Case Reports

Written By: Meaghan Duck Michigan State University College of Veterinary Medicine 2023

Patient Name: “Darwin”

Signalment:  9-year-old male neutered Puggle

Clinical Problems:

• Left-sided hemineglect
• Right-sided cranial nerve deficits with mild head tilt and circling to the left
• Decreased left limb function with decreased muscle tone
• Mild myofascial back pain from T6-S3
• Right-sided tense muscles
• Suspected central right vestibular lesion – DDX include stroke, neoplasia, other

Rehabilitation Goals:

• Promote neuromodulation of the left side of his body through acupuncture
• Be able to lay in a sternal position for longer periods, if able.
• Reduce ataxia to a grade 3-4/5, if able.

Modalities Used:

• Acupuncture
• Restricted activity – No jumping onto or off of high surfaces or stairs
• Prednisone – Omeprazole while taking this.
• Rehabilitation therapy sessions – Therapeutic physical exercises and development of a home exercise program. If set-backs occur, additional modalities such as laser therapy or PEMF.
• At home – Basic massage and core strengthening

Assessment:

• Darwin first came to Pawsitive Steps Rehabilitation and Sports Medicine in late January approximately 3 weeks after the onset of his acute neurological signs. On presentation Darwin demonstrated a mild right-sided head tilt, a grade 2-3/5 ataxia affecting all limbs, a severe right-sided side wind, and inability to lay down in a proper sternal down. When moving, he circled in a wide fashion to the left while his right side was supported by a wall.
• Within a few weeks of beginning Prednisone and his rehabilitation plan, Darwin showed significant improvement. He no longer needed the support of a wall to walk and he had minimal circling during his recheck examination in late February. His ataxia improved beyond his original goals and was a grade 4-5/5, and he was able to stand independently during his examination.
• During the weaning course of Prednisone, he did experience a brief setback when he was moved to every other day dosing in which his circling came back when he was excited. His Prednisone was then increased back to daily dosing, after which his circling decreased again.
• At his most recent recheck (3 months post original presentation) he maintained his improvement in his ataxia at a grade 4-5/5, can walk well unassisted, circles infrequently, is able to lay in a sternal down unassisted, and is now able to easily durn his head to the left with minimal balance issues. He is currently maintained on daily Prednisone due to the setbacks he previously experienced which has contributed to some mild muscle wasting in his hind limbs and temporalis muscles.