Neurological Disorders in Cats

Spina Bifida

Question: My 3 months old kitten Angel Bear has just been diagnosed with spina bifida by my vet. What we had thought was urine creeping up in the area where his tail ought to be (he's a himalayan/alley type manx mix) is in fact spinal fluid oozing out. He has no other health problems, and is perfectly nimble and coordinated. My vet is calling around to find out what the best treatment possibilities are, if any. I hope you have experience with this type of problem, and that you could offer some guidance as to what seems to you the best recourse at this point. Thank you so much! Anne-Marie

Answer: Anne-Marie-

I do not have personal experience with this problem in Manx or Manx cross cats. There are a number of reports in the literature about this problem, though.

A myelomeningocele (or just meningocele) is very likely as the cause of the fluid leakage. This is a bulge of the tissue that covers and protects the spinal cord (the dura) through the abnormally formed vertebrae (spina bifida), forming a pocket of dura containing spinal fluid under the skin, or in some cases opening through the skin. The spinal fluid leaks to the outside if there is an opening (a fistula). This can go on for some time, apparently, as there is at least one case report of a 5 year old Manx cat having surgical repair of a meningocele that was apparently present since birth (Hall et al, Journal of the American Veterinary Medical Association, 1988).

The most common recommendation is to have a myelogram (dye contrast X-ray) or an MRI scan done to confirm the myelomeningocele and then to repair the defects identified on the X-rays or MRI. Personally, I would refer a case like this to a veterinary neurologist or surgical specialist for repair but your vet may have a strong interest in surgery and may be comfortable performing this kind of surgery. In the article noted above, a muscle fascia graft was used to provide support over the malformed vertebrae for a stronger repair.

Another complication of the spina bifida / myelomeningocele problem in Manx cats is a condition referred to as "tethered spinal cord syndrome" or other things similar to that. In this syndrome the original disorder leads to scarring that fixes the spinal cord in place and this fixation causes problems as the kitten grows. I am not certain how to identify this problem but am under the assumption that it would show up on an MRI. This problem is another reason to consider referral to a surgical or neurosurgical specialist.

It is not uncommon for megacolon problems to occur as affected Manx kittens age or for this complication to occur later in life. It is also not uncommon for urine retention to be a problem due to inadequate nerve function. If fecal or urinary motility problems do occur, medications can sometimes help with these problems. Ranitidine (Zantac Rx) or cisapride (Propulsid Rx) can be helpful to encourage bowel movements and bethanecol can be helpful in promoting urinary bladder contractions.

If you can't afford to pursue expensive diagnostic tests and/or surgery, this may not cause problems even if left alone. The biggest worry is infection of the spinal cord due to exposure to bacteria on the skin surface through the fistula but this apparently does not always occur, or at least doesn't always occur quickly. Surgery is almost certainly a better option if it is something you can afford to consider, though.

I hope that this helps some.

Mike Richards, DVM 9/29/2001

Rear leg weakness

Question: Wally is a 15-y/o neutered male cat (Bombay) who has been indoor/outdoor for the past three years. For about the past three weeks, he's been getting progressively wobblier (technical term, I know) in his back legs.

After two trips to the vet, the following pathologies have been ruled out: CRF, dilatative cardiomyopathy, thromboembolism, hyperthyroid, diabetes, FeLV/FIV, masses, spinal cord injury, and arthritis. The only thing they can find wrong is slight anemia and a heart murmur (now a III-IV) that was diagnosed years ago. X-rays show no masses in his abdomen, no enlargement of his heart, no degeneration of his spine or hips. UA shows no elevated sugar and his specific gravity is fine. Electrolytes are fine. Blood count is fine aside from the anemia. They sent me home with Hi-Vite and said they wished all their patients were this healthy. I was told he's old and is suffering loss of mobility due to diminished muscle mass and suggested that I arrange the environment to accommodate his disability.

This does not explain why he's deteriorating so quickly! What could cause this? The vet says it's probably neurological and without an MRI no certain diagnosis can be made, and there's probably no effective treatment anyway.

Now he can hardly stagger a few feet before his hind legs just sort of fall over and he decides "this is a good place for a lie-down, I like it, it's good." His attitude is good, he doesn't seem to be in any pain, he still makes it to the litterbox, but his appetite seems to be falling off and it's harder and harder to tempt him.

