Asymmetric Multifocal Neurological Signs in a Dog With Eunatremic, Eukalemic Hypoadrenocorticism With Severe Hypoglycemia

Abstract

Objective

To describe the clinical presentation of a dog with eunatremic, eukalemic hypoadrenocorticism (EEH) with multifocal, asymmetrical neurological signs.

Case Summary

A 7-year-old neutered male miniature Poodle presented for collapse, vomiting, and acute onset of neurological signs. The dog was obtunded and nonambulatory, with a right-sided head tilt and turn with rotary nystagmus. No seizure activity was observed by the owner. The patient was in hypovolemic shock. Hypoglycemia, mild azotemia, and metabolic acidosis characterized by hyperlactatemia were identified. Magnetic resonance imaging of the brain and CSF analysis performed within 24 h of presentation were unremarkable. ACTH stimulation testing confirmed hypoadrenocorticism. Neurological signs failed to significantly improve despite systemic stabilization, glucose supplementation, and dexamethasone administration until approximately 48 h following admission. A mild proprioceptive ataxia was present at discharge approximately 84 h following admission and had resolved by the time of initial recheck 7 days following discharge.

New Information Provided

EEH can cause neurological signs with forebrain localization that are typically symmetrical due to the global nature of the injury. To the authors’ knowledge, this is the first report of a dog with EEH presenting with severe, asymmetric, and multifocal neurological signs.