In this retrospective study, medical records of 9 cats with dysautonomia from 2 U.S. university teaching hospitals and a private specialty/emergency veterinary clinic in the Midwest from 2001 to 2006 were described and compared to reports of feline dysautonomia outside the United States and to reports of canine dysautonomia in the midwestern United States. Cats included had been diagnosed with dysautonomia on the basis of a complete medical history and either a histologic confirmation of the disease or clinical signs. Various autonomic nervous system function tests performed in 8 of the 9 cats supported the diagnosis. Definitive diagnosis of this disease is based on characteristic histologic lesions in the autonomic nervous system. The median age of the cats in this study was 1 year, which is consistent with previous reports that young cats are more often affected. Several different breeds were represented. Four cats were kept indoors, and 4 went inside and outside. Housing data were unavailable for 1. Six cats were from multicat households but were the only animal affected. All cats were native to eastern Kansas or western Missouri, and none had traveled outside of these states. From 1986 through 1994, only 4 feline cases were confirmed in the United States; however, hundreds of feline cases have been reported in Europe (mostly in the United Kingdom and Scandinavia). Six cats were euthanized within 5 days of hospitalization and 1 at a later date due to ongoing vomiting/regurgitation, weight loss, and inappetence. Another cat died 11 months later at home from an undetermined cause, and the other cat was lost to follow-up after 1 year. Previous studies indicate that the disease carries a poor prognosis, as no definitive treatment is available.

COMMENTARY: This article provides an in-depth report on a rare but devastating disease. Dysautonomia is a dysfunction of the autonomic nervous system. The cause is unknown. The disease has been reported in several different species. Feline dysautonomia should be suspected in any cat with a combination of vomiting, anorexia, elevated third eyelids, dilated pupils, and decreased pupillary light response. Several autonomic function tests can support the diagnosis. -- Perri C. Stark, VMD, MBA

Feline dysautonomia in the Midwestern United States: A retrospective study of nine cases. Kidder AC, Johannes C, O'Brien DP, et al. J FELINE MED SURG; in press, corrected proof, available online Oct 23, 2007.