He hasn't been outside in two days, and previously he at least went out to sun himself on the concrete.

I'd really just like some idea of what could be causing this. It's rather alarming.


Answer: Nikki-

I am not sure how some of the diagnoses were ruled out. Without cardiac ultrasound exam I don't think it is possible to rule out cardiomyopathy and thromboembolism resulting from it, although clinical signs can go a long way towards ruling out the thromboembolism possibility. Without the MRI, or possibly a myelogram, it is not possible to rule out spinal injury from disc disease, trauma or spinal cord tumors. Another possible explanation for wobbliness in the rear limbs is hypokalemia (low blood potassium), which is a part of many lab profiles, but not all of them. It is very likely that this has been checked on and ruled out, but it is another possible problem. Cats get geriatric vestibular syndrome, which is loss of vestibular (balance) function, rather acutely. This usually clears up without treatment within a few days to a few weeks. If both sides are affected dogs and cats sometimes have a crouched, wobbly walk. If only one side is affected they sometimes refuse to walk but more commonly circle in the direction of the affected side when they walk and appear to be very uncoordinated at the same time. Some pets do not recover fully from this condition but I can't remember one that didn't make at least reasonable progress after three or four weeks. An inner ear infection or polyp affecting the middle ear might produce incoordination like this but they are not that common in older cats.

I tend to disagree that there is no hope for a spinal cord problem, especially if it is a ruptured disc that isn't showing up on plain X-rays. However, you do have to accept that the prognosis is guarded, or worse, before you pursue expensive testing options like an MRI or myelogram to rule in or rule out these types of problems. It is a tough choice to make sometimes in an older cat.

I can't think of any other things to suggest looking for at this time. Good luck with this. I really hope that Bombay has improved some by now.

Mike Richards, DVM 11/26/2000

Feline hyperesthesia syndrome possible

Question: Dr Richards,

My cat is a 7 year old castrated mail cat. He seemed normal until August 31 of this year. Since that time he has had problems with hysterical licking of his flanks and back which moves autonomously, like shivering. This happens before, during and after he licks at himself. Sometimes his back moves when he is resting or sleeping. He seems warm around his ears, neck and feet at times. He has had fleas at times. He seemed to have some swelling around his tail region when this first occurred but no wound could be found. He was treated with antibiotics which seemed to help for some time but now the problem has returned, although the frequency of the problem seems to be a little less. He is still licking at himself several times a day, though. He licks at his tail and feet as well as his back. I am worried that he continues to have these problems.


Answer: Danielle,

In reading your note, there are several possible problems that come to mind. It would be hard to tell you which of these problems is most likely, though. It may take continued testing and work with your vet to sort through these problems in order to figure out what is going on.

There is a condition in cats that is referred to as feline hyperesthesia syndrome. In this condition, a cat's skin "rolls" or twitches over its back, from about the level of the last rib to the base of the tail. During these episodes many cats have dilated eyes. Cats may cry out or snarl. Some cats bite themselves and they may inflict serious injury or cause abscessation of the affected area in severe cases. Cats may bite if touched during one of these episodes and they often whip their tail from side to side in an agitated motion. In some cats, sudden biting behavior when they are being petted has been associated with this condition, which might have led to the name "hyperesthesia syndrome" since hyperesthesia means increased sensitivity to touch (or other sensations). This can be an intermittent problem or it can occur very frequently, in some cases more than once a day.

There are several identified causes of hyperesthesia syndrome but they represent only a small percentage of the cases of this disorder. For most cats, a specific diagnosis of an underlying cause is not possible to obtain.

In some cats, this is apparently a form of seizure activity, based on response to treatment with phenobarbital. Due to the difficulty in diagnosing seizures the most common way of trying to rule out this condition is just to try phenobarbital and see if it works. Usually, one to two months of therapy is enough time to decide if phenobarbital will be helpful, or not.

There have been a few cases of hyperesthesia syndrome linked to spinal cord injuries. There are several reports of muscular disorders with inclusion bodies or vacuoles recognized on muscle biopsy of the muscles of the back. Cats with muscle disorders may respond to treatment with l-carnitine, CoEnzyme Q10, riboflavin and/or Vitamin E (from the Veterinary Information Network, 2000).

