Page 593 - Cote clinical veterinary advisor dogs and cats 4th

268 Disorientation/Confusion

with clinical improvement. Radiographic may be the best way to achieve control in should be used to ensure the spine is parallel
signs of healing: group populations and to avoid zoonosis. • Due to its zoonotic potential, care should be
to the tabletop. Sedation is often required.
VetBooks.ir • Antimicrobials can be discontinued 4-6 weeks PEARLS & CONSIDERATIONS taken while handling patients (handwashing,
○ Absence or smoothing of the lytic focus
○ Bridging spondylosis/new bone formation
gloves, minimizing exposure to urine) until
after there is no evidence of ongoing lysis.
• Discospondylitis should be considered as a
• Recheck radiographs 1-2 months after Comments B. canis has been ruled out.
discontinuation of therapy. differential diagnosis for puppies with back Client Education
pain, especially those with a recent history of Discospondylitis can be a life-threatening illness.
PROGNOSIS & OUTCOME trauma or systemic infection. Radiographic Compliance with medication administration
findings can differ in juveniles compared to and follow-up is essential to ensure a positive
• Bacterial discospondylitis: good to excellent adults. outcome.
prognosis. Patients with pronounced neuro- • Multiple organism infections are possible,
logic deficits often have a more protracted including mixed bacterial and fungal infec- SUGGESTED READING
recovery but can still have a functional tions. Although cultures help guide therapy, Burkert BA, et al: Signalment and clinical features of
outcome. the bacterial organisms identified in urine discospondylitis in dogs: 513 cases (1980-2001). J
• Fungal discospondylitis carries a poor cultures may not be those present in the Am Vet Med Assoc 227:268-275, 2005.
prognosis and may require lifelong treatment. disc space.
• The prognosis for B. canis infection is AUTHOR: Kathryn Winger, DVM, DACVIM
EDITOR: Karen R. Muñana, DVM, MS, DACVIM
guarded. Poor response to therapy is likely Technician Tips
due to the intracellular nature of the organ- • A complete study of the vertebral column
ism and periodic bacteremia. Relapses are involves five lateral radiographs and five
common. Euthanasia of affected individuals orthogonal projections. Positioning devices

Disorientation/Confusion Client Education
Sheet

BASIC INFORMATION • Pre-existing liver or kidney disease, diabetes PHYSICAL EXAM FINDINGS
mellitus, hypothyroidism, or other diseases • Physical exam findings depend on the cause
Definition causing osmotic, electrolyte, and/or acid-base (see specific diseases).
An inappropriate state of confusion with respect disturbances • For accurate treatment and prognosis,
to time and/or place and/or identity characterized Clinical Presentation it is important to identify the cause of
by atypical and/or inappropriate behaviors to a disorientation:
given stimuli or environmental condition (e.g., HISTORY, CHIEF COMPLAINT ○ Primary brain origin (e.g., canine or
pacing, wandering aimlessly, not responding to Can be acute or insidious in onset. Acute feline cognitive dysfunction syndrome,
being called by name in a normal-hearing patient, presentations often associated with trauma, congenital hydrocephalus, brain neoplasia)
escalating separation anxiety) ingestion of toxic substances with central ○ Secondary to some other cause (e.g.,
nervous system (CNS) effects, encephalopathy, trauma, various metabolic encephalopa-
Epidemiology or metabolic illness. thies, various toxicities)
SPECIES, AGE, SEX • Barring history or suggestion of observed ○ Resulting from visual impairment: may
Dogs and cats, any age or sex trauma or intoxication, owners may describe note mydriasis in normal ambient lighting
any combination of the following signs: (p. 123)
GENETICS, BREED PREDISPOSITION ○ Not responding to being called by name ○ Resulting from hearing impairment
• Brachycephalic and dome-headed breeds are ○ Wandering aimlessly (p. 237)
prone to congenital hydrocephalus (p. 481). ○ Seemingly getting stuck in corners of home ○ Benign behavioral origin
• Breeds predisposed to inherited inborn errors ○ Behaving unaware or forgetful of sur-
of metabolism (e.g., various lysosomal storage roundings or of owner/family members Etiology and Pathophysiology
diseases) ○ Urinating or defecating in inappropriate • Disorientation can result when a disease
• Breeds predisposed to various diseases places affects the cerebrum.
resulting in metabolic derangements (e.g., ○ Not behaving in anticipatory manner with • Pathophysiologic explanation of altered
portosystemic shunts resulting in hepatic regard to daily routines (e.g., not being frontal and temporal lobe function varies
encephalopathy [p. 814]) excited to be fed at usual time) with each disease but may include
• Breeds of animals predisposed to epilepsy • Obtain clear, concise description of primary ○ Alterations in neuronal metabolism
(i.e., disorientation/confusion during the complaint, and ask questions about (e.g., hypoglycemia, hypothyroidism,
postictal period [p. 301]) ○ Vision or hearing changes hypocalcemia)
• Breeds predisposed to blindness (e.g., sudden ○ Potential access to toxins or psychotropic ○ Accumulation of neurotoxic substances
acquired retinal degeneration [p. 883]) drugs (e.g., hepatic encephalopathy)
○ Signs associated with metabolic distur- ○ Chronic oxidative stress in the brain,
RISK FACTORS bances (e.g., alterations in thirst, appetite, leading to neurodegeneration (e.g.,
• Old age: canine and feline cognitive dysfunc- gastrointestinal/urologic behaviors) canine and feline cognitive dysfunction
tion syndrome (p. 188) ○ History of recent trauma syndrome)
• Access to psychoactive drugs or potentially ○ History of seizures (animals can be ○ Alterations in brain neurotransmitters
neurotoxic substances disoriented during the postictal period) (e.g., hepatic encephalopathy, epilepsy)

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