Evaluation of cerebral blood flow with transcranial Doppler ultrasound in a dog with surgically treated intracranial subdural empyema

10 Nov 2019

Santiago, R., Ros, C., Garcia de Carellan Mateo, A., Laborda-Vidal, P.

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A three-year-old spayed female Yorkshire terrier presented with a three-week history of lethargy and weight loss. Physical examination showed left exophthalmos with left nasal discharge. A lesion in the left brainstem was suspected based on the neurological examination. Pre/postcontrast CT images were consistent with an extensive subdural empyema in the region of the left forebrain, extending from the level of the frontal to the occipital lobe. At presentation, transcranial Doppler (TCD) ultrasound was performed in the left (LMCA) and right middle cerebral arteries (RMCA) showing marked hyperaemia (LMCA velocity: 81.9 cm/s; RMCA velocity: 90.3 cm/s; reference ranges: LMCA velocity 62.3±10.9 cm/s; RMCA velocity 62.5±10.9 cm/s). A left-sided rostrotentorial craniectomy was performed, followed by medical treatment. TCD was monitored daily postoperatively returning to within the reference range five days after surgery (LMCA velocity: 54.9 cm/s; RMCA velocity: 63.6 cm/s). Normalisation of the systolic velocity was associated with clinical improvement. TCD is a useful and non-invasive method for monitoring of cerebral blood flow in patients with intracranial empyema.