Stroke?

Hi,
Does anyone know if it's possible for a cat to have a stroke or clot and recover within a matter of minutes? My 6 year old cat had a temporary "funny turn" 2 days ago where she was unable to walk properly. My initial thought was that she had been hit by a car, but logic of no pain quickly told me otherwise. Plus, she had just come downstairs from being on my bed. She was walking oddly, like the problem was coming from her rear right side. She then appeared drunk, lay down briefly, then got up and walked some more, the same staggery drunk, then Kay down again and looked very odd. My next thought was that she may have been poisoned, so I dived for the phone and cat basket and within an hour and a half had her at the vets where she presented perfectly normally. Aged 5 on a routine inoculation visit, her regular vet commented that she had a heart murmur. The vet 2 days ago confirmed this and stated it was a grade 2-3. I have since researched the Internet and am so very concerned that she may have had a mini stroke. The vet said he could do a blood test and depending on results a heart scan, or I could just monitor her and see if there are any more occurrences. I don't know what to do for the best. I am so scared it will happen again and be more serious and do don't want to ignore it. Equally I don't want to put her through unnecessary stress. Please does anyone have any experiences? I don't know for fact it was a stroke, just going by things I have read on the Internet and YouTube videos of cats seemingly walking in the same way she did. Please help. I am so worried [emoji]128554[/emoji] thanks, lisa

hi and welcome to TCS!

i'm so sorry your girl has had these symptoms. may i ask her name?

i don't have experience with strokes or clots in cats, but i do have experience with a cat having a heart murmur -- more specifically, my mickey was diagnosed with arrhythmia.

i was given similar options, testing with a specialist, or just to monitor my boy and see if there were any further episodes/symptoms.

i would suggest discussing with your vet, your concerns re a stroke or a clot. also, you might ask the costs of and what exactly is involved with the heart scan -- like if your girl would need to be sedated or under anesthesia, how long it would take, and any risks to having it done. after you have those facts, i'd then consider them along with how you feel your girl would do with the testing --  to make a decision as to whether you want to go forward with further testing. and, you may even decide not to test at this time, but leave the option 'open' -- have it there should you/your vet decide to sometime in the future.

in my mickey's case, as a kitten, when he was being anesthetized for his neuter procedure, mickey had turned blue and had been revived. i was told that many/most times kittens will 'grow out of' or a heart murmur will disappear, but this didn't happen with my mickey.  about 7 or 8 years later, and mickey had had no episodes, a different vet recommended that my boy should be tested by a specialist. i considered it, (just as you) weighing the stress my boy might very well experience, and decided against further testing at that time. fast forward another few years, and our regular vet was able to do the testing she recommended right there in the exam room and send it off to the specialist to 'interpret' via the phone line -- not exactly sure how that worked, but much better than going to a specialist (and less costly than a specialist appointment). since my mickey had had only one episode as an adult (very scary for me, but was a pretty mild episode) several years prior to the discussion with our vet, the vet and i left it open -- we could do the further testing when/if needed.  my boy never had another episode, but our vet did recommend that mickey should never be anesthetized -- only if it were a 'life or death' kind of situation.

i have a lot of confidence in my vet, trust her totally. quite a few times, when i'm considering a treatment or procedure for one of my cats, i've asked her what she would do if this was her cat. she's always given me her opinion as well as her reasons why. i've found this helpful in making my decisions.

i would caution that many illnesses, diseases, and medical conditions share some of the same symptoms. so when we look symptoms up on the internet, we many times read about serious medical issues that have those symptoms. i think it's certainly worth bringing up and discussing with our vet, but the vet is going to have the training and expertise to be able to diagnose.

Hi....Thankyou so very much for taking the time to reply and to share your experiences with your Mickey. I really appreciate it and it helps to feel I am not alone. It has been a very stressful couple of days. I spoke with the vet this morning and decided to have the blood test done, so took Kitty in this afternoon. Bless her, the vet said she was good as gold. Apparently the test will show markers which will highlight if her murmur is causing any problems with the heart. They use it as a "screening test" to determine whether a heart scan would be advisable. The results should be here Wednesday or Thursday. I felt what I witnessed on Saturday was potentially too serious not to investigate it further. I am keeping everything crossed that the results will be normal, so that I can just monitor her and hope that nothing like that ever occurs again. If the results highlight a problem with her heart, I will have to weigh up and consider all options from then. Like you say, with Mickey, it was very scary. I absolutely adore Kitty. we are so close and share a very special bond. I just don't know how I would cope without her. Thankyou again for your very kind message, Lisa x

Another possibility could be something like vestibular disease or an inner or middle ear problem. Has she had ear mites? Any recent medications?

