Case Report: Post-stroke hemorrhagic infarction in a status epilepticus Beagle dog

This case describes the acute neuropathology of a 4.5-year-old male Beagle that presented with status epilepticus and a simultaneous post-stroke hemorrhagic infarction. The clinical course involved 5 days of refractory cluster and generalized seizures, during which the patient remained in a "grave" borderline threshold on the Modified Glasgow Coma Scale. Initial hematobiochemical analysis revealed marked elevated levels of serum creatine kinase and aspartate aminotransferase, indicating severe muscular exertion, alongside dehydration and a 30% decline in serum albumin levels. Concurrent absolute monocytosis and neutropenia were observed, reflecting a systemic neuroinflammatory response. Treatment included intravenous diazepam boluses followed by a constant rate infusion of oral potassium bromide and hypertonic saline to manage suspected cerebral edema; however, the animal remained refractory to therapy. A gross examination at necropsy showed that the frontal lobe had multifocal tarry red subarachnoid and parenchymal hemorrhage extended to the olfactory bulb with a contralateral dull gray focus of infarction. Histopathological analysis confirmed multifocal thrombosis and liquefactive necro-hemorrhagic foci, accompanied by significant neuronal degeneration and spongiosis. The newly formed vessels in the peri-infarct regions demonstrated robust expression of VEGF-A and reticulin, which is an early marker of inflammatory extracellular matrix changes, while mature collagen and elastin were completely absent. These findings indicate that the observed vascular proliferation was an acute and active process rather than a pre-existing lesion, contrasting with previous findings on chronic epilepsy in dogs. This case reinforces the critical role of VEGF-A-driven angiogenesis and vascular growth in the development of acute structural epilepsy in dogs. Furthermore, the case exhibits features of post-stroke epilepsy, indicating a potential tissue-based marker that could enhance the detection of seizure recurrence through advanced imaging and assist in the discovery of novel therapeutic targets.