How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask nekovet Your Own Question

nekovet
nekovet, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 6841
Experience:  Hello, I am a small animal veterinarian and am happy to discuss any concerns & questions you have on any species.
60269376
Type Your Dog Veterinary Question Here...
nekovet is online now
A new question is answered every 9 seconds

is DIC a possible cause of head tilt and ataxia in a 3 mth

Customer Question

is DIC a possible cause of head tilt and ataxia in a 3 mth old puppy with susp ICH. What is the prognosis for recovery?
Submitted: 2 years ago.
Category: Dog Veterinary
Expert:  nekovet replied 2 years ago.

Thank you for your question and I am very sorry to hear about how ill Lady is.

I do apologize for the delay in answer, but your question only just arrived to the veterinary category (and I suspect lingered unanswered in the dog veterinary category). That said, as soon as I saw your serious situation, I did not hesitate to answer your query.

The short answer to your query is yes. It is possible to see DIC cause a head tilt, ataxia, and even circling or seizures. It can do so because as DIC progresses the affected animal will become less able to clot their blood. And if the puppy has had a wee bleed in his brain (ie spontaneous, viral induced, etc), she suddenly would be unable to clot the bleed as readily as before and could end up with a hematoma. This would put pressure on the brain (just like any space occupying lesion) and then cause these neurological signs you have mentioned.

Now the neurological signs are a negative progression of her condition, as I am sure you can understand but they play a limited role in her prognosis for recovery. They are a complication that may resolve with time provided she could recover from the viral infection and its secondary DIC.

In regards XXXXX XXXXX without actually having evaluated her myself, I would say that she has a guarded prognosis if she has been diagnosed with secondary DIC. But if she does respond to the vet's intensive care and can be nursed through the ICH + DIC, then her prognosis would be more favorable though we might see residual neurological signs if the bleed in her brain was severe.


I hope this information is helpful.
Please do let me know if you have any further questions.
If you have no further questions, feedback is greatly appreciated.

All the best,

Dr. B.

-----------------------------------------------------------------------------------------------------------------

Please remember to rate my answer, so that I may receive credit for my assistance today. IF you have any lingering questions or concerns, please reply to me via the REPLY or CONTINUE CONVERSATION button with the questions or issues you might have. I will be happy to continue further and do everything I can to provide you with the service you seek. If you are satisfied, please click the 4-5 stars or associated happy face so that I may receive credit for my assistance.

Customer: replied 2 years ago.
Looking at the possibilities in this case, hepatic encephalopathy seems more likely and my thoughts are that a portosystemic shunt is more likely the cause. In which case unless the precise location of the shunt is pinpointed it cannot be surgically corrected, and would be extremely difficult in such a small patient. The other problem is that once clinical signs have started,the prognosis seems to get poorer.yorkies seem to be a breed overpresented here.
Expert:  nekovet replied 2 years ago.

Hi again,

I had assumed you had confirmed ICH and the DIC in Lady's case. If you had not, then hepatic encephalopathy secondary to portosystemic shunt (PSS) would be a top differential for a young (perhaps petite) Yorkshire terrier showing these neurological signs (though the DIC isn't typically a feature). So, if you haven't actually confirmed ICH, consider doing so but also if PSS is suspected then you might consider checking bloods with a bile acids and ammonia level to confirm the diagnosis. A definitive diagnosis will shine a lot of light on treatment options and prognosis overall for her.

You are correct that PSS is a condition we are seeing in this breed more and more frequently (though also Miniature Schnauzers, Maltese, and Cairn Terriers). I would say that Yorkies seem to be becoming the poster child for this condition. That said, it is the most common circulatory anomaly we see in veterinary medicine.

In regards XXXXX XXXXX correction, you are right that the location of the shunt would need to be determined. As well, the approach also depends if it is intra or extra-hepatic in its locale. That said, I have seen many of these dogs referred to the specialist facilities (ie vet schools, referral centres) where specialist ultrasonographers can identify the shunt site, determine if it is intrahepatic or extrahepatic and therefore help surgery go ahead. Alternatively, we can use contrast portography to visualize the vessels pre-operatively. And it is worth noting that while smaller dogs can be more of a challenge it isn't a prohibitive factor blocking potential surgical correction of the vascular anomaly. So, while it might not be an operation for a general practicing vet, it is one that specialist surgeons can and do carry out.

In regards XXXXX XXXXX prognosis post-onset of signs, this is the case for all animals with a shunt of this nature. This is because the clinical signs are secondary to the build up of nitrogenous wastes (ie ammonia) that the liver is supposed to be filtering out. In essence the liver's inability to carry out this function means the body is essentially being poisoned by its own metabolites. And that causes signs, and can have lasting effects. So, if an animal has a shunt, suffers clinical signs of it, and isn't treated --well, the overall prognosis is understandably going to suffer.

