fibrinous clots. 250mcg/ml Injection, 25mcg/dog, intracamerally in anterior chamber of affected eye, once
- In case of tumors, surgical intervention is required to remove tumors and repair blood vessel abnormalities
- Physical therapy and rehabilitation may be beneficial for animals recovering from apoplexy to improve mobility and function.
- Treating and managing underlying conditions such as hypertension or diabetes can help prevent future strokes