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  Discussion on Stroke, brain hemorrhage
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Member:
tite

Posted on Thursday, Feb 22, 2007 - 9:03 am:

I'm not quite sure if this is the right section for the case I would like to share, and to obtain, if possible, further information about.
Anyway, here goes:
Yesterday morning, our 17 year old French mare Toto - a former show-jumper - who was, at least apparently, in perfect health the night before, was found literally "falling about" in her box. Her forelimbs were swollen, and she could not seem to coordinate her movements, to the point that she would actually bump against the walls, and fall to the ground, having great trouble in getting up again. Urgently summoned, our assistant veterinary surgeon examined the mare thoroughly, having diagnosed a stroke, probably caused by brain hemorrhage. Although the prognostic was poor, he put her on DMSO, one other non-corticosteroïd anti-inflamatory, and a mild diuretic. For a while, after the first treatment, she seemed to be responding positively, as the swelling subsided, and she stopped stumbling around, although there was a persistent general tremor, and her head was kept low, with a slight tilt towards the left. A couple of hours later, however, the whole situation worsened again, and the stumbling, falling, and bumping against the walls was so bad - much worse, in fact, than it had been in the morning, before the treatment - that the vet returned and discussed the option of putting the mare down with us, which we finally accepted. So, my wish to know more about our mare's diagnosed condition now, may seem somewhat futile... but I would still very much appreciate any further information on this subject, nonetheless.
Thank you very much in advance for your comments.
Alexandra
Member:
tuckern

Posted on Thursday, Feb 22, 2007 - 12:05 pm:

Alexandra, my condolences to you on your loss. It sounds like to made the right, albeit hard, decision in letting your mare go. She is no longer in pain, and is running across the Rainbow Bridge with her head and tail hung high!

Although I've had no direct experience with a stroke in horses, I do know of a friend who's horse had a stroke. He presented with the same symptoms as your mare, he was touch and go for a week, and it has taken him 2 years to recover. He's also not really the same horse either.

Sorry I do't have any more information, I'm sure DrO will.

Nicole
Member:
canyon28

Posted on Thursday, Feb 22, 2007 - 2:14 pm:

I lost my 13 year old cutting mare to either a brain hemmorage or a heart attack in 2005. I was riding her at the time. It was quick and it was awful, but I am glad she died almost instantly. She did fall on my left leg, which took a long time to heal. She staggered two steps to the left and DrOpped like a rock. I had no time to try to jump off. Luckily she did get up off of me and staggered about 50 feet away and collapsed again, struggled for just a few seconds to get up again, and then died. I sure miss her, she was a wonderful all around riding horse as well as a finished cutting horse and a great friend. I also lost my stallion, Bill The Cutter in 2006 to most likely a heart attack or stroke in his sleep. He laid down to sleep for a while and never woke up, and there was absolutely no signs of any struggle in his bedding. He was 31 years old. www.canyonrimranch.net
Moderator:
DrO

Posted on Friday, Feb 23, 2007 - 6:34 am:

My condolences Alexandria. We do not diagnose stroke commonly in the horses so have little information on it. This information comes from Wikipedia, edited a bit to keep it applicable to horses:

What is a Stroke
A stroke, also known as cerebrovascular accident (CVA), is an acute neurological injury in which the blood supply to a part of the brain is interrupted. That is, a stroke involves the sudden loss of neuronal function due to disturbance in cerebral perfusion. This disturbance in perfusion is commonly arterial, but can be venous.

The part of the brain with disturbed perfusion no longer receives adequate oxygen. This initiates the ischemic cascade which causes brain cells to die or be seriously damaged, impairing local brain function. Stroke is a medical emergency and can cause permanent neurologic damage or even death if not promptly diagnosed and treated. It is the third leading cause of death and the leading cause of adult disability in the United States and industrialized European nations.

Types of stroke
Strokes can be classified into two major categories: ischemic and hemorrhagic. Ischemia can be due to thrombosis, embolism, or systemic hypoperfusion. Hemorrhage can be due to intracerebral hemorrhage or subarachnoid hemorrhage. ~80% of strokes are due to ischemia.

Ischemic Stroke
In an ischemic stroke, which is the cause of approximately 80% of strokes, a blood vessel becomes occluded and the blood supply to part of the brain is totally or partially blocked. Ischemic stroke is commonly divided into thrombotic stroke, embolic stroke, systemic hypoperfusion (Watershed or Border Zone stroke), or venous thrombosis.

Thrombotic stroke
In thrombotic stroke, a thrombus-forming process develops in the affected artery. The thrombus — a built up clot — gradually narrows the lumen of the artery and impedes blood flow to distal tissue. These clots usually form around atherosclerotic plaques. Since blockage of the artery is gradual, onset of symptomatic thrombotic strokes is slower. A thrombus itself (even if non-occluding) can lead to an embolic stroke (see below) if the thrombus breaks off—at which point it is then called an "embolus."

