Loss of house-training

11 Loss of house-training




INITIAL PRESENTATION


Behaviour change: loss of house-training.



INTRODUCTION


Occasional urinating or defecating in the house by the pet is often excused by the owner as ‘having accidents’. If it breaks the life-long pattern of behaviour, it is abnormal. Loss of house-training is a common early sign of cerebral dysfunction. Medical causes such as reservoir (bladder or rectum) or sphincter incompetence and anxiety disorders should be ruled out.



SIGNALMENT


An 11-year-old male domestic shorthaired cat.



CASE PRESENTING SIGNS


Loss of house-training.



CASE HISTORY


The cat had been urinating and defecating in the house in different places for three months. Episodic periods of unresponsiveness, sitting quietly and staring into space, had occurred during the same period. No abnormalities were found on blood work. Thyroid function was normal. Blood pressure was normal.



CLINICAL EXAMINATION


The cat dashed out of the carrier and then sat, immobile, outwardly unresponsive to the environment. When coaxed, the cat walked normally but tended to circle to the right. Left-sided placing responses and hopping were slow. The menace response was absent in both eyes. PLR were normal. Pupil size was normal and so was fundic examination.



NEUROANATOMICAL DIAGNOSIS


Right cerebrum indicated by the behaviour change, obtunded state, circling to the right, left-sided postural deficits. The bilateral loss of the menace response could be ascribed to the dull mental state of the cat.



DIFFERENTIAL DIAGNOSIS



• Meningioma

• Other cerebral neoplasia.

The long time course and presentation as a behaviour change is quite typical of a slowly expanding intracranial lesion in a cat.



Urine found in house


Loss of consciousness with urination occurs more commonly with seizures than syncope. It also depends on bladder fullness at the time of the event. Finding puddles (or floods) of urine in the house caused by an otherwise house-trained dog may be the first sign of seizure activity noted by the owner. Loss of house-training with an apparently random pattern of urination is a common behaviour change induced by cerebral disease.



CLINICAL TIP


Rather than ask if the pet is house-trained (the answer will be yes), ask if the pet has urinated in the house recently.


Weakness or pain may prevent the animal from going outside or to a litter tray to urinate. Cats may only be able to negotiate the cat flap in one direction.


Polydipsia/polyuria can result in the house-trained animal being unable to hold a large volume of urine for the usual length of time.



CASE WORK-UP


MRI: a large contrast-enhancing broad-based peripherally-attached mass on the right (Fig. 11.1).


image

Figure 11.1 Right-sided meningioma.



DIAGNOSIS


Surgical removal of the mass confirmed the diagnosis of meningioma and resulted in a dramatic improvement in the cat’s mental state which returned to normal. No seizures were noted postoperatively. The cat remains normal several years after the surgery (Fig. 11.2).


image

Figure 11.2 Note the shift of the falx cerebri to the left, and the compression of the lateral ventricles. The capsule on the right is used a marker.



Brain tumours



What is wrong with my pet?


The presenting signs depend on the location of the lesion and the speed of onset. Gradually increasing intracranial pressure is accommodated by the collapse of the ventricles and compression of the blood vessels. This phase of expansion may be overlooked as signs can be vague: lethargy, depression. Owners ascribe them to the advancing age of their pet.



CLINICAL TIP


Old age is not a disease.


A sudden onset of signs is usually a result of secondary change such as oedema, haemorrhage, compression of the brainstem, or blockage of the ventricular system.


The presentation ranges from seizures to behaviour change to collapse, as most brain tumours occur in the cerebrum (telencephalon). Cats usually present with a behavioural change and altered alertness, whereas dogs most commonly present with seizures.


The inter-ictal phase may be normal. Questioning may reveal a loss of house-training or a subtle change in personality. Frontal lobe tumours often present as seizures with a normal inter-ictal phase: months can pass before an altered personality develops.


Intracranial neoplasia may present as neck pain. The associated lethargy/depression can be mistaken for that caused by severe pain.


The overall incidence of brain tumours in the canine population is quoted as 0.01% to 3%. To put that in context, the overall incidence of seizures, from any cause, in the dog population is about 3%. Every general practice sees a few new seizure cases a year, so it stands to reason each veterinary practice would also be seeing similar numbers of dogs with brain tumours. (The comparison of seizures to tumours is not to imply that the latter causes the former. It was made to give a sense of proportion to a clinical occurrence.) To re-use a bankrupt expression, brain tumours are ‘not uncommon’.

Related posts:

  1. Metabolic encephalopathy: hepatic encephalopathy
  2. Meningioma
  3. Behaviour change – an introduction
  4. Idiopathic facial paralysis

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Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Loss of house-training

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