In some cats this seems to be a behavioral disorder, based on response to medications used for behavioral problems. Diazepam (Valium Rx), buspirone (Buspar Rx), clomipramine (Clomicalm Rx) and megestrol acetate (Ovaban Rx) have all been used to treat this disorder successfully in some cats. Megestrol acetate can have serious side effects in cats so it is not a first choice medication.

Other medications that have been reported to work in some cats are prednisone and fluoxetine (Prozac Rx). There are probably other medications that have been tried in some cats since this disorder can be very hard to control in some patients.

There is also the possibility that this is not hyperesthesia syndrome, of course. Other possible conditions include retroperitoneal abscesses (a condition in which an abscess forms in the space between the lining of the abdominal cavity and the muscles of the back), flea allergy dermatitis, other allergies, spinal injuries and eosinophilic granuloma complex.

I think that it is hard to absolutely rule out allergies in cats but your vet may have good reasons to be putting them very low on the list of differential diagnoses. This would explain much of the licking behavior, though. Eliminating the fleas would be a good idea and I really do think that you will find that fipronil (Frontline Topspot Rx) is safer and more effective than fenthion (Tiguvon Rx). It may help a great deal if fleas are contributing to the problem by producing itchiness.

There are two forms of bacterial infection in cats that can be pretty hard to get rid of. Atypical mycobacterial infection is one of these. It usually causes draining tracts (persistent infection), usually affecting the caudal abdominal region. The other resistant organism is an unusual form of bacteria referred to as l-form bacteria. These respond best to treatment with doxycycline or tetracycline. I do not know how to identify an infection with l-form bacteria but the mycobacterial infections can be identified by acid fast stains of wound aspirations or biopsies and also by bacterial culture.

It is always a good idea when there is chronic illness to consider testing for feline leukemia virus and feline immunodeficiency virus. These can complicate the diagnosis of almost any other illness.

There are probably other conditions that could be leading to the signs you are seeing but these are the ones that I can think of right now.

I hope this is helpful to you.

Michael Richards, DVM 10/31/2000

Brain injury in cat

Question: we have a cat we found approx. 3 mos. ago. he did not seem to have very good sight and our vet believes he only sees shadows. he has another problem, he circles for hours on end. we took him to a neurologist who said the cat has damage to the left side of his brain, is psychotic and living a miserable life, he recommended euthanasia. as we do have grown very fond of "boots" we do not want to do this unless we are absolutely certain his condition is causing him misery. he does not appear to be in pain but does appear to frighten easily and because of his poor sight he falls off things, he seems to have not depth perception and does not understand how to put his front legs forward when hopping down from a "perch" (we only let him into rooms that have nothing higher than 2 ft. from ground). his circling is not constant, but we have not been able to associate a cause, anxiety, noises, etc. to it, he just does it whether alone or in our company. he has shown aggression for no apparent reasons on 2 occasions; another reason our vet recommends letting him go. he bit one person and has tried to bite another. we feel they may have just moved too quickly around him but our vet feels he may be so unstable as to "turn" unprovoked any time. the neurologist has said our only option was to do an MRI which might explain more of his condition but probably not enough to provide a treatment. we are willing to keep him if we know his life has some sort of quality. is there any way this can be accessed? it is so hard to decipher his actions.

Answer: C-

There are times when being able to ask our patients what they are feeling would be really useful. This is one of those times. Without being able to do that, I am not at all sure that it is possible to accurately assess the quality of life with certain conditions, including brain injuries. There are some things that you can do to help in assessing the situation and then you are just going to have to make your best guess from there.

The most serious problem, from a family standpoint, is the aggression. If the aggression is truly unpredictable then you really do have consider the potential for injury to a family member since cat bites can produce serious wounds, especially when the high potential for infection in bite wounds is considered. If the aggression can be controlled by recognizing the situations in which it is likely to occur and then avoiding those situations, then I think that the risk may come down to levels that are acceptable for some people to take. Thinking back carefully over the circumstances of each of the previous aggressive instances may enable you to see something, such as the cat feeling cornered or reacting to being petted, that might allow you to avoid a problem in the future. It can be helpful, when possible, to discuss this sort of situation with a veterinary behaviorist. Tufts University provides on-line behavioral counseling for some behavioral problems, if you do not have the option of discussing this with a behaviorist near you. There is a chance that this behavior pattern is due to the same brain injury causing other problems but it could be unrelated, as well.

