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Hi everyone,
I posted a question here about a suspected herniated disc in my 5 year old cat, Pumpkin, about three months ago. After 10 months of seeing a wide variety of doctors and specialists, we finally have a diagnosis: our cat had a stroke last July. I am writing this post in case it is helpful to someone else in a similar situation.
Pumpkin was a stray at my daughter's high school and was about 9 months old and feral when we trapped her. She has always been in good health once we got her weight up to normal and had her dewormed, vaccinated, etc.
On July 4, 2014, Pumpkin was in the back yard with me and was fine one minute and nearly comatose-acting the next minute. She was sitting in a hunched forward position with her head low and her eyes squeezed shut. She didn't even open her eyes when I talked to her. I immediately took her to a large emergency/specialty clinic in our area. The emergency vet did CBC/chemistry, FeLV/FIV test and x-rays. All were normal. However, while the vet and I were discussing Pumpkin, she had two small seizures. The seizures looked like this: her eyes were squeezed shut, she was sitting in the "loaf position" and she trembled significantly for about 20 seconds. The veterinarian gave her subcutaneous fluids and said to watch for trouble urinating, difficulty breathing, or any unusual neurological activity. None of those symptoms followed, but she has never been the same cat since that day. She is a much more lethargic cat, completely lacking the high energy and mischievousness she once had. She has also been far more irritable, both with us and with our other animals (4 other cats and a dog). She seems very fearful of being touched by either us or the other animals. She also no longer jumps to her favorite high spots that she used to love. Her appetite is normal.
I won't bore you with all of the veterinary appointments we have had since that day. I will tell you that, at one point, we had spent a total of $8000 and still did not have a diagnosis. Over the 10 months, she has had a ton of blood work, ultrasounds and x-rays. She was tested for a wide variety of illnesses including toxoplasmosis, FIP titers, pancreatitis, various muscle diseases, and I can't remember what else. At various times over the past 10 months, she has been on pain medications, anti-inflammatories and steroids. The symptoms that have concerned me most have been the way her breathing looks labored whenever she sleeps and the permanent irritability. Whenever she sleeps, she looks like she is in pain. With each breath, she hunches up her shoulders and squeezes her eyes shut. When I originally posted here in February, a surgeon had diagnosed her with a likely ruptured disc and wanted to do back surgery. The surgeon had based the ruptured disc conclusion on Pumpkin's sensitivity when her back was palpated and her sluggish back left leg. She thought these were the effect of a ruptured disc pressing on a nerve.
I am so grateful we pursued a second and third opinion. I found that the two specialists we consulted were different that the other vets we had seen in that they visually observed Pumpkin far more extensively and asked many more questions than all the other vets had. The two doctors from whom we sought second and third opinions did not know of each other's conclusions, yet they came to the exact same conclusion. The second opinion was by a wonderful internist/oncologist named Dr. Cheryl Harris who, after watching Pumpkin walk and conducting several neurological tests with her reflex hammer, was sure that we were looking at a neurological problem. (Dr. Harris diagnosed my dog's bladder cancer years ago after many trips to other vets who were not able to figure out what was going on.) She noticed that Pumpkin was goose-stepping with her back left leg, lifting it higher than needed before placing it down with each step. She explained that Pumpkin would be doing this because she had less sensitivity in that leg, making her less sure of where she was placing it. She also looked at videos I had taken of Pumpkin's breathing when she slept and thought the jerkiness and eye squeezing indicated a neurological problem. Both of these symptoms made her suspect that these were the residual effects of a stroke.
Today, I met with a renowned neurologist. His brilliance is richly deserved. He is a teacher at Ohio State University's Veterinary School, in addition to his neurology consulting work. I had been given his name by 3 different veterinarians. For anyone who might need it, his name is Dr. William Fenner. He thoroughly examined Pumpkin and explained that he was quite positive she had suffered a stroke back in July. Here are some of the activities he did that brought him to that conclusion: He brought a hand from behind Pumpkin's head on her left side, and she barely noticed. When he brought his hand from behind on her right side, she flinched dramatically. When he touched the left side of her nose, she didn't react. When he touched the right side of her nose, she jumped away. When he had her jump up on a table, her left leg lagged behind her right. As he watched the videos of her sleeping, he noticed her left eye squeezing shut more dramatically than her right eye as she breathed in that jerky manner. He asked many questions, such as whether her breathing jerkiness got worse when she was more tired/stressed (it increases dramatically on those occasions, especially after visits to vets). I also mentioned that she only lays on her right side now, never on her left side.
