Key-Gaskell Syndrome in Cats

All breeds and ages are at risk, although more cases of younger cats with this syndrome have been reported. It is a relatively rare issue, having only been seen in the past 35 years. Both sympathetic (chain-like groups beside the spine) and parasympathetic (near or in organ walls) ganglia, or cell groupings, are affected by feline dysautonomia. The onset of this syndrome can be as fast as a few hours or as gradual as a few weeks. It seems there is a contagious or common element aspect to Key-Gaskell Syndrome. Symptoms are very aggressive and need veterinary treatment to maintain the cat's comfort level.

Feline dysautonomia, often called Key-Gaskell Syndrome, is an occurrence of the autonomic nervous system (ANS) malfunctioning in a degenerative manner. The ANS monitors autonomic processes in the body such as breathing, digestion, and heart rate. When this system starts to lose function, all of the automatic happenings in the body also lose function.

There is a very wide range in severity of symptoms depending on how the cat responds to the syndrome and how far it has progressed. Symptoms are varied and extensive:

• Depression
• Weakness
• Protruding third eyelid
• Upper respiratory problems
• Diarrhea
• Vomiting
• Exaggerated swallowing
• Constipation
• Anorexia (lack of appetite)
• Weight loss
• Dry eyes/nose/mouth
• Dilated pupils and light sensitivity
• Incontinence
• Dilated anus
• Swollen esophagus
• Swollen abdomen
• Swollen bladder
• Droopy eyelids
• Slow heart rate <120 beats per minute
• Stranguria (extremely painful and slow urination)
• Coughing 

Currently, the cause of this syndrome is unknown, although dysautonomia is seen in other mammals. It was first recorded occurring in a cat in 1981 in England. Since then, other reports worldwide have turned up, increasing as the years go by.

Your veterinarian will request the cat's medical history prior to conducting an extensive physical examination. A biopsy may be needed to complete a histopathologic examination of an affected ganglia (cluster of cells). X-rays will be used to confirm dysfunction of the esophagus, and may also be used to check for aspiration pneumonia. Fluoroscopy (video-like X-ray) is sometimes used for this process.

A Schirmer Tear Test may be conducted, checking for eye secretions. Pilocarpine can be placed in the eye, which will have no effect on a healthy cat, but will constrict the pupil of a cat with Key-Gaskell Syndrome within 15 minutes. The vet will also test for feline leukemia virus, as it shares some of the same symptoms.

Unfortunately, no cure for this syndrome has been found. All treatments are strictly symptomatic, with supportive care being the main focus. 

Hydration 

The cat should be kept hydrated at a constant rate, with the bladder being manually emptied 3 times daily. 

Steam Inhalation 

This can help keep the cat breathing properly. It is important to keep the cat upright to prevent pneumonia from developing. 

Artificial Tears 

These may be used to keep the eyes comfortable while bringing back moisture to the mucous membrane.

Medications

Drugs such as metoclopramide, cisapride, or bethanechol may be prescribed to treat nausea, constipation, and urinary issues.

Feeding Tube 

In some cases, this may be the only way to provide nutrients to the cat.

General Nursing 

Keeping the cat clean and warm can help promote healing throughout this strenuous process.

This syndrome carries a poor prognosis with high mortality rates. Often, affected cats are euthanized to end suffering. Aspiration pneumonia is a secondary condition that can set in and it has the potential to cause death. For cats that do recover, the healing process takes up to a year and usually leaves the cat with lasting neurological problems. A small number of cats have made a full recovery.

Treatment can improve the function of the digestive system and help reduce vomiting. If nutrients are kept flowing through the cat, the overall attitude of the cat may improve. Survivors often maintain higher heart rates throughout symptoms.