I have several cat patients with brain injuries or congenital brain problems (usually cerebellar hypoplasia) that would count as significant disabilities if they were present in a person. These cats seem to be reasonably happy to me, although they do tend to be a little more nervous and unsure of themselves in new situations. I don't think that these cats worry over their inability to do things in the same way or same time period, as other cats, in the way a person might. I think they tend to accept the situation and adjust to it --- which is also a pretty common way for people to react.

If there are no signs of pain, such as sleeping excessively, variable appetite, head pressing, crying or vocalizing in some other manner, then it is reasonable to question whether this problem really makes Boots miserable. As the neurologist suggested, an MRI might give some way to objectively assess whether the brain injury that is present is causing pain, by comparing the injury present to similar injuries in humans, who can tell us what they feel. It would be the best way to try to obtain more information but would not necessarily provide an answer.

The aggression is something that you have to figure out as a family. If Boots is endangering other family members and if there does not seem to be a way to avoid or minimize the problem, then I think you should give serious consideration to euthanasia. To me, the human family members safety has to come first. I know that not all people agree with that philosophy but I know of several situations in which cat bites have led to long term disabilities and humans do have a strong potential for depression and psychological problems from these kinds of problems.

These are tough problems and I really sympathize with your situation. I am sorry I can not provide a more concrete answer to your questions.

Mike Richards, DVM 9/10/2000

Neurological problems in feral kitten

Question: We recently picked up a feral mom and 7 kittens.

She was running with one of the kittens prior to capturing her. neighbor kids were chasing her.

The kitten who had seemed normal now seems to have some damage. We got the kitten on Thurday of last week, on Friday we trapped the mom. this kitten is 4.5 ounces and is now 6-7 days old and is eating well.

Kitten was examined on Friday as it was not holding its head properly and limb motion was jerky and odd. kitten kept rolling over to one side. We (vet/I) thought that the kitten may have had some spinal or nerve damage.

Kitten was put on amoxy and had one shot of steriod on Frid. Today the movement in the legs seems to be much better that is the kitten is able to pull his front legs forward, he still continues to roll. He got another injeciton of steriods and is now on baytril as well as amoxy.

We took xrays of the kitten and saw an area in the skull that look like a very small triangle my vet wasnt sure if this wasnt a soft spot where the skull plates converge, she thinks it is possible that the mother in her haste bit into the skull causing the damage.

Going on the premise that it has to do with damage to the brain, is there any thing else that you can think of that we should or could be doing?

The vet is a personal friend and would welcome any suggestions, she said that she doesnt have any brain comparison info to compare what we are seeing so we dont know if it is normal or not.

any help would be appreciated. Cindy

Answer: Cindy-

My first thought in this case was that the kitten probably had cerebellar hypoplasia. This occurs when the mother is exposed to panleukopenia virus during the pregnancy. An affected kitten has balance problems and difficulty walking. Head trauma is also a strong possibility. Parasite migrations and infections (roundworms, Cuterebra larvae, toxoplasmosis) can cause neurologic signs in kittens. This is a list of possible causes of neurologic problems in kittens:

toxoplasmosis parasitic larva migrations through the nervous system (roundworms or cuterebra larvae are possible in kittens) congenital portosystemic (liver) shunts feline leukemia virus feline infectious peritonitis feline immunodeficiency virus metabolic encephalopathies ( liver or kidney disease leading to CNS signs are most likely in a kitten of this age but should be causing clinical signs other than just nervous system signs) encephalitis hydrocephalus cerebellar hypoplasia cerebellar abiotrophy lissencephaly lysosomal storage diseases fungal infections (not too likely at this age) feline polioencephalomyelitis (also unlikely at this age)

Unfortunately, it is pretty hard to diagnose most of these problems. It is reasonable to treat for the parasitic illnesses and to test for several of the viral illnesses, though.

Hope this helps some.

