Web-Vet TM Neurology Specialists
Meningitis / Myelitis
Steroid-Responsive
Meningitis Arteritis (SRMA)
The aim of this study was to determine whether breed differences exist in clinical features, treatment response, and relapse in 61 North American dogs with SRMA, and to evaluate the effect of disease on dogs' quality of life (QoL).
Breeds represented most often included the Golden Retriever (n = 12), Bernese Mountain Dog (10), Wirehaired Pointing Griffon (9), Boxer (9), and Beagle (6). No breed differences were identified with respect to clinical severity, diagnostic findings, or outcome. Twenty‐nine dogs (48%) had ≥1 disease relapse. There was a significant effect of cerebrospinal fluid nucleated cell count on the frequency of disease relapse, but no relationship was identified between treatment protocol and relapse. Dogs' QoL was associated with the severity of corticosteroid‐related adverse effects, which were dose‐related and more prevalent in Wirehaired Pointing Griffons than in other breeds.
This is a multi-center retrospective case series of 53 dogs diagnosed with steroid-responsive meningitis-arteritis (SRMA) in the UK that underwent MRI. The presence or absence of specific MRI abnormalities were analysed for significant associations with presenting signs, results of investigations or case outcomes.
The most common MRI findings were paravertebral muscle changes (30/53; 56.6%), meningeal contrast enhancement (13/41; 31.7%) and spinal cord parenchymal T2-W hyperintensity (15/53; 28.3%). Hemorrhage was observed in five of 53 (9.4%) cases which was positively associated with the presence of parasis/paralysis as was T2W intramedullary hyperintensity. Approximately a third of dogs relapsed but there was no associated MRI finding.
Steroid-responsive meningitis-arteritis: What have we learned since 2010? a narrative review
This article reviews a common neurologic disease and maybe the most frequent cause of neck pain with pyrexia in dogs. Although Boxers, Beagles, and Bernese mountain dogs are classically predisposed breeds, any breed could be affected and predispositions have also been described for multiple other breeds which include Border collies, Jack Russell terriers, Golden retrievers, German Shorthaired pointers, English Springer spaniels and Whippets. The most common clinical sign is neck pain - neurological signs can indicate progression of the disease and associated vascular compromises. The prognosis with early diagnosis and aggressive immunotherapy can be excellent but there are high recurrence rates noted in some studies. This review discusses the most recent studies which especially highlight new diagnostic and therapeutic considerations.
This study evaluated whether the resolution of clinical signs and rate of relapse of SRMA would be significantly different between a 6-month prednisolone protocol and a 6-week protocol.
All 44 included canine cases responded to their treatment protocol. Relapses occurred in 6/20 (30%) of the 6-month protocol and 9/24 (38%) of the 6-week protocol. There was no statistical difference in the incidence risk of at least 1 relapse between the 2 groups. Among the 15 dogs that relapsed, 10/15 (67%) relapsed once, 3/15 (20%) relapsed twice, and 2/15 (13%) relapsed 3 times. No statistical difference was detected in the incidence rate ratio of total relapse events between the 2 groups.
The study concluded that a “short” 6-week prednisolone protocol could be used to treat SRMA, thereby presumably reducing the duration and severity of prednisolone's adverse effects.
This study looked at the MRI characteristics of of the cervical spine in dogs diagnosed with SRMA. 70 dogs were selected with MRI abnormalities found in 69 of them. Enhancement of the meninges, nerve roots, synovium of the articular facets and paravertebral muscles was present in 61 (87.1%), 10 (14.3%), 34 (48.6%), and 34 (48.6%) cases suggesting that MRI can be a useful complementary tool to CSF analysis
Acquired cervical scoliosis in two dogs with inflammatory central nervous system disease
Scoliosis can be congenital, usually related to vertebral malformation or acquired. The latter has been reported in dogs as a sign secondary to syringomyelia. A different pathophysiology of scoliosis in those acquired cases has been suggested. The first one revolves around the damage to the LMN in the ventral horn of the spinal cord grey matter. As a result, there is asymmetrical paraspinal muscle denervation and atrophy secondary to ventral horn damage with a secondary imbalance in muscle tone with flexion of the neck away from the side of muscle atrophy. The second one results from interference with the proprioceptive innervation by interruption of the dorsally located general proprioceptve tracts receiving input from the neuromuscular spindles involved with stretch reflexes necessary to maintain muscle tone. In this scenario, unilateral denervation results in unopposed contraction of the contralateral paraspinal muscles and deviation of the neck to the contralateral side of the lesion. In this cases series, the authors describe two dogs with inflammatory CNS disease affecting the cranial cervical spinal cord gray matter with acute onset cervical scoliosis which resolved upon treatment with immuno-suppressive medications.
The image below is taken from this article and shows the curvature of the neck from above.
Empyema
This retrospective case series study describes the clinical and magnetic resonance imaging (MRI) features of SEE in 30 dogs. The most frequent clinical sign was pain 28/30 (93%), and 22/30 (73%) showed neurological signs with ambulatory paraparesis/tetraparesis 15/30 (50%), monoparesis 1/30 (3.3%), non-ambulatory paraparesis 3/30 (10%), or paraplegia 3/30 (10%). In this group of dogs, 24/30 (80%) were conservatively treated and 6/30 (20%) were surgically treated. The outcome was considered favourable in all dogs: 20/30 (66.6%) achieved full recovery (3 surgically treated and 17 medically treated) and 10/30 (33.3%) dogs had an improvement in the neurological signs with residual ambulatory paresis (3 surgically treated and 7 medically treated). Surgical treatment showed better short-term (7 days) outcomes than medical treatment in non-ambulatory paraparetic or paraplegic dogs (33%). Nevertheless, this study suggests that a good recovery may be achieved with conservative treatment even for non-ambulatory or paraplegic dogs.
The aim of this multicenter retrospective study is to describe the clinical presentation and outcome of 41 dogs undergoing spinal surgery or conservative management for SEE.
SEE was treated surgically in 17 dogs and conservatively in 24 dogs. Two dogs underwent spinal surgery after failure of conservative management, meaning that 19 dogs in total had spinal surgery. Long-term (i.e., >6 months) follow-up was available in 35 dogs (19 conservatively treated and 16 surgically treated dogs). Recovery to a functional pet status was achieved in 15/19 (78.9%) conservatively treated and 12/16 (75%) surgically treated dogs. There was no significant difference in long-term outcomes between conservatively and surgically treated dogs (78.9 and 75%, respectively). However, significantly more surgically treated dogs were non-ambulatory at presentation compared with conservatively treated dogs. Age may be a negative prognostic indicator as dogs with poor long-term outcomes were significantly older than dogs with a good long-term outcome.
Although idiopathic sterile inflammation of adipose tissue, referred to as panniculitis, more commonly affects subcutaneous tissue, its presence in the vertebral canal is rare. Specific MRI findings described in this report may help in reaching a presumptive diagnosis of this neurologic disorder. A definitive diagnosis and successful long-term outcome in affected patients can be achieved by decompressive surgery and histologic examination of surgical biopsy samples.