Cerebrovascular Accident (Stroke) in Captive,Group-Housed,Female Chimpanzees

Over a 5-y period, 3 chimpanzees at our institution experienced cerebrovascular accidents (strokes). In light of the increasing population of aged captive chimpanzees and lack of literature documenting the prevalence and effectiveness of various treatments for stroke in chimpanzees, we performed a retrospective review of the medical records and necropsy reports from our institution. A survey was sent to other facilities housing chimpanzees that participate in the Chimpanzee Species Survival Plan to inquire about their experience with diagnosing and treating stroke. This case report describes the presentation, clinical signs, and diagnosis of stroke in 3 recent cases and in historical cases at our institution. Predisposing factors, diagnosis, and treatment options of cerebral vascular accident in the captive chimpanzee population are discussed also.Abbreviations: CVA, cerebrovascular accidentCerebrovascular accident (CVA; stroke) is a disturbance in brain function due to insufficient or complete loss of blood supply to an area of the brain. The lesion and clinical signs depend on the severity and location of the blockage. The 2 main categories of stroke—ischemic and hemorrhagic—both result in a loss of blood flow to an associated area of the brain. Ischemic strokes are due to either insufficient or direct loss of blood flow to the affected area of the brain from either temporary or permanent arterial occlusion of vessels supplying that area. Hemorrhagic strokes occur from rupture of a blood vessel and subsequent leakage of blood intracranially or into the subarachnoid space which results in clotting and decreased blood flow within that vessel and compression of the brain.^8,14,16,19 Loss of blood supply to a part of the brain, which can occur with ischemic or hemorrhagic stroke, initiates an ischemic cascade. The ischemic cascade is the result of secondary lack of oxygen and glucose; this lack consequently changes the intracellular metabolism from aerobic to anaerobic. This process ultimately leads to cell death and resultant disruption of cell membranes, thereby releasing toxins into the surrounding area and leading to increased cell death. This process results in a centrifugal progression of irreversible tissue damage and cell death.^1,11Brain tissue ceases to function when deprived of oxygen for more than 60 to 90 s, and irreversible tissue necrosis and brain damage can occur after a few hours. Ischemic strokes can result in varying degrees of damage to the tissue; consequently, clinical signs depend upon the amount of collateral circulation supplying the affected region of the brain. Part of the tissue may die immediately, whereas other parts may be injured only temporarily and ultimately recover.⁸ Clinical signs that are typical of stroke victims consist of abnormal sensations, hemiparesis (that is, paralysis in one arm or leg or on one side of the body), aphasia, ataxia, and urinary incontinence. Severe strokes can result in stupor or coma. The defect in the brain usually is manifested as clinical signs on the opposite side of the body, depending on the part of brain that is affected.^8,9 Diagnosis typically is based initially on clinical signs and confirmed with imaging techniques such as CT and MRI, or the lesion is noted at necropsy.^6,16Whereas strokes are common in humans, only one report to date has discussed and documented spontaneous stroke in a chimpanzee.⁶ In 2004, a 29-y-old male chimpanzee at a zoo experienced an ischemic stroke that most likely was due to occlusion of the middle cerebral artery.^2,6 The area of the brain supplied by the middle cerebral artery is the area most often affected in ischemic stroke in humans.^2,10 Although stroke has not been thoroughly researched in chimpanzees, studies in other species of nonhuman primates suggest that the predisposing factors and pathology are similar to those in humans.^3,18,20This case report describes the presentation, clinical signs, and diagnosis of CVA that occurred in 3 chimpanzees over a 5-y period at our institution and in an additional 3 animals identified during a retrospective review of the health records from the last 30 y. We also discuss predisposing factors, diagnosis, treatment options, and statistics of CVA in the captive chimpanzee population.