Mike Richards, DVM 7/19/2000

Neurologic disease in a kitten

Question: This poor kitten was bitten at around 5 weeks of age and entered the shelter as an injured stray. He was then fostered out to me, appearing fairly OK at 6 weeks but I detected subtle problems with his development. A week later began a decline that left him with massive neurological problems. This kitten needs help and the shelter wasn't sending him for any specialized treatment. I adopted him--I felt that they were hoping he'd die and stop being a problem that couldn't be solved and I hoped that his steady improvement meant this would soon be behind him. (It also was a factor that he had a very strong attachment to me and was terrified of new places and people--he lacks the normal kitten adaptability with his brain damage.) He's since developed a new problem which my own Vet couldn't for sure diagnose--she told me take him home and give him a good home for however long it might be, whether a day or perhaps much longer...He ran a FUO that they think could be due to his brain failing to regulate his own body temperature. Dr. Mike seems to have some knowledge that the three vets involved so far don't, into the neurological problems that cats can have. I have had him worked up and seen by local vets, they are just stumped.

Answer: Bev-

If there was trauma to the brain from the bite wound, that could explain the symptoms seen. I am assuming that the bite didn't involve the head or spine since you didn't mention it as a problem.

I am not a specialist in any field, so I doubt that I'll think of something that your sister and the other vets didn't think of but this is a list of the disorders that might cause neurologic disease in a kitten this age that I can think of:

toxoplasmosis parasitic larva migrations through the nervous system (roundworms or cuterebra larvae are possible in kittens) congenital portosystemic (liver) shunts feline leukemia virus feline infectious peritonitis feline immunodeficiency virus metabolic encephalopathies ( liver or kidney disease leading to CNS signs are most likely in a kitten of this age but should be causing clinical signs other than just nervous system signs) encephalitis hydrocephalus cerebellar hypoplasia cerebellar abiotrophy lissencephaly lysosomal storage diseases fungal infections (not too likely at this age) feline polioencephalomyelitis (also unlikely at this age)

These are the disorders that I can think of that might be present. Unfortunately, many of these conditions are hard to diagnose without pretty extensive testing. Perhaps something on the list will seem likely to your vets and make it possible to narrow the list down some.

Good luck with this.

Mike Richards, DVM 7/17/2000

Dysautonomia in cat

Question: We are a subscriber to Vet Info Digest and receive it regularly by mail - thanks, a very interesting read. I have an important question I need to ask for advice on about one of our cats.

Bogus is a 13 year old moggy who has been seriously losing weight for the last 18 months or so. He also frequently vomits and has occasional diarrhea. Our vet has tested him for all sorts of things - leukemia, feline aids, hyperthyroidism etc. All came back negative and he's been vaccinated where appropriate. He did a 'T4' assay which showed up pretty normal. Eventually (and after some pretty hefty bills) they drew a blank and for the last 6-9 months have been giving him regular (every six - eight weeks) injections of an anerbolic steroid (don't know the name) and a vitamin cocktail. This seems to keep his appetite up and he now has plenty of energy for an elderly chap.

Nonetheless he has gained no weight, and if anything is continuing to lose it. We recently took him to another local vet for a second opinion. The new vet described him as chronically cachexic (?) and first tried a barium meal test. X-rays over the next 2 hours showed that the food stayed in the stomach and did not pass into the intestines at all. It was later passed as diarrhea the next morning. The vet suspected a possible tumour or other obstruction, although there was no perceptible sign of this on the X-ray. Today he has opened Bogus up to have a good look inside. He found no tumour or blockage of any kind. The intestine does not appear to be 'spasming' correctly - only in around 1 inch of it, and very dramatically. He tells me that he has surgically opened up the pyloris to release the sphincter. Bogus's pancreas was also apparently a greyish colour and did not look normal. He has sent a biopsy to a lab for evaluation. This new vet suspects that Bogus is suffering from something called Key Gaskill Syndrome or feline disautonomia. He has given us a 10 day course of miatonin and metoclopramide and wants to see him again after that is completed.

Do you have any information on this condition?

Many thanks! Hilary

Answer: Hilary-

Dysautonomia is a disorder of the autonomic nervous system that can affect both dogs and cats but is much more common in cats. It is reported more commonly from the United Kingdom than from other countries (at least more often than the US).

I have seen one case of this illness and it was a number of years ago, so I am not an expert on it, but there is a summary of the information I can find on dysautonomia.

Dysautonomia has been reported in cats up to eleven years of age in the literature I can find, but is more common in young cats. It can occur quickly or come on in a more subtle manner.

