Traumatic Brain Injury in a 10-Week-Old West Highland White Terrier

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A 10-week-old West Highland White Terrier presented to Cornell’s Emergency Service following a traumatic fall from the owner’s arms onto a concrete floor. Immediately following the incident, she was unresponsive. The owners performed cardiopulmonary resuscitation until they saw her breathing again. They immediately brought her to a local emergency clinic where an initial evaluation showed cervical pain and absent paw placement in all four limbs.
The patient was then transferred to Cornell’s Emergency Service for further assessment and imaging. When she arrived at Cornell, she was non-ambulatory and mentally inappropriate, persistently vocalizing without stimulus. In addition, her pupillary light response was absent in the left eye, and her pupils were miotic. Absent paw placement in all four limbs and absent cutaneous trunci were also observed. Upon intake, the patient was started on oxygen therapy, fluids, and a constant rate infusion of pain medication. After therapy was initiated, the patient progressed from non-ambulatory tetraparesis to hypermetria of all four limbs. Her postural reactions returned, though they were delayed, and a severe intention tremor and titubation became evident. The lesion was localized to her forebrain and cerebellum and a whole-body computed tomography scan was performed.
The computed tomography scan revealed a morphologically normal brain, with no compressive lesions or hemorrhage appreciated. A linear fracture of the occipital bone coursing through the tentorial process of the right parietal bone with a small, minimally displaced, mineral fragment dorsal to the foramen magnum was noted. The fracture line extended dorsally from the right-dorsal aspect of the foramen magnum through the left occipitoparietal suture. The patient continued to improve throughout her stay in the hospital. She was weaned off of her pain medication and was discharged to the care of her owners. At the time of discharge the patient was still exhibiting cerebellar ataxia and a mild intention tremor, but all other clinical signs had resolved.

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canine, traumatic brain injury, modified Glasgow coma scale, prognosis


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