I had a strange case this week where a patient had a grand mal seizure immediately after an FNA of the liver. The patient never recovered from this and we euthanized the next day. Just wondering if anyone has had this happen as I can not find any references anywhere about liver FNA’s causing seizures.
– 10 year old MN German Shephard cross history of mild weight loss and a “little off” according to the owner 2 weeks prior to presentation; no prior history of seizures
– ALP around600, ALT 236, bilirubin normal, CBC normal, being treated for hypothyroidism and T4 normal
I had a strange case this week where a patient had a grand mal seizure immediately after an FNA of the liver. The patient never recovered from this and we euthanized the next day. Just wondering if anyone has had this happen as I can not find any references anywhere about liver FNA’s causing seizures.
– 10 year old MN German Shephard cross history of mild weight loss and a “little off” according to the owner 2 weeks prior to presentation; no prior history of seizures
– ALP around600, ALT 236, bilirubin normal, CBC normal, being treated for hypothyroidism and T4 normal
– pet admitted for ultrasound and pre/post bile acids test on Tuesday
– 0.2 mg/kg butorphonal given IV prior to FNA as patient very stressed and wiggly
– ultrasound showed a hyperechoic liver with multiple ill-defined nodules of various echogencities and round liver margins
– spleen mutiple hypoechoic nodules of various sizes, some distorting the capsular margins and several target lesions noted
– no effusion, lymphadenopathy or other lesions noted
– 3 FNAs of the spleen were taken with 25 gauge needle and 1 FNA of the liver using a 22gauge spinal needle
– immediately after the liver FNA, pet had a grand mal seizure – gave valium (twice) then needed to give phenobarb to control
– started IV fluids
-pet never recovered from “coma-like” stated and then several hours later started cluster seizuring and owners elected euthanasia
– pre-post bile acids came back as significantly elevated; FNA results consistent with a hepatic carcinoma with metastasis to the spleen.
So, a very sick dog but still not sure if it was the butorphanol, the stress or the FNA that may have caused to seizure? Any thoughts?
Comments
Sounds more like carcinoma
Sounds more like carcinoma mets to the brain or some sort of paraneoplastic release at worst from the fna but i doubt th efna had anything to do with it with a 25g. The CNS does weird things when riddles wiht neoplasia and combine with sedation…. its like the threshold drops… Given that multicentric badness was present and documented makes sense that th ebrain was likely involved as well.
Sounds more like carcinoma
Sounds more like carcinoma mets to the brain or some sort of paraneoplastic release at worst from the fna but i doubt th efna had anything to do with it with a 25g. The CNS does weird things when riddles wiht neoplasia and combine with sedation…. its like the threshold drops… Given that multicentric badness was present and documented makes sense that th ebrain was likely involved as well.
I really doub’t the FNA had
I really doub’t the FNA had anything to do with the seizure. I reviewed the side effects of Butorphanol and it does state not to use it in animals with severe liver or kidney disease. It has caused seizures in some animals when overdosed. I suppose even a reasonable dose of Butorphanol (like you gave) in a diseased brain or liver could cause an issue. Considering the results of the biopsy there was not much that could have been done to extend life. I am not sure what would have been a safer alternative.
I really doub’t the FNA had
I really doub’t the FNA had anything to do with the seizure. I reviewed the side effects of Butorphanol and it does state not to use it in animals with severe liver or kidney disease. It has caused seizures in some animals when overdosed. I suppose even a reasonable dose of Butorphanol (like you gave) in a diseased brain or liver could cause an issue. Considering the results of the biopsy there was not much that could have been done to extend life. I am not sure what would have been a safer alternative.
Thanks for contributing the
Thanks for contributing the butorphanol research Randy!
Thanks for contributing the
Thanks for contributing the butorphanol research Randy!
I remember during my
I remember during my internship year 2 or 3 cases with undiagnosed brain timors having adverse effects to butorphanol sedatIon. I will check with my intern buddies because I don’t remember the specifics.
I remember during my
I remember during my internship year 2 or 3 cases with undiagnosed brain timors having adverse effects to butorphanol sedatIon. I will check with my intern buddies because I don’t remember the specifics.