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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 28538
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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My cat had sudden onset of blindness starting in one eye and

Customer Question

My cat had sudden onset of blindness starting in one eye and progressing to the other. The onset was in a matter of days and was also accompanied by thirst and every diluted urine. Blood test are normal and ruled out renal failure and diabetes, blood pressure
is normal and the cat is eating but driving a lot of fluids. My vet has not been able to offer much beyond making her comfortable and providing some steroids. The treatment seems very non specific and diagnosis is simply neurological. What next steps can I
take to understand if there are some treatment options at least to help restore some sight or to help with the water retention issue.
Submitted: 1 year ago.
Category: Cat
Expert:  Dr. Michael Salkin replied 1 year ago.
Can you upload a copy of her test results to our conversation? I understand that you might not have a copy of the results at home but her vet should be able to give you one which you could scan into your computer and give me the link or you can photograph the page(s) and upload the images by using the paperclip icon in the toolbar above your message box (if you can see such an icon) or by using an external app such as dropbox.com. Hypertension causing retinal hemorrhage and detachment is the most common cause of Twitch's blindness and so I'm circumspect about her blood pressure readings. Hypertension may be primary and idiopathic (unknown cause) in cats and often accompanies hyperthyroidism in cats of Twitch's age. If hypertension can be ruled out, optic nerve, chasm, or tract disorder as well as a tumor in her visual cortex need to be considered. Ideally, a specialist veterinary ophthalmologist should take a look at Twitch and will be able to narrow down the differential etiologies. Her polydipsia (increased thirst) and polyuria (increased volume of urine) with dilute urine is common at her age and usually due to chronic renal insufficiency. I also consider chronic hepatic insufficiency, diabetes mellitus and diabetes insipidus (rare), urinary tract infection involving the kidney(s), electrolyte (sodium, potassium, calcium) imbalances, Addison's disease (rare), Cushing's disease (rare), and brain tumor. Most of the aforementioned should have been ruled out by normal test results; hence, my needing to review the results.
Customer: replied 1 year ago.
The Vet did say they had checked her blood pressure and it was fine and said her retina was 100% normal in both eyes. They did say they run a full spectrum of test on the bloods and they were all normal for a cat of her age. Also when they shown a torch in her good eye, when it was still working there was no response from the bad eye. A friend of ours who is a doctor did mention Diabetes Insipidus…. She is due to see the vet again on Friday but I will see if I can get the bloods and blood pressures tests tomorrow. Another Vet had mentioned the possibility of a stroke and brain bleed leading to pressure on the brain?
Expert:  Dr. Michael Salkin replied 1 year ago.
Thank you for the additional information. The lack of the consensual pupillary light reflex ("...no response from the bad eye.") is a poor prognostic indicator because minimal retinal function is required to retain that reflex. It's dependent on the integrity of the subcortical pathway (it doesn't involve the cerebral cortex) and so stroke is less likely unless bleeding caused a more general inflammation that also involved that pathway. Unfortunately, we don't have specific therapy for stroked patients. Treatment is symptomatic and supportive, only.Please continue our conversation if you wish.
Customer: replied 1 year ago.
Thank you for your comments. I think we are going to see how she progresses for a couple of weeks and then make a call on the options. She is old cat, last thing I want is more invasive tests and scans if the prognosis is poor. We may just her checked by an ophthalmologist before making any final decisions.
Expert:  Dr. Michael Salkin replied 1 year ago.
You're quite welcome. I understand your pragmatic approach. I can't set a follow-up in this venue and so would appreciate your returning to our conversation with an update - even after rating - at a time of your choosing.
Customer: replied 1 year ago.
We have seen a quite sudden deterioration, lethargic, unable to control urination. The Veterinarian has prescribed some wide spectrum antibiotics before we make a call on euthanasia. One thing i didn't say, all the symptoms seemed to have started when the cat was found drinking water from the christmas tree bowl. We check the water for heavy metals such as lead, pesticides and nitrates and all were negative. We did check the water for dangerous bacteria, that came back positive but we would need to send another sample to find out what bacteria were present. We don't know if this would be related to the blindness or the loss of bladder control / increased thirst and diluted urine.
Expert:  Dr. Michael Salkin replied 1 year ago.
While possible, I would consider the water far less likely to be incriminatory than what we've previously discussed in such a geriatric Twitch. There's every reason to believe that her brain is irreversibly affected at this time. I wish I could be more encouraging...
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Customer: replied 1 year ago.
Thanks for your help and advise, Twitch is now existing rather than living. We believe its time to do the right thing for her and feel comfortable we have done all we can.
Expert:  Dr. Michael Salkin replied 1 year ago.
You're quite welcome. I agree with you. My condolences in advance.
Thank you for your kind accept. I appreciate it.
You may receive an inappropriate follow up sent by the site ostensibly sent by me. It wasn't and I apologize in advance should you receive it.