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Dr. B.
Dr. B., Veterinarian
Category: Dog Veterinary
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Experience:  Hello, I am a small animal veterinarian and am happy to discuss any concerns & questions you have on any species.
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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: 4 years ago.
Category: Dog Veterinary
Expert:  Dr. B. replied 4 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.


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Customer: replied 4 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:  Dr. B. replied 4 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.