Cats affected by this condition may have many different clinical signs but not all are present in all patients. This is a list of possible symptoms:

Lethargy or depression, decrease in appetite or lack of appetite, dryness of the nose, oral membranes and eye region, decreased esophageal motility, delayed emptying of the stomach, constipation, dilated pupils, protrusion of the third eyelid, difficulties walking or weakness, fainting, vomiting, decreased rectal tone (touching of the anus doesn't cause it to pucker or flinch) and secondary complications like pneumonia and lack of control of defecation.

My impression is that the eye signs are pretty likely to be present and the other signs more variable but it is very likely that your vet has more experience with this disease than I do, so if he or she has experience with this disease it should hold more weight than what I read in general texts.

I am glad that your vet sent a biopsy sample of the pancreas. This is a really good idea in an older cat with non-specific weight loss, as chronic pancreatitis is not that uncommon in cats.

I hope that Bogus is responding to the medications. Response to medications is variable but it is possible for cats to recover from this condition.

Mike Richards, DVM 6/7/2000

Twitching in cats

Question: Doctor Mike, My 7-year-old cat has been twitching for the past 6 months (at least). The twitching is mainly centralized in the ears, face and upper body, but has affected her entire body at times. I've told my vet about this several times, but no possible answer. I am very worried because my three-year old cat had toxo and was treated, but the 7 year-old tested negative at the time. What causes twitching in cats? The episodes are pretty mild, but frequent. I am worried--I just lost my 3-year-old cat to hypertrophic cardiomyopathy. I am devastated by her death because after she fought so hard and survived the toxo, she died so suddenly of heart disease (just over a year later). I want to make sure my other cat is in good health. Please help with possible causes of twitching in otherwise seemingly normal cats. Thank you!


There are a number of causes of twitching in cats, because this can be associated with pruritis (itchiness) and there are a lot of causes of pruritis. If this occurs very frequently during the day it is probably more likely to be some sort of problem with itchiness. If it occurs infrequently during the day then something like a focal seizure may be possible. These are reported in cats more frequently than in dogs (at least that is my impression, I'm not sure it is actually true). Twitching is sometimes seen with liver disorders, pancreatitis, low blood sugar and high blood sugar, as well. I think that toxoplasmosis causes enough neurologic problems that twitching could be related to it, but haven't seen that written anywhere.

One particularly common cause of twitching is feline hyperesthesia syndrome, but normally the twitching occurs more along the flanks and top of the spine near the base of the tail. Often, cats with this condition are OK unless they are touched or petted, but many will have twitching and even self-mutilation without any external stimulus.

Facial twitches have been reported with feline immunodeficiency virus infection and sometimes occur when there is periodontal disease, odontoclastic lesions of teeth or stomatitis in cats.

Ear mites make some cats twitch their heads or ears. Fleas can do this. Allergies make some cats so itchy that they have skin twitching. Mite infections (cats get several skin mites) can cause itchiness and twitching.

Your vet probably didn't see any clinical signs of skin disease or ear mites and may think that the other conditions are unlikely. If this problem is getting worse, if there is visible skin damage in addition to the twitching or if you just want to know if a cause can be identified, you should schedule a visit with your vet for this particular problem. Sometimes I forget to take things that clients mention during an exam, that isn't part of the presenting problem, seriously enough. I assume other vets might do that, too.

Hope this helps some. Feel free to write back if you need clarification about what any of these conditions are.

Mike Richards, DVM 2/16/2000

Strokes and other possibilities in Cats

Question: Dear Dr. Richards: I am a subscriber to your web-service. My question is: What are the symptoms of a stroke in a cat? Elderly "Kitty" has had about four episodes since August of this year whereby she walks as if intoxicated. She's taken to meowing rather loudly, early in the am (not @ typical "feeding" time).

Also, Kitty recently was running around the house in a disorientated state, urinating randomly. A bladder infection might explain the latter symptoms, but we're quite anxious about her spells of "drunken-disorderly" conduct. We love her dearly, and all will truly appreciate any feed-back you have to offer.

Respectfully requested,

R. W.

Answer: RW.-

Strokes are unusual in cats but not impossible. The first concern is to accurately diagnose what is going on with your cat. The symptoms could occur with vestibular problems, hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), hypertension (high blood pressure), seizure activity, heart problems, strokes (can occur when cats have low platelet counts, very high red blood cell counts, high blood pressure and probably other causes), toxoplasmosis, brain tumors, inner ear disorders, liver disease, hyperthryoidism, hypokalemia, cognitive dysfunction and probably other stuff I'm not thinking of at this time.

