Head Trauma in Dogs

Canine Head Trauma

Head trauma is a blunt or penetrating injury occurring to the head. In dogs it may occur due to a variety of causes, the most common of which is a motor vehicle accident. Other causes include blunt trauma such as being hit by bats or swings or being stepped on, falls, gunshot wounds or animal fights.

Brain dysfunction may be the result of concussion, swelling, bruising, laceration, fractures, compression or bleeding.

What to Watch For

If you suspect that your dog has suffered head trauma observe him for the following:

• Abnormal level of consciousness
• Differences in pupil size
• Rigid limbs
• Flaccid limbs
• Unusual eye movement
• Bleeding from the nostril
• Bleeding from the ear canal
• Seizures
• Head tilt

Diagnosis of Canine Head Trauma

Veterinary care should include diagnostic tests and subsequent treatment recommendations.

Diagnostic tests are needed to recognize head trauma and determine its severity. A complete medical history and physical examination are important parts of the initial diagnosis of head trauma. Tests and procedures that your veterinarian may wish to perform include:

• Initial neurologic examination. Your veterinarian will need to rapidly assess your dog’s status, which may include evaluation of brain function and determination of the site of the damage. During the initial evaluation, your dog’s level of consciousness will be assessed. The size of the pupils and their response of light will also be tested to help determine the severity of the injury. A more complete neurologic examination may need to wait until your dog is alert; however, eventually it will be important to determine if there are other significant injuries, such as to the spinal cord.
• Physical examination. Your veterinarian will perform a more complete physical examination as soon as your dog is stable. Other injuries, particularly those that are not life-threatening, may have been overlooked during the initial examination when your dog’s condition was critical. Once your veterinarian has the opportunity to examine your pet thoroughly, trauma to the abdomen, chest or even fractures of the limbs may be noted.
• Radiographs (X-rays) or CT Scan. If indicated, your veterinarian may recommend radiographs in order to look for skull or spinal fractures and CT scan to look for fractures as well as brain injury.

Treatment of Canine Head Trauma

The treatment of head trauma will depend upon the cause and magnitude of the injury.

• Repeat neurologic examinations. If your dog has evidence of head trauma, your veterinarian will perform repeat neurological examinations because the status of the injured brain can change quickly. Even if your dog initially seems normal, it is wise to have your veterinarian observe him for 24 hours to allow repeat neurologic examinations to be done. Abnormalities may become apparent as the brain swells or bleeding occurs into or around the tissues.
• Supportive care. An intravenous catheter will be placed to allow fluids to be given to prevent dehydration. Your veterinarian may provide pain-killers as needed.
• Control of seizures. Seizures may occur in animals that have suffered brain trauma. Diazepam (Valium®) or phenobarbitol may be given to control these seizures.
• Treatment for brain swelling. Drugs may be administered to prevent or treat swelling of the brain tissue. Solutions that draw fluids from the tissues (hyperosmotic solutions) and/or decrease the production of spinal fluid, such as mannitol, may be given. Oxygen therapy may also be recommended. Care should be taken to avoid cough/sneeze reflexes as much as possible because these raise intracranial pressure, which is pressures within the skull or cranium. Any increase in brain swelling or intracranial pressure may contribute to neurologic deterioration such as dullness, stupor or coma.
• Skull fractures. Conservative non-surgical treatment may be recommended for fractures that are not displaced, that is the bone is broken but the fragments have not shifted position. However, fractures that place pressure on the brain – that are displaced inwards – may need to be removed or repaired surgically.
• Treatment of shock. If your dog has evidence of shock or other injuries associated with trauma, specific treatment should be provided for these conditions.

Home Care and Prevention

Head trauma is a life-threatening emergency. If you suspect that your dog has suffered head trauma, take him to your veterinarian for evaluation as soon as possible.

While you are waiting for your dog to be examined, keep him warm, hold his head elevated or level with the rest of the body and minimize pressure on his neck, head or back.

Be careful when handling your dog to avoid being bitten. Your dog may not be aware of what he is doing and could inadvertently injure you.

Keep your dog on a leash to avoid the potential for an accident that might result in head trauma. Take special care with frightened animals; they may run into the street or highway. Do not let dogs outside unleashed and unattended.

Puppies are particularly prone to injury by being stepped on, rolled on with a rocking chair or caught in a recliner. Do not allow young children to handle puppies unsupervised.

In-depth Information on Canine Head Trauma

Other medical problems can lead to symptoms similar to those encountered in head trauma. It is important to exclude these conditions before establishing a definite diagnosis. In cases where there is obvious external injury to the skull or bleeding from the ear canal or nostrils, a diagnosis of head trauma is more obvious. In situations where there is no obvious evidence of head trauma, an alternate diagnosis list should be considered. This includes:Abscess or infection in the brain

• Brain tumor
• Distemper (a viral disease that can affect the brain)
• Drug intoxication
• GME (granulomatous meningioencephalitis)
• Hypocalcemia (low blood calcium)
• Hypoglycemia (low blood sugar)
• Inflammatory disease of the brain
• Seizure disorder
• Toxicosis (pesticides, antifreeze, rat poisons)

Veterinary care should include diagnostic tests and subsequent treatment recommendations.

