Pneumocephalus due to temporohyoid osteoarthropathy in a 16-year-old Friesian mare.
Authors: Witt P, Stas E K L, Hardeman L C, van Proosdij E R, Weerts E A W S, Lloyd-Edwards R A, Veraa S, Kranenburg L C, van den Boom R
Journal: Journal of equine veterinary science
Summary
# Editorial Summary: Pneumocephalus Secondary to Temporohyoid Osteoarthropathy Temporohyoid osteoarthropathy (THO) is a well-documented cause of neurological disease in horses, but this 2024 case report describes an unusually severe presentation with potentially life-threatening consequences. A 16-year-old Friesian mare presented with progressive anorexia, weight loss, fever, bilateral nasal discharge, unilateral facial paralysis and a non-healing corneal ulcer—a constellation of signs initially consistent with severe THO affecting the cranial nerves. Computed tomography revealed grade 3 unilateral THO with fracture of the petrous temporal bone, which had created a communication between the cranial vault and the nasal passages, resulting in pneumocephalus (air within the cranial cavity). What distinguishes this case is the extension of the fracture into the petrous temporal bone and intracranial space; whilst temporal bone fractures are recognised complications of advanced THO, intracranial involvement with air accumulation has not previously been documented in equine literature. Despite medical management, the mare's condition deteriorated, and given the poor prognosis and extent of bony pathology, the owner declined surgical intervention and the horse was euthanased with post-mortem confirmation of the diagnosis. For practitioners managing older horses with progressive THO-related signs, this case highlights the importance of advanced imaging in severe presentations and the potential for life-threatening complications beyond the typical cranial nerve deficits typically associated with this condition.
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Practical Takeaways
- •Severe THO can lead to petrous temporal bone fractures with life-threatening complications including pneumocephalus; consider advanced imaging (CT) in THO cases with neurological signs.
- •Facial paralysis, non-healing corneal lesions, and persistent bilateral nasal discharge may indicate severe THO with bone involvement requiring immediate diagnostic evaluation.
- •Poor prognosis cases with severe THO complicated by temporal bone fracture may require euthanasia due to limited treatment options; discuss realistic outcomes with owners early.
Key Findings
- •Pneumocephalus developed secondary to grade 3 unilateral temporohyoid osteoarthropathy with petrous temporal bone fracture in a 16-year-old Friesian mare.
- •This is the first reported case of pneumocephalus due to petrous temporal bone fracture in a horse with THO.
- •Clinical presentation included anorexia, weight loss, fever, bilateral nasal discharge, unilateral facial paralysis, and non-healing corneal lesion.
- •Computed tomography imaging successfully identified the fracture extension into the cranial vault and associated pneumocephalus.