A good blood panel with a complete blood cell count including platelet count and a complete serum chemistry panel including a total thyroxine (total T4) level would be a good idea as it would help to rule out most of the above problems. A physical exam could help to rule out neurologic and cardiac problems. If you get to this point and there still isn't a good indication of what the problems relate to then it gets a little harder to figure out which direction to go in.

Strokes often result in paralysis of one side, paralysis of facial muscles or other discrete paralysis problems associated with the area of the brain that is affected. This doesn't seem to be occurring based on your note. That doesn't totally rule out a stroke, it just makes it less likely.

Hyperthyroidism is sometimes linked to increased vocalization and increased activity at night and it could cause the other symptoms either by inducing hypertension or cardiomyopathy. It is pretty easy to check for this problem in most cases so it is usually worth ruling out in an older cat with behavioral changes. I'm not sure anyone else has noticed a link between hyperthyroidism and really odd bouts of urination but we have had a client complaint similar to yours and that cat did have hyperthyroidism. More normal "spraying" behavior has been noted to increase in hyperthyroid cats. I'm not sure there is a strong link with this symptom but it isn't out of the ballpark. Weight loss usually occurs with hyperthyroidism, so it is less likely to be the problem if there is no change in weight.

If you have already had lab work and physical examinations and there is no diagnosis, then it might be a good idea to consider asking your vet to refer you to a veterinary neurologist or internal medicine specialist (depending on which your vet thinks is best).

Hope this helps some. The first step really is a good chemistry panel and blood count. There is a good chance something useful will show up in the blood work. Talk to your vet about getting this done.

Mike Richards, DVM 11/20/99

Feline Vestibular Disorder

Q: Last Friday, our cat came staggering out to us unable to balance himself, with is turned to one side, and his eyes out of control wandering all over. He is a 1 1/2 year old neutered male, had been fine up to that point, I can't find anything ,which could have poisoned him. Cannot straighten his head to drink out of the bowl when he tries. My vet seems to think he got into poison, and now is brained damaged, but would he have reconized me today if he was brain damaged. Connie

A: Connie - A toxin is possible. It wouldn't be my first thought but that could just be my mindset.

I would worry about feline vestibular disorder (sudden onset of balance problems with abnormal eye movements). This usually lasts less than two to three weeks and clears up with or without medication. Trauma is possible (a head injury). Ear infections and ear tumors are possible (tumors do occur in young cats at times). Feline leukemia, feline infectious peritonitis and feline immunodeficiency virus can sometimes cause central nervous system problems, too.

Good luck with this. Hopefully you are already seeing improvement.

Mike Richards, DVM

Cerebrovascular injury

Q: Dear Dr. Mike: My 8 year old cat, Eenie, just suffered what appears to be a stroke. The lingering effects are an inability to control the right side; he is unable to stand up and walk because of right-side impairment. He was treated at the Animal Emergency Clinic with 13 hours of oxygen, an anti-inflammatory injection and a neural stimulator. The Dr. put him on a regime of homeopathic remedies which, after 48 hours, seem to be working well as he is very alert and eating, eliminating and responding to stimuli. My questions are: is sleep and rest the best medicine at this point or should I be encouraging exercise and activity? What are the "regular" treatments usually used? Who can I call to find out the best physical therapy for him? Thank you very much. My regular vet was singularly unhelpful about this condition.

A: Cerebrovascular accidents are less common in cats and dogs than they are in people, but they do occur. Unfortunately, there is no good way to diagnose them that I am aware of. There is also no documented successful treatment for them that I am aware of. So the disinterest from your regular vet may stem from an inability to confirm the emergency veterinarian's suspicions or an unwillingness to believe the diagnosis. It also may stem from the use of homeopathic remedies. Many vets have no idea how to discuss this situation with their clients -- most vets (including me) believe there is little basis for the theories behind homeopathy and we get in the situation where the only things we have to say are bad things. So we follow our mother's advice and don't say anything since we don't have anything nice to say. It doesn't serve the patient or client well but it avoids a certain amount of controversy and it seems to be human nature to do that.

