Need insight: Sprite dx with hydrocephalus
 

Our Sprite, 3.5 years old, started having seizures approx 4 months ago. She had numerous blood tests and after inconclusive results was referred to a neurologist. In the meantime she was placed on Kepra to help control the seizures. On Friday the neurologist performed an MRI which indicated hydrocephalus with COM (caudal occipital malformation) syndrome. Her left ventricle is almost 3x the size of the right. The neurologist has put her on prednisone and omeprazole in addition to kepra, but this will only help short term. She needs a ventriculoperitonneal shunt inserted to save her life. Does anyone have experience with this procedure? We are devastated and need to make a decision very quickly about whether to treat her palliatively or proceed with having the shunt inserted. Our regular vet has no experience with this procedure so can't really guide us in terms of the right decision. Any help would be very appreciated.

I don't but I've read about it and would go forward if this was my dog.

I don't have experience with this condition. But always ask about the risks n benefits of surgery, and also how effective Palliative care might be.

I am so sorry you are going through this. I do hope you have informed your breeder of this vey serious health condition.

I had a hydrocephalus pup but his did not warrant surgery; so I really am not certain what I would do. I usually tend to do whatever is possible for a pup; but I always rely on my vet and specialists to guide me. I think if there was a good chance of a positive outcome for Sprite and she were mine, I would go for it.
If seizures are the only indication of a shunt, it sort of sounds to me like she might do well. I hope that is the case.
Please keep us posted on whatever you decide to do. I will keep little Sprite and you in my thoughts and prayers.

This is a congenital condition she was apparently born with and has gradually worsened until the point where she started having seizures. She was very difficult to housetrain, and from time to time walked with a funny little gait, almost like prancing, but we had no idea these were signs of hydrocephalus. Her vision is fine and her head doesn't appear enlarged, so no obvious external signs. Since we learned she had this disorder we have been able to look back and see some of the signs, but they weren't obvious at the time. She started suddenly having seizures up to 4 times a day, had difficulty with balance, and was very lethargic and not eating well. She has had so many tests trying to find out what was wrong. The surgery has it's own risks as they must insert a shunt (drainage tube) from her brain to her abdomen to drain the fluids and relieve the pressure. If we don't have the surgery we can give her meds for a short while but eventually she will suffer a hemorrhage from the pressure. Because her condition is severe now, it will be fatal without surgery. We will ask the neurologist more questions this week, but at our appointment I was too upset by the news to think of questions about what happens after surgery etc. thank you all for your responses and suggestions.

I meant to add that we will definitely notify her breeder, and that palliative care as far as I understood from the neurologist is giving her lots of love, meds to help reduce pain, inflammation and production of cerebrospinal fluids, which will only be effective for a short while, and then inevitably euthanasia. Very sad.

It doesn't sound like you have many options. I know what you're going through on some level having done two MRIs on dogs and having to rule out these kinda of things for our dogs. I didn't have the bad news you have had. But you've come this far, and if the procedure would give a quality of life that she can't have without it, then to worth trying it if you can handle it emotionally and financially IF the neurologist thinks it's worth it. I think it would be ok to decide not to do it too. It's hard, I know I would go for it. I was ready to do brain surgery in my 13 year old of needed but it wasn't.

Yes, we really only have 2 options, surgery or euthanasia. We are still waiting for some test results to determine whether she can even go ahead with the surgery but should have those results by Tuesday. Cost is definitely an issue that needs to be considered. We have an idea for the surgery cost, but don't know about ongoing care expenses afterwards. As you can imagine we haven't slept well the last couple of days trying to figure all this out.

Hopefully there won't be that many costs after the surgery. Speak with the neurologist about that.

I will pray for your baby. I hope you can swing the surgery...she is young and may do really well after it is repaired.

The little one I had was also congenital...he had many other neuro issues but he did really well until he had to be euth for a different condition. He was estimated to be around 12 so he had a full life.

