Electroencephalographic alterations in a mare with presumed intermittent neuroglycopenia caused by severe hypoglycaemia-associated with nonislet cell tumour

The focus of this report was to document the electroencephalogram (EEG) findings associated with nonislet cell tumour-induced hypoglycaemia (NICTH) in a racing Thoroughbred mare subsequently diagnosed with renal carcinoma and carcinomatosis. We evaluated cortical cerebral activity and confirmed paroxysmal activity consistent with subclinical seizures by performing an EEG prior to onset of clinical signs of seizures. We showed that the electrical activity pattern progressed in a similar fashion as in humans with severe, progressive hypoglycaemia and presumed neuroglycopenia. The glycaemic threshold for abnormalities detected in EEG showed that abnormal electrical cortical activity appeared when blood glucose dropped to 44 mg/dL (2.4 mmol/L) and paroxysmal activity spread, becoming generalised when blood glucose dropped to 23 mg/dL (1.3 mmol/L). NICTH is an uncommon paraneoplastic phenomenon in several species. In horses, NICTH has been reported most frequently in primary renal tumours, followed by primary hepatic tumours. This report highlights the importance of investigating the possibility of hypoglycaemia in cases of horses that present altered state of consciousness with or without intermittent seizures. This case report also highlights that the diagnostic work-up for horses presenting with episodic hypoglycaemia should comprise investigation of possible neoplasia, as paraneoplastic hypoglycaemia should be included in the list of differentials of horses with hypoglycaemia.