Dr. Seuss–Brain Infection
10 week-old Siamese kitten
Dr. Seuss presented to Southeast Veterinary Neurology (SEVN) for evaluation of a head tilt. She was adopted as a stray and had an ear infection at the time of adoption. Her veterinarian had treated her for the ear infection which improved, but the head tilt worsened. On initial examination at SEVN, she displayed a head tilt to the right. She would occasionally fall to the side. Her mentation, remainder of cranial nerves and spinal reflexes were normal. This localized her problem to the PERIPHERAL vestibular system. On otoscopic evaluation, a pink/purplish mass was visualized behind the ear drum. A nasopharyngeal polyp was suspected based on the age, clinical signs and physical examination findings. A blood test for feline coronavirus (FIP) was performed and was negative. Further diagnostics were not pursued at that time, a course of antibiotics was prescribed, and it was recommended that surgery be performed to remove the suspected polyp at the time of her spay.
Dr. Seuss did well for a few months, but had an episode of disorientation, drooling and poor appetite. She was treated at a local internal medicine specialty hospital with antibiotics and she improved. About a month after this, she was re-evaluated at SEVN. She was laterally recumbent, with her front legs outstretched and with her head arched backwards. This is called opisthotonous. She was minimally responsive, had vertical nystagmus, and was unable to move her legs. This localized her problem to the CENTRAL vestibular system (located within the brainstem). Differential diagnosis included FIP, intracranial extension of her previous ear infection, a malformation, or other less likely cause. A second corona virus test was submitted and was still negative. Magnetic resonance imaging (MRI) of the brain was performed and showed an ear infection, as well as fluid and pus surrounding the brain.
Emergency brain surgery was performed to relieve the fluid and pus build-up within the brain. After the brain surgery, a ventral bulla osteotomy was performed to remove the ear infection which was thought to be the source of her brain infection. Post-operatively, Dr. Seuss was more alert and was able to walk with support. Long-term antibiotics were prescribed based on results of culture and sensitivity. We are happy to report that almost a year after her surgery, Dr. Seuss is a happy, playful cat.
Thank you to Dr. Maria Diaz at Banfield for referring Dr. Seuss to SEVN. Also, a huge thank-you to Dr. Seuss’ owner for giving us the opportunity to help her.