Modified Manual Therapeutic Plasma Exchange Technique as a Successful Treatment for Postattenuation Neurological Signs (PANS) in a Dog.

Manual therapeutic plasma exchange may be a viable rescue therapy for refractory PANS following portosystemic shunt attenuation in dogs.

This case report describes the successful use of a modified manual therapeutic plasma exchange (MTPE) technique to treat postattenuation neurological signs (PANS) in a 4-year-old neutered female Yorkshire Terrier. The dog was diagnosed via computed tomography with a congenital extrahepatic portosystemic shunt (left gastric to azygos vein) and underwent uncomplicated surgical attenuation. Within 48 hours postoperatively, the patient developed refractory generalized tonic-clonic seizures unresponsive to standard medical management. Hepatic encephalopathy was ruled out, and a presumptive diagnosis of PANS was established based on clinical timing and progression. MTPE was performed over an 8-hour period with minimal procedure-related complications, resulting in marked clinical improvement and complete resolution of neurological signs prior to discharge. PANS is a recognized but poorly understood complication following portosystemic shunt attenuation in both dogs and cats, characterized by neurological dysfunction that persists or develops after surgery despite normalization of hepatic portal circulation. Its pathophysiology remains incompletely elucidated, and therapeutic options are limited. This report represents the first documented application of MTPE for PANS in a dog, with only one prior feline case report existing in the veterinary literature. The technique offers a potentially viable rescue therapy for refractory PANS cases when conventional medical management fails, though further prospective studies are needed to establish standardized protocols, efficacy, and safety profiles across larger patient populations.

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