Conventional wisdom would be to look very hard for a source of the infarcts that lead to the cerebrovascular injury. In cats, cardiomyopathy must be rule out since it is the most common cause of infarcts in that species. Fungal brain infection, toxoplasmosis, feline infectious leukemia and feline immunodeficiency virus should all also be ruled out. Causes of hypertension, such as kidney failure and hyperthyroidism should also be ruled out.

Recovery from cerebrovascular injury usually does occur in cat and it often occurs quickly. If there is not a serious underlying cause like cardiomyopathy there is a good chance of full or nearly complete recovery with just good nursing care. There can be permanent personality changes or motor function losses. If the residual problem is minor, Eenie should adjust OK.

Mike Richards, DVM

Cerebellar Hypoplasia

The cerebellum is the portion of the brain responsible for the control of motion. When a puppy or kitten is born with an underdeveloped cerebellum, the condition is known as congenital cerebellar hypoplasia. There are infectious causes of this condition in both cats (panleukopenia infection prior to birth) and dogs (herpes virus infection prior to birth). Improper development of the cerebellum may occur due to injury, poisoning or just from an accident in development in the uterus. It is generally possible to see signs of this condition almost as soon as the puppy or kitten is born. Affected animals have tremors and unusual jerky movements or may fall down when they try to move. The symptoms do not get worse as they age. As the kitten or puppy grows it will learn to compensate for its condition but there are usually lifelong signs of a decreased ability to coordinate movement. Almost all dogs and cats with congenital cerebellar hypoplasia can live happily as pets with a little special care to compensate for their disabilities. This condition can be confused with cerebellar abiotrophy, a different disorder in dogs in which the puppy has a normal cerebellum at birth but it gradually dies. Signs of disease identical to cerebellar hypoplasia occur but the timing is different. Puppies with this condition seem normal at birth but usually start to show signs of problems after they are 2 months or more of age.

Mike Richards, DVM

Cerebellar hypoplasia in kitten

Q: My 4 week old kitten was born with some problems. He has since birth not been able to walk more than a couple of feet without tipping over several times on the way. He gets right back up and trys again just cant seem to get the coordination or has an uncontrolled loss of balance. He also has very big eyes that do not have the pupils like a cats (you know the slits) his are like peoples round. He cannot see anything but shadows and hears very well this is how he gets around. When he hears my voice he can't get to me quick enough. He has a lot of personality and eats fine from his mom he just gets lost sometimes since he doesnt see very well and tips over all the time. His brothers and sisters are fine and healthy and so is the mama kitty. If this sounds familiar please give me some insight on this. We are going to keep this cat and want to understand his problem or know if it will improve. My husband and I don't have alot of money for a vet so maybe you can be of help. Thanks M.

A: Your kitten may have cerebellar hypoplasia. This is lack of development of the cerebellum, which controls balance functions. If this is the case the condition is not curable but most kittens will learn to get around well enough to have a good life. Ear diseases can lead to similar signs. It really would be worth one office visit to get a better idea of the diagnosis and to make sure that you didn't miss something treatable that could help this kitten out.

Hope this helps.

Mike Richards, DVM

Seizures in Cats


A: Seizures are not as common in cats as they are in dogs and there seem to be fewer common inciting causes. Primary epilepsy (basically seizures that can't be explained for any other reason) may occur in cats, especially pure-bred cats. Feline infectious peritonitis causes seizures and feline immunodeficiency virus and feline leukemia virus probably do, too. Toxoplasmosis, a protozoal infection, causes seizures in cats. Some cats have liver or kidney problems that lead to seizures. Cats can have seizures after ischemic neuropathy (loss of blood flow to a portion of the brain). Trauma is a possible cause. The seizures can occur a long time after the initiating trauma. Some toxins cause seizures, such as lead and insecticides. Brain tumors can cause seizures but this usually occurs in cats that are older than yours.

I think it is a good idea to try to rule out feline leukemia and feline immunodeficiency virus (FIV) since there are good tests for these problems. It would be a good idea to consider bloodwork to check on liver and kidney disease, at least. Ruling out toxoplasmosis and FIP can be difficult but there are some clinical signs associated with these diseases. Your vets will probably suggest these things, too. Sometimes, there is a tendency to wait until the seizures recur (since that doesn't always happen) but with the close occurrence of the two episodes you have seen, I really think a good lab workup is in order. I hope this all works out OK.

Mike Richards, DVM

Last edited 03/13/04


Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...