I'm sure I've forgotten some of our conversation, but he said we could have an MRI done, but he was 100% sure an MRI would show she had right frontal lobe damage. The very likely explanation is that it was caused by a stroke. The most typical residual effect of a frontal lobe stroke is a personality change, most often a dramatic increase in aggression. Pumpkin's increased aggressiveness is much less than that of most cats who have suffered a stroke, most likely because she had such a sweet disposition before the stroke. She never harmed anything. She was the type to lay down to watch a moth or a butterfly with great interest, but she never approached or harmed anything. The lack of reactivity on the left side of her face is caused by diminished vision and sensitivity due to the stroke in the right side of her brain. A stroke on the right side of the brain causes damage on the left side of the body, and vice versa.
The goose-stepping she does with her back left leg and the way the left leg lags when she jumps are both evidence of the right brain stroke. The jerky breathing and eye squinting when she sleeps are actually seizures that are occurring when she sleeps. That horrified me, but the neurologist doesn't think this is causing her pain, even though it is so disturbing to watch. He asked me many questions and from my answers concluded that her condition is static, which means that she is basically stable. He discussed treating the seizures with a twice a day pill, but thought having to administer the pill twice per day (Pumpkin is terribly hard to give pills to) would stress Pumpkin more than benefit her. He suggested we enter a period of "watchful waiting." Hopefully, she will remain as she is and not decline in any way. Of course, if her seizure activity increases or other symptoms develop, we will have to re-evaluate what to do.
After 10 months of worry, we are so grateful to have had the second and third opinions by brilliant specialists. While we are very sad that Pumpkin suffered the stroke, we are thankful she survived it and still has some quality of life. My main points in writing this were to explain what a stroke in a cat might look like in case you are seeing similar symptoms in your own cat and to encourage people to seek second opinions by highly-esteemed experts. The very knowledgeable eye of an expert can often be more cost-effective than extremely expensive tests in the hands of a less seasoned professional.
I posted a question here about a suspected herniated disc in my 5 year old cat, Pumpkin, about three months ago. After 10 months of seeing a wide variety of doctors and specialists, we finally have a diagnosis: our cat had a stroke last July. I am writing this post in case it is helpful to someone else in a similar situation.
Pumpkin was a stray at my daughter's high school and was about 9 months old and feral when we trapped her. She has always been in good health once we got her weight up to normal and had her dewormed, vaccinated, etc.
On July 4, 2014, Pumpkin was in the back yard with me and was fine one minute and nearly comatose-acting the next minute. She was sitting in a hunched forward position with her head low and her eyes squeezed shut. She didn't even open her eyes when I talked to her. I immediately took her to a large emergency/specialty clinic in our area. The emergency vet did CBC/chemistry, FeLV/FIV test and x-rays. All were normal. However, while the vet and I were discussing Pumpkin, she had two small seizures. The seizures looked like this: her eyes were squeezed shut, she was sitting in the "loaf position" and she trembled significantly for about 20 seconds. The veterinarian gave her subcutaneous fluids and said to watch for trouble urinating, difficulty breathing, or any unusual neurological activity. None of those symptoms followed, but she has never been the same cat since that day. She is a much more lethargic cat, completely lacking the high energy and mischievousness she once had. She has also been far more irritable, both with us and with our other animals (4 other cats and a dog). She seems very fearful of being touched by either us or the other animals. She also no longer jumps to her favorite high spots that she used to love. Her appetite is normal.
I won't bore you with all of the veterinary appointments we have had since that day. I will tell you that, at one point, we had spent a total of $8000 and still did not have a diagnosis. Over the 10 months, she has had a ton of blood work, ultrasounds and x-rays. She was tested for a wide variety of illnesses including toxoplasmosis, FIP titers, pancreatitis, various muscle diseases, and I can't remember what else. At various times over the past 10 months, she has been on pain medications, anti-inflammatories and steroids. The symptoms that have concerned me most have been the way her breathing looks labored whenever she sleeps and the permanent irritability. Whenever she sleeps, she looks like she is in pain. With each breath, she hunches up her shoulders and squeezes her eyes shut. When I originally posted here in February, a surgeon had diagnosed her with a likely ruptured disc and wanted to do back surgery. The surgeon had based the ruptured disc conclusion on Pumpkin's sensitivity when her back was palpated and her sluggish back left leg. She thought these were the effect of a ruptured disc pressing on a nerve.
