PETER J. BROFMAN, DONALD E. THRALL.
Eight months before admission to Veterinary Specialty Hospital of the Carolinas (VSH), the patient had been seen by another veterinarian for a 4-day history of acute diso- rientation and a left head turn and circling. At that time, an abnormality localized to the left forebrain was suspected. Thoracic radiographs and abdominal ultrasonography were unremarkable. In magnetic resonance (MR) imaging of the brain, a small (o5 mm) ill-defined region of T2 hyperinten- sity was present in the left subthalamic globus pallidus re- gion. This lesion was isointense on T1-weighted images with minimal contrast enhancement. This lesion was thought to represent a nonhemorrhagic infarct. Cerebrospinal fluid was normal. The patient was discharged with no further treatment and was normal within several weeks.
The patient presented to the same veterinarian 6 months later for acute head pressing and circling to the left with right-sided hemiparesis. A lesion was again localized to the left forebrain. Systolic blood pressure was 180mmHg. A voided sample of urine had 3 þ blood, 10–15 white blood cells (WBC)/high-power field, and a specific gravity of 1.010. Aerobic culture from the urine was negative. Serum chemistry abnormalities included a mildly decreased po- tassium and elevated cholesterol, bilirubin, alkaline phos- phatase (ALP), alanine amino transferase (ALT), and creatine kinase (CK). There was a neutrophilia with a mild left shift, lymphopenia, monocytosis, and mild thrombo- cytopenia. Serum titers for Rocky Mountain Spotted Fe- ver, Ehrlichia canis, Babesia canis, Lyme, and Bartonella vinsonii and Bartonella henselae were negative. There were slightly decreased total and free thyroid hormone levels. Amoxicillin, prednisone, and doxycycline were prescribed and the dog discharged.