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Figure 1: Bone window - red arrow points to a depressed skull fracture in the right frontal bone with multiple fragments within the brain.
Figure 2: Soft tissue window - red arrow indicates hyperintense tissue/fluid fills cranial cavity created by depressed skull fracture and causes compression of the brain. Hyperintense fluid (blood) lies around the bone fragment.
Case Presentation
A case came to the Pet ER. He was a rescue with no history and no owner. The rescue and veterinary partner had been taking care of him for the past week. His initial physical exam showed a dull and disinterested adult male dog that tended to circle to the right. No external wounds were noted and his blood work showed mature neutrophilia.
Over the course of 5 days, he progressed to stupor. On the morning of presentation, he had a generalized seizure.
Exam showed a very dull, stuporous dog. His Modified Glasgow Coma Score (MGCS) was 12/18. A CT was performed.
The importance of imaging:
Depressed skull fractures in dogs, as seen in this case, can cause deteriorating neurological signs such as dullness progressing to stupor and intermittent seizures. Imaging, such as CT scans, can reveal the extent of the fracture and associated hemorrhage, which in this case caused compression of the brain parenchyma.
CT imaging in dogs with an abnormal Modified Glasgow Coma Score is crucial for identifying the underlying cause of neurological deterioration. As seen in the case of the male schnauzer, CT can reveal critical details like skull fractures and associated hemorrhage causing brain compression, which may not be evident from external examination alone. This information is vital for guiding appropriate treatment and management decisions.
Treatment for pets with depressed skull fractures and progressive neurological decline
Surgical Intervention: For depressed skull fractures causing brain compression, surgical elevation of the bone fragments and removal of hemorrhage is likely necessary to alleviate pressure on the brain.
Supportive Care: Given the dog's neurological symptoms (stupor, seizures), supportive care such as IV fluids, pain management, and anti-seizure medications would be essential components of treatment.
Monitoring: Close monitoring of the dog's neurological status using tools like the Modified Glasgow Coma Score would be crucial to assess response to treatment and guide further interventions.
Modified Glasgow Coma Score ( MGCS)
A MGCS should be performed on a dog or cat when there are signs of neurological abnormalities, such as changes in mentation, behavior, or physical coordination. This would help in assessing the severity of the neurological condition and guiding further diagnostic and treatment decisions.