I'm so sorry to hear of Sprite's condition. I'm saying prayers for her and also for you and your husband. Hopefully, the neurologist can give you more solid information this week that will make your decisions a little easier for you.

I am so very sorry for your little Sprite. I will pray for her well being and to give you and your husband the strength and guidance to to deal with this horrific decision you are faced with.(((hugs))))

Thank you all for your support. It is really helping me get through this difficult time. We are looking forward to speaking with the neurologist again because we don't have enough information yet to make a fully informed decision. Our regular vet has a large practice with 3 vets on staff and none of them have ever come across a dog that has had the shunt installed, so that tells me that either this procedure is rarely done or hydrocephalus is very rare, or both. He was very concerned about what the ongoing expenses would be post surgery and also her quality of life. Hopefully we can get those questions answered tomorrow. We are still waiting for test results to make sure there is no infection in the cerebrospinal fluid and that her liver is functioning properly. She's doing a lot of head pressing now, so she must be having a whopper of a headache in spite of the pain meds. I will post an update after I speak to the neurologist.

Here is a link to one of Sammy's threads. You will see all of the neurological issues he had that he did fairly well with. The thing that got him in the end was a perineal hernia because his bladder kept getting trapped in it and multiple repairs did not help. The neurologists see more of the neuro things than regular vets do....yes, they are rare, but not so rare that they don't know how to treat them! It just is something a regular vet does not see and have the experience handling. I am certain you will get better information from the neurologist regarding after care. I think there are videos of Sammy in that thread somewhere...I will look for them later. If not, I think I have them on You Tube and will post for you to see. The neurologists assured me he was not in pain!

http://www.yorkietalk.com/forums/sic...ro-issues.html

Maybe the thread will give you some hope that after surgery Sprite could do well .. that is IF the neurologist feels that the seizures can be minimized by the surgery. Sammy was a trooper in spite of all of his neuro issues. He was such a joy! :)

Thinking of you and praying for Sprite...

Actually, I don't think it is rarely done in the large specialty hospitals. I know it is done at Angell and I found this photo borrowed from TX A&M on their website. Neurology Service. I also found this story of a puppy there who had it done Blind Puppy Suffering from Congenital Brain Disease Abandoned at Supermarket

I can tell from your posts that you and your husband love Sprite and want to truly do the best for him and my heart is breaking for you to be facing such a huge decision regarding his care. It's great that you are trying to gather as much information possible from both YT members and through your vet as well as a neurologist. I have no personal experience with hydrocephalus and cannot offer you anything more than my comfort for what you are faced with in making a proper choice. If the neurologist feels after your consult that Sprite can recover and live a fulfilled life then I say go for it. If you decide that the outcome will not truly benefit him with surgery there is nothing wrong with making a decision to offer comfort until the end. Please keep us posted on what the neurologist consult offer you in answers to his treatment.

Thank you ladyjane and 107barney for the links. Little Sammy was such a precious angel with so many challenges but he was a fighter. I think the human description for COM Syndrome is Chiari Type 1, which it seems Sammy had also. I loved the video's. Little Sprite walks off balance like that just before and after her seizures. Normally she is quite coordinated, but sometimes she walks with the strangest little gait, like she is competing in a dressage competition. She lifts her little front legs high up one at a time like prancing. It was uplifting to read about the little chihuahua. Our neurologist seemed very confident about doing the surgery, but yes, this is a very specialized clinic that sees complex cases so it makes sense that regular clinics probably wouldn't come across this often. We have to imagine what life will be like for Sprite because we don't know anyone else whose pet has had this procedure. He also told us there are risks involved, mainly infection and blockage developing in the shunt, and of course the surgery itself. I'm feeling more optimistic today about Sprite's chances.

I'm so glad you're feeling a little better. I feel confident that you'll do what you believe is in her best interests - be it surgery or letting her go - and there is no right answer except the one you make!

