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Six percent of older dogs with acute neurological signs had brain hemorrhage on MRI
A 25-dog retrospective study found spontaneous intra-parenchymal hemorrhagic stroke in 6% of dogs age 6 and older undergoing brain MRI for acute neurological signs, with frequent excellent outcomes.
A retrospective study of 25 dogs diagnosed with spontaneous intra-parenchymal hemorrhagic stroke found that the condition occurred in 6% of older dogs undergoing brain MRI for acute neurological signs, and that outcome was frequently excellent.
The frequency figure gives a number to use when a client asks whether their older dog with sudden-onset prosencephalon signs and seizures might have had a stroke. The outcome data let a practice counsel realistically rather than defaulting to euthanasia conversations before imaging.
What the study found
Older, small to medium breed dogs presented most often for prosencephalon dysfunction or new-onset seizures. Prosencephalon dysfunction occurred in 19 of 25 dogs, and new-onset seizures in 13 of 25, according to the study. MRI commonly showed a single, well-defined hemorrhage within the prosencephalon.
Outcome was frequently excellent and complete seizure remission was common, the authors reported. Larger lesion volumes were associated with poor outcomes. One dog had clinical signs consistent with a second spontaneous intracranial hemorrhagic stroke 4 months after the initial event. The authors stated that development of poststroke epilepsy is unlikely and that dogs rarely experience another hemorrhagic stroke.
How the study was built
This was a retrospective medical-record review of 25 dogs diagnosed with spontaneous intra-parenchymal hemorrhagic stroke between 2010 and 2024. The authors reviewed signalment, neurological and clinicopathologic findings, imaging, anatomic localization, comorbidities, therapy, and outcome. The study recorded lesion number, location, and volume, and outcome was defined as excellent, good, or poor. Frequency was calculated out of a contemporaneous population of dogs age 6 years and older presenting with acute neurological signs.
A retrospective design means the study describes what happened in these cases. It cannot prove that lesion volume predicts outcome or that any specific therapy changed survival. The study reviewed comorbidities and therapy in the medical records but the abstract does not detail what was found.
The number, and its error bars
The study reports 25 of 427 dogs age 6 years and older undergoing brain MRI for acute neurological signs had spontaneous intra-parenchymal hemorrhagic stroke, the 6% frequency. The abstract does not provide a confidence interval or p-value for that estimate. The abstract states that larger lesion volumes were associated with poor outcomes but does not quantify the association or provide a threshold volume.
If the neurologist calls with a preliminary read showing a large bleed, the data support tempering expectations. If the lesion is small and prosencephalic, the data support encouraging the workup.
What the authors say it cannot tell you
The authors state that secondary hemorrhage must be excluded before diagnosing spontaneous intra-parenchymal hemorrhagic stroke. The abstract does not detail what workup is required to make that exclusion. The study does not state other limitations.
Who paid for it
The abstract does not state funding sources or conflicts of interest.
What this means for your practice
VeterinaryPracticeNow's read, not the study's. Everything in this section is our editorial interpretation for practice owners. The study does not claim any of it.
One dog had a second event four months later. That is one recurrence in the series, not enough to change discharge instructions, but enough to mention when a client asks whether it will happen again. The honest answer is that it rarely does, based on this series.
The frequency figure is the number needed when a worried owner asks how common this is. It is not rare in the population this study looked at, older dogs sick enough to warrant brain MRI, but it is also not the first thing to rule out. We'd use it to justify imaging in an older dog with acute prosencephalon signs, and to counsel that excellent outcomes are common in this condition once secondary hemorrhage is excluded.
