Hemophilia A Resulting in Severe Hyperesthesia Due to Extraparenchymal Spinal Cord Hemorrhage in a Young Golden Retriever Puppy

SIMPLE SUMMARY: This case report describes a case of a male Golden Retriever puppy with spinal cord bleeding caused by hemophilia A. Hemophilia A is a congenital clotting disorder in which there is a lack of one of the clotting factors (factor VIII). It can cause spontaneous bleeding in the skin, muscles, and joints, and, in rare circumstances, also in the vertebral canal. Spinal cord bleeding most frequently results in neurologic deficits such as weakness or even paralysis of one or more limbs, but it has also been associated with spinal pain. Our case presented with severe, generalized pain and mild hindlimb weakness. Computed tomography findings of the spinal cord showed changes compatible with hematomas in the vertebral canal. A diagnosis of hemophilia A was made based on abnormal clotting test results and a significantly decreased factor VIII activity (FVIII:C). Currently, there is no treatment for hemophilia A, so medical management is mainly supportive, and aimed at stopping severe bleeding episodes. Even though the dog responded well to analgesic treatment, the prognosis for severely affected dogs is guarded as recurrent bleeding is often seen. Because of this, the owner of the puppy elected humane euthanasia. ABSTRACT: A ten-week-old male Golden retriever puppy was presented with severe hyperesthesia, mild neurological deficits and episcleral bleeding. Clotting times showed a normal prothrombin time (PT) and prolonged activated partial thromboplastin time (aPPT). Computed tomography (CT) of the vertebral column showed intradural, extraparenchymal hyperattenuating changes on precontrast CT images and epidural mass lesions, suggestive of hematorrhachis. Hemophilia A was confirmed by a low-factor VIII activity (FVIII:C). Although the dog improved clinically with intravenous analgesia and cage rest, it was euthanized by the owners’ choice because of the risk of developing future episodes of spontaneous hemorrhage. In young male puppies with severe hyperesthesia and mild neurological deficits, hemophilia A should be considered as a possible differential diagnosis.