Embolic stroke
Embolic stroke refers to the blockage of arterial access to a part of the brain by an embolus -- a traveling particle or debris in the arterial bloodstream originating from elsewhere. An embolus is most frequently a blood clot, but it can also be a plaque broken off from an atherosclerotic blood vessel or a number of other substances including fat (e.g., from bone marrow in a broken bone), air, and even cancerous cells. Another cause is bacterial emboli released in infectious endocarditis.

Systemic hypoperfusion (Watershed stroke)
Systemic hypoperfusion is the reduction of blood flow to all parts of the body. It is most commonly due to cardiac pump failure from cardiac arrest or arrhythmias, or from reduced cardiac output as a result of myocardial infarction, pulmonary embolism, pericardial effusion, or bleeding. Hypoxemia (low blood oxygen content) may precipitate the hypoperfusion. Because the reduction in blood flow is global, all parts of the brain may be affected, especially "watershed" areas --- border zone regions supplied by the major cerebral arteries. Blood flow to these areas does not necessarily stop, but instead it may lessen to the point where brain damage can occur.

Hemorrhagic stroke
A hemorrhagic stroke, or cerebral hemorrhage, is a form of stroke that occurs when a blood vessel in the brain ruptures or bleeds. Like ischemic strokes, hemorrhagic strokes interrupt the rain's blood supply because the bleeding vessel can no longer carry the blood to its target tissue. In addition, blood irritates brain tissue, disrupting the delicate chemical balance, and, if the bleeding continues, it can cause increased intracranial pressure which physically impinges on brain tissue and restricts blood flow into the brain. In this respect, hemorrhagic strokes are more dangerous than their more common counterpart, ischemic strokes. There are two types of hemorrhagic stroke: intracerebral hemorrhage, and subarachnoid hemorrhage.

Intracerebral hemorrhage
Main article: intracerebral hemorrhage
Intracerebral hemorrhage (ICH) is bleeding directly into the brain tissue, forming a gradually enlarging hematoma (pooling of blood). It generally occurs in small arteries or arterioles and is commonly due to hypertension, trauma, bleeding disorders, amyloid angiopathy, illicit drug use (e.g., amphetamines or cocaine), and vascular malformations. The hematoma enlarges until pressure from surrounding tissue limits its growth, or until it decompresses by emptying into the ventricular system, CSF or the pial surface. A third of intracerebral bleed is into the brain's ventricles. ICH has a mortality rate of 44 percent after 30 days, higher than ischemic stroke or even the very deadly subarachnoid hemorrhage.

Subarachnoid hemorrhage
Main article: subarachnoid hemorrhage
Subarachnoid hemorrhage (SAH) is bleeding into the cerebrospinal fluid (CSF) of the subarachnoid space surrounding the brain. The two most common causes of SAH are rupture of aneurysms from the base of the brain and bleeding from vascular malformations near the pial surface. Bleeding into the CSF from a ruptured aneurysm occurs very quickly, causing rapidly increased intracranial pressure. The bleeding usually only lasts a few seconds but rebleeding is common. Death or deep coma ensues if the bleeding continues. Hemorrhage from other sources is less abrupt and may continue for a longer period of time. SAH has a 40% mortality over 30 day period.
Member:
tite

Posted on Friday, Feb 23, 2007 - 12:20 pm:

Thank you, dear Nicole and Christine, for your support and feedback - and my condolences, Christine, on the loss of your friends of so many years. To say farewell to our horses is never easy, regardless of the cause... but then, they're also such sources of joy in our lives, aren't they?

Thank you, also, dear Dr. Oglesby, for this most informative article. I haven't had the opportunity of discussing Toto's case more in depth with the veterinarian surgeon who did the diagnosis, because he had to travel to Spain after his last visit to our yard, so I can't really make out which of the above types of stroke Toto's may have been. However, recalling a heart malfunction that killed her dam and which was found to be not only congenital but also hereditary, for it also killed her half-brother - who had, according to his owner, similar symptoms prior to his death - I now have to wonder if the same problem could have been at the root of Toto's condition.
Again, my heartfelt thanks for your help, and best regards.
Alexandra
Member:
qh4me

Posted on Tuesday, Feb 27, 2007 - 2:31 pm:

Alexandra,

My condolances to you on your loss. It is so hard to lose one of our beloved companions, but at least she didn't suffer. A friend of mine had a 26 year old gelding who had a similar episode this fall. They tried to keep him for a couple of weeks, but he wasn't himself, he startd to lash out an everyone, and they made the tough decision to put him down as well. It sounds as if you made the right decision, no matter how hard that must have been on you.

Her memory will live on forever, as you remember all the good times you shared with her.
Member:
sonoita

Posted on Wednesday, Feb 28, 2007 - 10:27 am:

Alexandra,Christine
So sorry for your losses. It hurts so much when we lose our buddies. I used to think it was hard as a kid to lose one but now as a adult it is much worse.
Happy Trails
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