Laurie's Blogs.

This past weekend, I was asked to see a cat with possible vestibular disease.  However, the cat also had a bit of Horner’s syndrome and was on antibiotics for an ear infection.  So, I did some neuro tests (hopping, placing, flexor withdrawal).  They were all normal.  I did the Dix-Hallpike maneuver and it did not set off any nystagmus.  He was a bit unbalanced with shaking and turning, but not a typical vestibular disease case.  Fortunately, he had been to the vet and was on medications to sort out the ear infection, and my suggestion was to continue that path, and do some exercises for balance:

• Obstacle courses (under, over, and through objects)
• Play with a ‘feather stick’ – i.e. chase a toy object  to work on balance
• Play red light laser chase in the dark (i.e. to reduce visual balance cues)

Okay, I thought that last one was clever… but I don’t know how it will work out yet.

But the main reason for this blog is a wee overview of Horner’s Syndrome.  So, let’s dive into that as a refresher!

Horner's syndrome in animals is a neurological condition caused by the disruption of the sympathetic nervous system, specifically affecting the pathway that controls certain functions of the eye and facial muscles. The syndrome is characterized by a classic set of symptoms, including:

1. Ptosis: Drooping of the upper eyelid.
2. Miosis: Constricted pupil.
3. Enophthalmos: Sunken appearance of the eye.
4. Protrusion of the third eyelid.

Causes of Horner's Syndrome in Animals:

Horner's syndrome can be classified into different categories based on where the lesion occurs along the sympathetic nerve pathway. Causes may include:

1.Central (First-Order Neuron) Lesion:

• Trauma or injury to the brainstem or spinal cord.
• Tumors in the central nervous system.
• Inflammatory or vascular diseases affecting the central nervous system.

2.Preganglionic (Second-Order Neuron) Lesion:

• Brachial plexus avulsion (nerve injury to the forelimb).
• Chest or neck trauma.
• Tumors in the thorax, like mediastinal masses or spinal tumors.

3.  Postganglionic (Third-Order Neuron) Lesion:

• Ear infections (otitis media or interna).
• Trauma to the neck or skull.
• Idiopathic causes, where no definitive cause can be identified (commonly seen in dogs and cats).

Significance of Horner's Syndrome:

• Underlying Disease: The presence of Horner's syndrome often points to an underlying neurological or systemic issue that needs to be identified and treated. The specific location of the lesion helps in narrowing down potential causes.

• Diagnostic Tool: Horner's syndrome is valuable diagnostically because its clinical signs are distinct. Veterinarians can localize the cause (central vs. peripheral) by using pharmacologic testing or imaging (e.g., MRI, CT).

• Idiopathic Cases: In some animals, particularly dogs, Horner’s syndrome can be idiopathic (no identifiable cause), and the symptoms may resolve on their own over weeks to months.

• Associated Complications: If Horner's syndrome results from trauma, tumors, or infections, addressing the underlying cause is critical. In some cases, treatment of the primary issue will resolve the syndrome, while in others, the symptoms may be permanent.

Back to the CAT.

What else did I do with the cat?  Well, I lasered the ear and the occipital / suboccipital regions to target the ear infection itself and to target the brainstem / vestibulocochlear nerve.  I also used a few local acupuncture points to further stimulate blood flow in the area.  While I think that the antibiotic will do the majority of the work to heal this cat, I think that these things and the balance exercises might help speed thing up a wee bit for return to full function.  Time will tell!  It’s my first ear infection / Horner’s syndrome cat case!

So, there you go, a refresher and a novel rehab case!

Until next time,

Cheers!  Laurie