image of Seizures
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A seizure is caused by abnormal electrical activity in the forebrain and is characterized by a sudden episode of transient neurological signs. A seizure is not a disease entity in itself but is a clinical sign generally indicative of a forebrain disorder. This chapter considers clinical approach, differential diagnoses, diagnostic approach and management. : Emergency management of the seizuring cat.

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4.7.2 This 1-year-old female neutered DSH cat was presented for investigations for seizures and tremors. She had also experienced episodes of reduced mentation, alternating with episodes of aggression, and periods of being apparently normal. Extreme hypersalivation also occurred frequently, as can be seen in this photo. Portosystemic shunt (PSS) is an important differential diagnosis for seizures in a young cat, and is particularly likely when other consistent clinical signs are present (e.g. hypersalivation, periods of aggression), as in this case. Diagnosis was confirmed by demonstrating elevated postprandial bile acids and identification of the PSS on ultrasound scanning. Management options are medical management (low-protein diet, lactulose and antibiotics, together with anti-epileptic treatment if required) or surgical management. A portovenogram demonstrating a single portocaval shunt. Portovenogram following complete ligation of the shunting vessel.
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4.7.3 Transverse T1-weighted contrast-enhanced MR image of an 11-year-old cat with a large left-sided meningioma causing seizures and left forebrain signs (obtundation, compulsive circling to the left, right‑sided postural reaction deficit and right‑sided menace response deficit with normal pupillary light reflex). The owner reported that the cat had been ‘slowing down’ over the last 6 months and had started to circle to the left one week prior to presentation. Surgical treatment of meningioma in cats can carry a very good prognosis. Surgery (rostrotentorial craniectomy) was carried out successfully on this cat and resulted in resolution of the neurological signs and cessation of seizures. The cat was reported still to be ‘free’ of neurological signs 2 years later.
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4.7.4 Transverse T2-weighted MR images of a normal cat; and a 3-year-old DSH cat presented because of acute onset of behavioural changes and severe cluster of complex partial seizures that had started 24 hours before referral (complex partial seizures with orofacial involvement). There is marked bilateral hyperintensity (arrowed) within the hippocampus, suggestive of feline hippocampal necrosis (limbic encephalitis). The cat was treated symptomatically with anti-epileptic medications (oral phenobarbital initially as sole therapy, then oral levetiracetam added). Unfortunately the cat was euthanased 3 months later due to persistent behavioural changes and poor seizure control.
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4.7.5 Sagittal and transverse T1-weighted contrastenhanced MR images of a cat with a right-sided brain abscess (black arrow) secondary to a bite wound; the cat was presented with seizures and right forebrain signs (severe obtundation, circling to the right, left-sided postural reaction deficits and left‑sided menace response deficit with normal pupillary light reflex). Note the calvarial defect (black arrowheads) and contrast enhancement of the right temporalis muscle (white arrows) at the site of the bite. The abscess was drained surgically via craniectomy followed by a 2-week course of oral antibiotic. The cat regained normal neurological examination within 2 days of surgery and remained normal after that.
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