C10027017 / invoice 10000

Patient Information:- Rusty, Dog, 15 weeks old- Date of Examination: 13/03/2026Subjective:- Presenting for investigation of episodic neurological events; has been to the Emergency and Critical Care department twice previously- Initial episode occurred on 21/02/2026 when Rusty was racing down the hallway, could not pull up on floorboards, went into a skid position and hit his head; was unable to get up afterwards, though did not appear to lose consciousness completely- Subsequent episodes have occurred while asleep and waking up- First video-recorded episode: woke from sleep, on the ground, stood up stiff and ataxic but responsive; episode lasted approximately one minute before returning to normal within a couple of minutes with no ill effects; normal eating, drinking and behaviour resumed- Second video-recorded episode: awake, conscious but not very responsive with subtle tremor; episode lasted approximately thirty-five minutes; stood up and was slightly ataxic with altered consciousness; returned to completely normal within a couple of minutes- Owner has been working from home due to concerns about leaving Rusty- Appetite is very good- Vomited last night secondary to coprophagia- No diarrhoea- Diet consists of Supercoat puppy mix with boiled chicken breast on top- Has not eaten since last night, only water today- Booster vaccination was due yesterday but appointment was changed to blood tests following the first episode; blood tests were then cancelled after the Wednesday episode to proceed directly to referral- Rusty is insuredObjective:- Body condition score: 3 out of 5- General clinical examination: normal- Neurological examination: normal gait, normal postural reactions, normal tone, normal reflexes- Cranial nerve function tests: normal menace response, normal oculocephalic reflex, no nystagmus, normal pupillary light reflex direct and consensual- Integument: normal- Mentation: appropriateAssessment & Plan:1. Episodic Neurological Events - Suspected Focal Seizures- Assessment: episodes appear consistent with focal epileptic seizures based on video evidence; Rusty appears not quite responsive and abnormal during episodes with ataxia and altered mentation; episodes occur after resting- Differential diagnoses discussed: extracranial causes affecting the brain such as metabolic problems including liver disease or electrolyte abnormalities; intracranial causes including early onset epilepsy with no underlying cause, structural brain abnormalities such as a cyst, neurodegenerative condition, or meningitis; cancer considered unlikely in a dog of this age; portosystemic shunt considered less likely based on clinical appearance- Recommended diagnostic tests: full biochemistry, haematology and electrolytes; bile acid stimulation test to assess liver function and rule out portosystemic shunt- If blood tests are abnormal, no further investigation required at this stage; if blood tests are normal, magnetic resonance imaging of the head will be recommended- Magnetic resonance imaging would be booked for next week if indicated- Sedation may be required for blood collection given age and difficulty with venipuncture; gabapentin discussed as an option to take the edge off- Rusty admitted for blood tests today; owner to return at approximately 1 to 2 o'clock for collection- Results expected by Monday- Follow-up: monitor over the weekend; if further episodes occur, video record them; can present on Sunday if concerns arise as clinician available for emergency; if blood tests are normal and magnetic resonance imaging is required, will proceed with booking    Vital Signs    

History:- inital presentation to ECC on Friday 06/03/26 represented today for similar signs as last time, second video presented by owner shows Rusty was lying down then started having whole body tremors, after trying to stand he was notably ataxic, there was no loss of consciousness, paddling or urination/defecation during the episode, the episode lasted approximately 1-2 minutes with full recovery afterwards- since last presentation Rusty has remained EDDU normal, no V/D/C/S- owner has been more vigilant since initial episode and has been trying to look for any preceeding signs/events, none noted- owner unable to get vet appointment for bloodwork, was trying to call rDVM today to schedule Triage:- BAR- MM pink, CRT <2, HR 144- RR 24, normal effortCommunication:- advised Rusty would likely benefit from referral to neurology service rather than another ECC consult today as he appears stable on triage, bloodwork recommended and can also be performed during that time- owner happy to proceed with referral, appointment booked for Friday 13/03/26    Vital Signs    

Reason: Seizure-Like Activity. DAAppointment Notes: Special payment terms exist, Overdue remindersConsultation Time: 2150Hospital Time Period: N/AHISTORY:  Presented for concerns of tremoring and ataxia. Owner presented 1 minute video during consult which showed Rusty having whole body tremoring while he was lying down on his bed. He then stood up and tried to walk around but was notably ataxic. He was conscious the whole time. The episode started roughly 20 seconds prior to when the owner started videoing him and he was weak on his back legs for several minutes afterwards. He has recovered back to normal since then. There was no known trauma or precipitating event prior to this. A similar episode had occurred roughly two weeks ago when Rusty had hit his head on the floor, the episode was characterised by tremoring and ataxia as well. Rusty has been in the owner's care for roughly 6wks. He has no known previous medical history that the owner is aware of and there has been no known access to any toxins. He has otherwise been EDDU normal, no V/D/C/S has been noted. Rusty shares the home with one other dog who is not up to date with its vaccines.Diet: Supercoat puppy food with boiled chicken breast topper and puppy training treats.  Current meds: noneVaccination: UTD, next vaccine appointment booked for this coming TuesdayParasite Prevention: UTDPre-existing conditions: noneAccess to toxins: none SUBJECTIVE:- BAR- very wiggly to examineOBJECTIVE:Temp: unable           MM: pink             CRT: <2            HR: 152 (pulses)            FP: normokinetic and synchronous             RR: pantingBCS:    5/9                Wgt: 10.4 kg  CV: no cardiac murmur, normal rhythmRESP: clear lung sounds bilaterally, normal effort, costoabdominal pattern, no nasal dischargeGIT: soft and pliable, no obvious pain/discomfort even on firm palpation, no abdominal distensionU/G: entire male, both testicles descendedNeuro: mentation and ambulation appropriate, normal facial symmetry, pupils equal and responsive, normal facial/nasal/aural sensation, gag present, no postural defecitsM/S: ambulatory x 4, no obvious lameness or ataxia, full exam not performed Ophth: clear, no ocular discharge or other abnormalitiesInteg: normal coat, no dermatopathyLNs: no peripheral lymphadenopathyPROBLEM LIST:- Tremoring- AtaxiaDIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:- Focal seizures vs other episodic disorder vs other systemic disorders (e.G. PSS etc)ASSESSMENT:- cardiovascularly stable- neurologically normal TREATMENT:  - none required at this stagePLAN:- Recommended bloodwork, owner has appointment with primary care veterinarian next week for vaccination and would prefer to have blood test done there (advised owner should call first to notify clinic of this)- If episode reoccurs consider referralt to SAIM or neurology serviceCLIENT COMMUNICATION:Discussed that while the clinical signs are abnormal, Rusty is currently stable. Explained the recommendation for blood tests to screen for underlying congenital conditions (e.g., liver or kidney issues) that can cause neurological signs. Advised that referral to a specialist neurologist may be required for advanced imaging or further workup if episodes continue. Instructed the owner to inform their primary vet clinic of this visit and the plan for blood work to ensure they book an appropriate appointment length.    Vital Signs