Surgical management of a brain abscess in a cat

Abstract A 3‐year‐old, male, neutered, domestic, medium‐haired, crossbreed cat presented to a veterinary emergency department with a history of inappetence and neurological clinical signs following an unwitnessed catfight. Initial neurological clinical signs included mild obtundation, proprioceptive ataxia, wide‐based stance and rightward circling. The cat had bilaterally absent menace responses and bilaterally dilated pupils. Placing proprioception was reduced in the right thoracic and pelvic limbs, while myotatic and withdrawal reflexes were normal. There was no evidence of paresis. Initial management included a course of antibiotics and analgesia. The cat returned to the emergency department 12 hours later for reassessment due to a deterioration in neurological status. Repeat neurological examination revealed similar clinical findings, although there was development of a spontaneous horizontal nystagmus with the fast phase to the right, and the cat was also severely obtunded, with minimal response to external stimuli. Neurological findings and previous history suggested a structural lesion of the forebrain (possibly with a thalamic component and/or an increase of intracranial pressure) with lateralisation to the left. This deterioration prompted advanced imaging with computed tomography. The computed tomography study revealed a comminuted skull fracture and multiloculated cerebral abscess. An emergency craniectomy was performed to drain purulent material and relieve the increased intracranial pressure. Post‐surgical recovery was uneventful, with significant improvement in the cat's neurological status within 24–48 hours. This case highlights the critical need for a prompt diagnosis and surgical intervention of brain abscesses in veterinary patients, while also emphasising the favourable outcomes associated with timely treatment.