Strokes in Cats

By Dr. Justine A. Lee, DVM, DACVECC and http://www.askthecatdoctor.com/feline-stroke.html

There are two types of strokes in cats:

(1) Ischemic – the blood supply to an area of the brain is cut off

(2) Hemorrhagic – the wall of a blood vessel is damaged and blood leaks out of it into an area of the brain

In either case, an area of the cat’s brain can be deprived of oxygen or damaged from pressure and a stroke follows.

 

It’s scary to see your cat suddenly not be able to walk, look drunk, fall over to his or her side, have a head tilt, or act neurologically inappropriate (e.g., seizure). Other signs that look like “acute strokes” in cats include:

 

• sudden imbalance
• falling over to the side
• not being able to walk
• vomiting
• nausea
• inappetance (who wants to eat when they are nauseated?)
• rolling or circling to one side
• nystagmus (abnormal eye movement)

When this happens, there are four primary causes:

• an ischemic event secondary to hypertension
• a life-threatening blood clot called a “saddle thrombus”
• vestibular disease
• a brain tumor

 

Keep in mind, however, that these symptoms are the symptoms of so many other diseases. Just because your cat has some of all of the above symptoms does not mean she has had a feline stroke. All of the symptoms are serious so an immediate trip to the veterinarian is essential. I know that I say this in almost every article I write, BUT the earlier a diagnosis is made, the better the outcome.

Possible Causes of a Feline Stroke

• Trauma
• Anything that interferes with the clotting ability of the blood
• Blood clot
• Heart Disease
• High Blood Pressure
• Hyperthyroidism
• Diabetes
• Kidney Disease

 

In older cats, secondary hypertension (high blood pressure) may be a result of chronic kidney disease, hyperthyroidism (an overactive thyroid gland), or even cardiac disease. With uncontrolled hypertension (in other words, if it wasn’t previously diagnosed or isn’t responding to blood pressure medication called “Norvasc,” or amlodipine), an acute ischemic event can occur. This means that lack of blood flow occurs in a region (typically in the brain or spinal cord), and results in neurologic abnormalities. Thankfully, ischemic events often respond well to symptomatic supportive care and anti-hypertensive blood pressure medications. However, these ischemic events can leave permanent neurologic defects in your cat like wobbliness, a head tilt, etc.

 

The second cause may be due to a blood clot (commonly called a “saddle thrombus”). This is typically due to severe heart disease, and may result in severe pain. Due to the complexity of this disease, which typically has a poor prognosis, I’ll cover it in a separate blog.

 

The third cause is similar to old dog vestibular disease in dogs. While cats rarely get acute vestibular disease (like a tinnitus in humans), it can occur acutely for several reasons: from ear infections; from a tumor in the ear; from sticking aQ-tip too far down in your cat’s ear; cleaning your cat’s ear with liquid ear medications; from old trauma or underlying metabolic problems; or just simply for no reason at all (we call this reason idiopathic vestibular disease in cats, which is a fancy way of saying that we have no idea what caused it!).

 

Lastly, underlying cancer or infections in the brain or spinal cord can cause these signs. When in doubt, a CT or MRI may be necessary to diagnose what’s going on. But before potentially euthanizing for an “acute stroke,” make sure to check with a veterinarian. Simple tests like a blood pressure, thyroid level, kidney test, and chest x-rays are a great place to start to help rule out some of the more benign versus malignant causes.

 

Simple tests like a blood pressure, thyroid level, kidney test, and chest x-rays are a great place to start to help rule out some of the more benign versus malignant causes.

However, for a definitive diagnosis, CT or MRI is needed. In reality, most cat owners do not have this type of testing capability in their area or cannot afford it, so in many, many cases, the diagnosis of a feline stroke is made on the basis of history, physical exam and the ruling out of other diseases through laboratory tests and radiology.

Treatment of a Cat Stroke

Treatment for a cat stroke is most often supportive (warmth, food, care) although IV fluids may be needed as well as anti-inflammatories, seizure medications, and other treatments as determined by the cat’s needs. If an underlying cause has been determined, then treatment will also be directed at that cause.

For example, if feline heart disease has been discovered, then heart medications, dietary changes, and other treatments directed at the underlying heart disease will be prescribed. If the cat has an elevated thyroid level and has been determined to have feline hyperthyroidism, then medication for hyperthyroidism in cats will be prescribed.

However, in many cases, an underlying cause is not found and treatment will involve time, patience, and support. Keeping your cat well hydrated, well fed, warm and comfortable goes a long way toward recovery.