Page 790 - Clinical Small Animal Internal Medicine

758 Section 8 Neurologic Disease

open. In dogs, such fractures of the frontal sinus may be Predicting the outcome for an individual patient can be
VetBooks.ir associated with traumatic pneumocephalus and this difficult. Multiple prognostic factors have been identified
in human medicine. The most important factors identi-
should be considered in any dog deteriorating despite
aggressive medical therapy. If surgical intervention is
motor score, pupil response to light, and CT scan charac-
pursued, aggressive debridement should include removal fied include age, cause of injury, Glasgow Coma Scale
of all devitalized tissues and bone and should be guided teristics, including the presence of subarachnoid hemor-
by imaging. Large bone fragments may be spared and rhage. Secondary insults of hypotension and hypoxia have
replaced after thorough debridement, cleaning, and also been found to add important predictive information.
soaking in an antibiotic solution. The association between a patient’s score using the
Following surgery, seizure and antibiotic prophylaxis MGCS and prognosis has been evaluated. This evaluation
are recommended. Phenobarbital at 2–3 mg/kg IV every showed an almost linear correlation between score and
6–8 hours for 48 hours followed by maintenance paren- probability of survival within the first 72 hours. Therefore,
teral therapy is advised. An alternative approach is to use patients with a high score had a high probability of survival
levetiracetam at 20–60 mg/kg IV every 8 hours followed while patients scoring low on the MGCS were unlikely to
by 20 mg/kg orally every 8 hours. survive. A score of 8 on the MGCS was associated with
about a 50% chance of survival. The MGCS was recently
evaluated with long‐term survival at one and six months
Prognosis for Animals with Head Trauma
following injury. Again, a linear trend between MGCS and
Prognosis is dependent on severity of neurologic signs survival at one and six months was demonstrated. An asso-
and response to treatment. Potential complications ciation between MGCS and long‐term patient outcome
associated with brain trauma include coagulopathies, could allow prediction of acceptable patient recovery and
pneumonia, sepsis, transient or permanent central dia- aid in decision making at the time of injury.
betes insipidus, and seizures. Treatment in brain trauma In humans with head trauma, hyperglycemia on admis-
patients should be immediate and aggressive if the sion is a frequent component of the stress response to
animal is to survive and recover to a level that is func- the injury, a significant indicator of severity of injury, and
tional and acceptable to the owner. The ultimate goal in a potent predictor of the patient’s outcome. A recent
the management of brain trauma in veterinary medicine study in dogs and cats suggests that head trauma in these
is for the pet to maintain a good quality of life. Many species may be associated with hyperglycemia and that
patients can recover if systemic and neurologic abnor- the degree of hyperglycemia can be associated with
malities are identified and treated early. Dogs and cats severity of head trauma. However, the degree of hypergly-
have a remarkable ability to compensate for the loss of cemia does not seem to be associated with outcome for
cerebral tissue, making it important not to make rapid dogs and cats with head trauma. Because hyperglycemia
prognostic conclusions based on the initial appearance can potentiate neurologic injury, iatrogenic hyperglyce-
of a pet suffering from brain injury. mia should be avoided in patients with head trauma.