I feel like I should add to this. That chihuahua didn't ultimately make it but I didn't know that when I posted the original story. He had a second shunt repair and then was adopted. He passed a few months later from a seizure. I am so sorry I didn't see this earlier and I don't want you to think he was some great success now that I found that. Every case is different and maybe there are success stories. I would ask your neurologist how many of these he has done and how the life was after and for how long. I spend a lot of my dogs, but I'm not sure I would do this surgery if they couldn't give me a good prognosis. I just don't know. I feel horrible for you having to make this decision and want to cry.

Try not to focus on one failure. It happens in everything. I am sure there are some amazing success stories with these surgeries. Hopefully the neuro can share the good and bad with you and give you some information that will make this decision easire. I too am so sad that you are faced with such a difficult decision. Always remember, that there is no right or wrong whichever way you go.

Yes, Sammy was indeed precious. It broke my heart when I had to let him go. I loved to watch him walk and play...oh how he loved his toys! I have such wonderful memories of him.

Would love to see pics of Sprite! :)

I just had a thought about a few questions to ask the neurologist.

What damage has already been done to the brain when you take into consideration that the left ventricle is 3Xs the size of the right.

What is the long term prognosis and the possibility of needing to repeat the shunt surgery. If the shunt is placed will follow up surgeries need to be done to ensure that the shunt working properly and if so how often will they need to be done.

Thank you all for the support and the great suggestions about what to ask the neurologist. Her blood work results should be back today so hopefully we can have an opportunity to get some answers over the phone. Our follow-up appt is next week. I spent yesterday grooming Sprite and giving her a puppy cut...much needed as she had all these little shaved patches all over from all her tests. She looks so adorable. I'll try to post a couple of pics of Sprite later and will update after with any new info. I was saddened to read the update about the little chihuahua. That is exactly our concern about doing this procedure. Are we just prolonging the inevitable?

I like the commercial for the Cancer Center that says we don't have an expiration date stamped on our foot. I feel the same way about our pups. The inevitable is that we will outlive them (hopefully) and I try not to think of end results unless the odds are heavily stacked against. BUT...even with that sometimes there are amazing results in modern veterinary medicine. I have had pups die in ways I never expected. Sometimes the devil we know is better than the devil we don't.

Update: I spoke to the neurologist this evening and Sprite's liver and cerebrospinal fluid tests are both normal, so she is a good candidate for the shunt. He explained that 75% of dogs who have the shunt procedure live normal lifespans and follow up is minimal. Having the shunt should eliminate the seizures and prevent brain damage, which we don't see any major signs of with Sprite at this point. We would just need to be observant for any negative changes, reoccurrence of seizures etc but she wouldn't need MRI's or other expensive tests. There is a 25% risk of problems after having the procedure however, and the vast majority occur within the first two months, so that is the danger period. The most common problems are death during the surgery, bleeding in the brain, infection and blockages in the shunt. So it's not all clear sailing in the beginning. She would be hospitalized two to three nights after the surgery. If we decide to have the procedure (which I think we will) then we will meet with the neurologist and he will go over all the risks/benefits in detail. We need to let him know within a couple of days. The palliative option would be to continue with her meds and monitor her carefully. When the seizures become more frequent/harmful then we deal with euthanasia. We don't know the timeline for her but it is limited. We want to give her a chance for a long life but I won' lie, that 25% risk is greater than I would like, but the other choice isn't good either. Thanks again for all the support!

Keeping Sprite and you in my thoughts and prayers...

It sounds like you had a great discussion with the Neurologist and need to weight out all you options for Sprite. Whatever your final decision is regarding her care you can know it was made with nothing short of love. In my book that's what really counts! I will keep you all in my thoughts and prayers.

Sending out prayers for your sweet Sprite and support to you and your husband.
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:hands: SPRITE :hands:
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I'm so glad the neurologist was able to give you some data about the procedure. We are definitely supporting you and Sprite!

I have nothing to add other than sending good thoughts your and Sprite's way.