So, it you haven't reached a definitive diagnosis, that is the first step. If ICH is suspected, then this should be tested for. As well, if Lady has prolonged bleeding times but DIC hasn't been confirmed, this needs to be diagnosed as well (especially since ICH can slow bleeding times as part of its disease without full blown DIC).

Finally, if PSS hasn't been considered before now, you do want to consider an ultrasound and check a blood panel (having a special peek at the bile acid stimulation test results, urea/creatnine and ammonia levels in the blood). Because while both these conditions can show the signs you initially hinted at, they are very different diseases with very different treatments and prognoses. And knowing which is present is quite important to realistically evaluating her chances and treating her appropriately.

Dr. B.







JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • It was so professional, so personally concerned (as we were) and you answered all of our questions. George and I are so happy that I found "JustAnswer" on my Google search -- you are now in my "Favorites" list! And, yes we do love our kitty - she makes our life complete! Bev & George Boca Raton, FL
< Last | Next >
  • It was so professional, so personally concerned (as we were) and you answered all of our questions. George and I are so happy that I found "JustAnswer" on my Google search -- you are now in my "Favorites" list! And, yes we do love our kitty - she makes our life complete! Bev & George Boca Raton, FL
  • Wonderful service, prompt, efficient, and accurate. Couldn't have asked for more. I cannot thank you enough for your help. Mary C. Freshfield, Liverpool, UK
  • This expert is wonderful. They truly know what they are talking about, and they actually care about you. They really helped put my nerves at ease. Thank you so much!!!! Alex Los Angeles, CA
  • Thank you for all your help. It is nice to know that this service is here for people like myself, who need answers fast and are not sure who to consult. GP Hesperia, CA
  • I couldn't be more satisfied! This is the site I will always come to when I need a second opinion. Justin Kernersville, NC
  • Just let me say that this encounter has been entirely professional and most helpful. I liked that I could ask additional questions and get answered in a very short turn around. Esther Woodstock, NY
  • Thank you so much for taking your time and knowledge to support my concerns. Not only did you answer my questions, you even took it a step further with replying with more pertinent information I needed to know. Robin Elkton, Maryland
 
 
 

Meet The Experts:

 
 
 
  • Dr. Debbie

    Dog Veterinarian

    Satisfied Customers:

    902
    Companion animal veterinarian practicing for over 10 years.
< Last | Next >
  • http://ww2.justanswer.com/uploads/DE/debkatreyn/2011-11-28_33650_682e.64x64.jpg Dr. Debbie's Avatar

    Dr. Debbie

    Dog Veterinarian

    Satisfied Customers:

    902
    Companion animal veterinarian practicing for over 10 years.
  • http://ww2.justanswer.com/uploads/VE/vetforyou/2012-6-20_33122_PearlPhoto.64x64.jpg Dr. Andy's Avatar

    Dr. Andy

    Medical Director

    Satisfied Customers:

    13796
    UC Davis graduate, emphasis in dermatology, internal medicine, pain management
  • http://ww2.justanswer.com/uploads/doggfone1/2009-07-16_133633_vet_pic.jpg Dr. Scott's Avatar

    Dr. Scott

    Veterinarian

    Satisfied Customers:

    9550
    12 years of small animal, equine and pocket pet medicine and surgery.
  • http://ww2.justanswer.com/uploads/RY/rydergar/2012-6-6_192240_IMG0328.64x64.JPG Dr. Gary's Avatar

    Dr. Gary

    Dog Veterinarian

    Satisfied Customers:

    7758
    DVM, Emergency Veterinarian, BS (Physiology)
  • http://ww2.justanswer.com/uploads/AN/andrewDVM/2012-4-27_12585_iStock000011751407XSmall.64x64.jpg Dr. Drew's Avatar

    Dr. Drew

    Dog Veterinarian

    Satisfied Customers:

    6598
    Small Animal Medicine and Surgery
  • http://ww2.justanswer.com/uploads/1I/1ISUDVM/2011-3-1_22028_Honeymoon2005075294928803490646858.64x64.jpg Dr. Bruce's Avatar

    Dr. Bruce

    Veterinarian

    Satisfied Customers:

    6377
    13 years of experience as a small animal veterinarian
  • http://ww2.justanswer.com/uploads/BI/bigislandvet/2013-2-21_214244_IMG0357.64x64.JPG Dr. Michael Salkin's Avatar

    Dr. Michael Salkin

    Big Island Vet

    Satisfied Customers:

    6049
    University of California at Davis graduate veterinarian with 41 yrs. of experience.
 
 
 
Chat Now With A Dog Veterinarian
nekovet
nekovet
Dog Veterinarian
6841 Satisfied Customers
Hello, I am a small animal veterinarian and am happy to discuss any concerns & questions you have on any species.