I understand that he has had some issues and concerns with his heart and that could certainly be part of the problem or none of the problem. Vestibular disease can come on very suddenly and present in a way similar to what you describe. Hopefully your vet has this on the list of "possibles". 

You are doing right to have the heart investigated, but the ears or vestibular system (balance mechanism) could be at work as well. It's worth looking into if everything checks out okay on the heart.

I am not yet able to post links (I don't think-- I couldn't earlier because of my permission level), but I invite you to Google search on 'cat vestibular disease'.

Here is a tidbit from VCA, since I can't yet post the link-- for informational purposes:

 Feline vestibular  disease is a condition in which a cat suddenly develops incoordination, falling or circling to one side, involuntary darting of the eyes back and forth (nystagmus), a head tilt, and often nausea or vomiting. These clinical signs usually appear suddenly, many times in less than an hour.

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What causes it?

We do not fully understand why feline vestibular disease occurs in many cases. Conditions such as middle- and inner-ear infections are common causes of the disease. Tumors are a less common cause but must be considered, especially in older cats. Exposure to certain toxins or drugs can also cause symptoms that mimic feline vestibular disease. The vast majority of cases are diagnosed as idiopathic, meaning the exact cause isn’t known.

 The cause of feline vestibular disease is not fully understood.

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Siamese and Burmese breeds have been associated with an inherited or congenital form of the disease. Many affected cats are also deaf.

How is feline vestibular disease diagnosed?

There are no specific tests for feline vestibular disease. Most cases are diagnosed based on clinical signs. Tests such as magnetic resonance imaging (MRI), skull x-rays, blood and urine tests, spinal fluid analysis, and ear cultures and cytology are typically performed to rule out a more serious cause. Your veterinarian will determine which tests are appropriate for your cat based on medical history, clinical signs, and physical examination findings.

How is the condition treated?

Because the exact cause is often unknown, there is no specific medical or surgical treatment. In cases of middle- or inner-ear infection, appropriate antibiotics or anti-fungal medications will be used. In idiopathic vestibular disease, treatments aimed at reducing motion sickness, nausea, and vomiting are used. Many cats will require assistance eating and drinking during the initial stages of the condition.

How long will it last?

Idiopathic vestibular disease is a short-term, self-resolving condition. It does not continue for months. (Older affected dogs can have a residual, often permanent, head tilt, but this rarely occurs in cats.) Usually, the uncontrollable eye movement disappears within days.

Is it contagious to my other cats?

There is no evidence that idiopathic feline vestibular disease can be transmitted between cats or other animals, including humans.

This client information sheet is based on material written by: Ernest Ward, DVM

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Hi, Thankyou very much also for your reply. The vet didn't mention vestibular disease, but I did read about it during my research after Kitty's episode on Saturday and did consider it as a possibility. But from what I read about vestibular disease, it sounded like it would last longer. Kitty's episode lasted no more than a few minutes and she has appeared perfectly normal since. I think this baffled the vet somewhat. I suppose knowing she has a heart murmur, I thought it more likely this may be the cause. I also read that cats with heart murmurs sometimes have enlarged left atriums which are prone to "throwing clots", which scared me a great deal [emoji]128554[/emoji]. Do you know if vestibular disease could affect her for such a short time period? Or would it always last longer? Many thanks,Lisa

I'm sure that WAS really scary! 

At 5, with a murmur still present, it's not likely that your girl will simply "grow out of it". That's suspicious for some structural issue, cardiomyopathy, etc.

The blood test is a starting point, and it's probably a good idea to run that as a screen, but a bit of imaging might not be a bad idea, either. When was the last sonogram (ultrasound) of that heart, and has she ever had an echocardiogram? That's the "best" way to diagnose HCM or other structural abnormalities, and it's non-invasive and not painful. The blood test with imaging will provide a lot of information.

If you aren't sure what an echocardiogram is, it's like an EKG combined with a real-time ultrasound view of the heart. The vet can see the heart in action on the ultrasound screen while observing the electrical activity on the EKG. He can take measurements as needed. They are no more invasive than either an EKG (patches and leads) or sonogram (sono probe, slippery jelly, having to lie still) but it's not painful at all and doesn't take long if the kitty is cooperative. My good old 14 year old had one last spring. She was very cooperative and it was done in about 15 minutes. Our whole visit took about 45 minutes because the diagnostic center was busy. Her heart was fine and she's still going (though she has what looked like a seizure today, wouldn't ya know it? Went to the vet, she's fine now, perfectly okay there... maybe I was seeing things but she's under observation at home now). If this hasn't been done, it is a very good idea. Get a referral to a cardiologist or diagnostic center in your area if your vet isn't comfortable doing this test.

As for vestibular disease...

How long will it last?