I am so grateful we pursued a second and third opinion. I found that the two specialists we consulted were different that the other vets we had seen in that they visually observed Pumpkin far more extensively and asked many more questions than all the other vets had. The two doctors from whom we sought second and third opinions did not know of each other's conclusions, yet they came to the exact same conclusion. The second opinion was by a wonderful internist/oncologist named Dr. Cheryl Harris who, after watching Pumpkin walk and conducting several neurological tests with her reflex hammer, was sure that we were looking at a neurological problem. (Dr. Harris diagnosed my dog's bladder cancer years ago after many trips to other vets who were not able to figure out what was going on.) She noticed that Pumpkin was goose-stepping with her back left leg, lifting it higher than needed before placing it down with each step. She explained that Pumpkin would be doing this because she had less sensitivity in that leg, making her less sure of where she was placing it. She also looked at videos I had taken of Pumpkin's breathing when she slept and thought the jerkiness and eye squeezing indicated a neurological problem. Both of these symptoms made her suspect that these were the residual effects of a stroke.
Today, I met with a renowned neurologist. His brilliance is richly deserved. He is a teacher at Ohio State University's Veterinary School, in addition to his neurology consulting work. I had been given his name by 3 different veterinarians. For anyone who might need it, his name is Dr. William Fenner. He thoroughly examined Pumpkin and explained that he was quite positive she had suffered a stroke back in July. Here are some of the activities he did that brought him to that conclusion: He brought a hand from behind Pumpkin's head on her left side, and she barely noticed. When he brought his hand from behind on her right side, she flinched dramatically. When he touched the left side of her nose, she didn't react. When he touched the right side of her nose, she jumped away. When he had her jump up on a table, her left leg lagged behind her right. As he watched the videos of her sleeping, he noticed her left eye squeezing shut more dramatically than her right eye as she breathed in that jerky manner. He asked many questions, such as whether her breathing jerkiness got worse when she was more tired/stressed (it increases dramatically on those occasions, especially after visits to vets). I also mentioned that she only lays on her right side now, never on her left side.
I'm sure I've forgotten some of our conversation, but he said we could have an MRI done, but he was 100% sure an MRI would show she had right frontal lobe damage. The very likely explanation is that it was caused by a stroke. The most typical residual effect of a frontal lobe stroke is a personality change, most often a dramatic increase in aggression. Pumpkin's increased aggressiveness is much less than that of most cats who have suffered a stroke, most likely because she had such a sweet disposition before the stroke. She never harmed anything. She was the type to lay down to watch a moth or a butterfly with great interest, but she never approached or harmed anything. The lack of reactivity on the left side of her face is caused by diminished vision and sensitivity due to the stroke in the right side of her brain. A stroke on the right side of the brain causes damage on the left side of the body, and vice versa.
The goose-stepping she does with her back left leg and the way the left leg lags when she jumps are both evidence of the right brain stroke. The jerky breathing and eye squinting when she sleeps are actually seizures that are occurring when she sleeps. That horrified me, but the neurologist doesn't think this is causing her pain, even though it is so disturbing to watch. He asked me many questions and from my answers concluded that her condition is static, which means that she is basically stable. He discussed treating the seizures with a twice a day pill, but thought having to administer the pill twice per day (Pumpkin is terribly hard to give pills to) would stress Pumpkin more than benefit her. He suggested we enter a period of "watchful waiting." Hopefully, she will remain as she is and not decline in any way. Of course, if her seizure activity increases or other symptoms develop, we will have to re-evaluate what to do.
After 10 months of worry, we are so grateful to have had the second and third opinions by brilliant specialists. While we are very sad that Pumpkin suffered the stroke, we are thankful she survived it and still has some quality of life. My main points in writing this were to explain what a stroke in a cat might look like in case you are seeing similar symptoms in your own cat and to encourage people to seek second opinions by highly-esteemed experts. The very knowledgeable eye of an expert can often be more cost-effective than extremely expensive tests in the hands of a less seasoned professional.