Diagnosis In-depth

Diagnostic tests must be performed to confirm the diagnosis of head trauma and exclude other diseases that may cause similar symptoms. The initial diagnostic approach may include:

• Complete medical history and physical examination, including neurological and ophthalmic (eye) examinations. Your veterinarian should assess for shock and trauma, thus monitoring airway, breathing, heart rate and presence of bleeding or fractures.
• Assessment of hematocrit, which is the level of circulating red blood cells, to rule out bleeding (as with any trauma)
• Serial neurological examinations to assess progression and prognosis and to gauge therapy
• Radiographs (X-rays) of the skull to look for fractures when the dog is stable
• Evaluation of arterial blood gas samples to detect low blood oxygen levels (hypoxemia) or evidence of breathing difficulty (hypoventilation)

In-depth Diagnostic Information on Head Trauma in Dogs

Additional diagnostic tests may be carried out in order to detect other injuries:

• Thoracocentesis (tapping of chest cavity) to drain abnormal air or blood in the chest cavity
• Blood pressure measurements to evaluate for shock. It is important to maintain a systolic blood pressure of 80 to 100 mm Hg.
• Radiographs of other limbs or the spine to assess associated injuries
• Abdominal radiographs if indicated to assess injury
• Thoracic (chest) radiographsWhen a head trauma patient does not respond to symptomatic therapy or if a definitive diagnosis has not been attained, other diagnostic tests may be considered. Options may include:
• Referral to a neurologist or internal medicine specialist
• CT scan. This is available at some referral institutions (can detect hemorrhage, brain swelling, penetrating foreign bodies and depressed skull fractures).
• MRI (magnetic resonance imaging), which is available at some referral institutions
• Evaluation of brainstem auditory evoked potential to determine some brain stem functions
• Intracranial pressure measurement, which may determine the severity of an increase in intracranial pressure and aid in assessment of response to therapyOther tests may be indicated. These tests may reflect systemic effects of trauma or hypoxemia (low blood oxygen level) or pre-existing disease. There are no blood chemistry changes consistent with brain injury but these evaluations may also be useful in situations where alternate diagnoses are being considered.
• Hemogram (a differential blood count)
• Biochemistry profile, including blood glucose (sugar)
• Blood ammonia level, because high levels may be seen in certain diseases of the liver
• Coagulation studies if intracranial hemorrhage may be responsible for neurological signs
• Electrocardiogram to aid in evaluation of abnormal heart rates

In-depth Treatment Information on Head Trauma in Dogs

Treatment of head trauma must be individualized based on the severity of the condition and other factors that must be analyzed by your veterinarian. Initial therapy of head trauma follows rapid assessment of head injury and neurologic status. It includes oxygen therapy, possibly steroids (controversial), hyperosmotic fluids and repeat neurological examinations. Pain, seizures and hemorrhage are usually treated according to need. Severe cases of head trauma may be referred to an emergency clinic or neurologist.

• Oxygen may help reverse the cerebral (brain) edema and prevent the progression of brain damage. Oxygen may be provided via face mask or hood or by the use of a nasal cannula or oxygen cage. If the patient is not breathing appropriately and has high blood carbon dioxide levels, it may be necessary to breathe for the patient following intubation – a tube is placed down the windpipe and breathing is maintained by use of a manual breathing bag or a mechanical ventilator. This may aid in reducing the degree of cerebral edema and preventing further brain injury.
• Obvious hemorrhage should be controlled as with any trauma. Evaluation for traumatic damage to body cavities such as the chest and abdomen, such as abnormal bleeding or air accumulation (hemothorax and pneumothorax) or fractures of bones, should be carried out following initial stabilization of the patient.
• Elevation of the head may help decrease intracranial pressure and facilitate resorption of spinal fluid. When moving the patient, it is important to prevent compression of the jugular veins, as this can raise intracranial pressure and cause a deterioration in neurologic status.
• Intravenous fluids may be given initially to treat shock. Dextrose may be added if hypoglycemia (low blood sugar) exists. Fluids may also be used to maintain blood pressure which helps to maintain an adequate blood supply to the brain. Hyperosmotic agents such as mannitol are often used in patients with head trauma, particularly where there is a concern about cerebral edema, increased intracranial pressure, or a deteriorating neurologic status.
• Diazepam (Valium®) or phenobarbitol may be needed to control seizures.
• Conservative treatment may be used for non-displaced skull fractures. Surgery should be considered with depressed skull fractures or penetrating foreign bodies in the case of worsening neurological signs.

Supportive Therapy for Head Trauma in Dogs

• Dogs may need to be sedated or tranquillized to prevent self-injury, particularly if agitated. Cages may be padded.
• Frequent turning to prevent bedsores and lung congestion. Patient should be kept clean and dry.
• Provide oral or intravenous nutrition as appropriate.
• Monitoring is an important part of treatment. Your dog’s temperature should be monitored and heat support may be provided as necessary. Fluid and electrolyte balance, blood pressure and urine output should be monitored and fluid and drug therapy adjusted accordingly. Serial neurological examinations are usually important to assess treatment and progression of symptoms.
• Pain should be treated with analgesics such as butorphanol.
• Eyes should be lubricated if the blink reflex is diminished.

Prognosis for Head Trauma Injuries in Dogs

The prognosis is dependent upon the degree and area of brain injury, response to therapy as well as secondary injuries. Coma that lasts greater than 48 hours or deteriorating clinical signs carry a grave prognosis for recovery.

Home Care for Head Trauma in Dogs

Optimal treatment for your dog requires a combination of home and professional veterinary care. Follow-up for head trauma often includes the following recommendations:

• Administer prescribed medications as directed and be certain to contact your veterinarian if you are experiencing problems treating your dog.
• Observe your dog’s general activity level, appetite and interest. Keep your pet in a supervised area of the home.
• Re-evaluation is often recommended in three to four days after discharge from the hospital. Of course, the precise follow-up depends on the severity of your dog’s disease, response to therapy and your veterinarian’s recommendations.
• Recovery may take several days following the acute injury. On occasion it may take more than six months for some neurologic signs to resolve. It is important to be patient with recovery from head trauma and to be prepared to provide on-going nursing care at home, if necessary. Patients may improve slowly and the degree of recovery may be impossible to predict.

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