Idiopathic vestibular disease is a short-term, self-resolving condition. It does not continue for months. (Older affected dogs can have a residual, often permanent, head tilt, but this rarely occurs in cats.) Usually, the uncontrollable eye movement disappears within days.

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I don't know if vestibular disease causes brief episodes of "moments", but according to an article from Winn Feline Foundation-- most cases of idiopathic vestibular disease often begin to improve with supportive care in ~72 hours, and any eye movement (nystagmus) that's present along with it usually resolves shortly...

 Treatment of vestibular disease is dependent on the type present, peripheral or central, and determination of the underlying cause. Most cases begin to improve with supportive care within 72 hours and return to normal in one to three weeks. During treatment, many cats have difficulty eating and drinking due to a lack of coordination and associated nausea. Hand feeding and the nearby placement of the food, water, and litter boxes may be required. Drugs such as meclizine can be given for nausea. Antibiotics (topical and/or systemic), glucocorticoids, and miticide therapies may be used for otitis cases depending on the underlying cause. Infection, polyps, or cancer may require surgical exploration of the tympanic bulla.

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A common form of peripheral vestibular disease is otitis media or interna (middle or inner ear). Bacterial infections can result from an extension of disease in the external ear or the upper air passages by way of the auditory tube. Nasopharyngeal polyps and cancerous growths can be found in these same areas. Ear cleaning can lead to vestibular signs due to over-stimulation or inflammation of the eardrum and deeper ear structures. The use of certain drugs, such as aminoglycoside antibiotics, and the overdose of other medications such as metronidazole can be toxic to inner ear tissue. Deafness could be the end result in some cats.

 Idiopathic peripheral vestibular disease is also commonly seen in cats. The problem can arise acutely in any age, breed, or sex. One study indicated this form might occur more frequently in July or August. There is no known cause though involvement of a possible environmental source (migration of Cuterebra larva) is speculated, or a prior viral upper respiratory infection. As cats recover over the following few weeks, they may be left with a residual head tilt.

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Diagnosis of vestibular disease requires a good history and physical examination. A preliminary diagnosis between peripheral and central disease is important to guide testing methods. Examination of both ear canals and tympanic membranes along with a neurologic evaluation should be done. Baseline lab work includes a complete blood count, chemistry profile, and urinalysis. Baseline testing would also include testing for feline leukemia virus, feline immunodeficiency virus, and titers for feline coronavirus, Toxoplasma, and Cryptococcus. Evaluation for increasing IgG titers and presence of an IgM titer would signify an active toxoplasmosis infection.

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I hope this helps, and best to your fur baby.

~Mackie

Hi again,
Kitty has never had her heart investigated as it was only last year during her routine inoculation that the vet said "did you know she has a heart murmur". I was surprised as she was then 5, had been spayed when younger and had yearly vet visits for inoculations and one visit with a flea allergy, and no mention of it by any vet. the vet said sometimes they can "just develop", that it shouldn't cause a problem, but just to be aware. She didn't suggest any blood tests or heart tests and didn't seem concerned. Neither was I at the time. My mum has a heart murmur, as do many people I understand, will no ill effects.
Kitty, as far as I have been aware has always been healthy and very active. This is why I was totally freaked out by her episode the other day. I wish a vet could tell me for sure what it was. I am now neurotically looking out of the window every 5 minutes anxiously thinking " am I going to see her staggering again", and I worry when I go to work as there is nobody else at home to keep an eye on her for the 9 hours I am away. If it was a mild stroke or clot, I am fearful of a bigger one occurring. I have hardly slept as I am so upset and worried. I just love her to pieces. she is only young still and it seems so unfair for her. Sorry for the meltdown [emoji]128554[/emoji]

Hi Bubbins-- yeah, it might be a good idea to have that checked further. I get a fuzzy picture when a "doctor' (of any kind) says that "these things just develop sometmes". I think that's rather lazy medicine to not at least suggest further follow-up on something that is affecting a major body organ like the heart. I think it's important enough to at least check it out to rule in or rule out a serious problem... especially with a disturbing episode like your little one experienced recently. Even IF some abnormality is found, many times these things can be managed and the kitty can have a pretty normal life for quite a while with the right support and medication.

Those follow-ups might help give you the answer you're looking for, or reassure you that "at least it isn't that". And it may very well be a benign murmur. Lots of cats and people do have them. But the only real way to know that it's not some other kind of murmur is to follow up and look more closely.

Hope that helps...

~Mackie

Thankyou Mackie,
I am trying not to think too negatively, but it's been a really tough few days. It's all just such a shock. Although she appears absolutely fine, I know that you don't just have an episode like that for no reason, and so, of course, I fear something sinister.
I dug out some old Feliway....more for my benefit than hers! Although I don't know that it works on humans! Maybe the placebo effect? [emoji]128563[/emoji]