Adult Equine: Nervous System Diseases Flashcards
What are the possible DDx of Intracranial Diseases?
- Head trauma
- Ischemia
- Infection: Meningitis or Encephalomyelitis
- Space occupying lesions
- Toxins
- Narcolepsy
What are the most commonly affected areas of the skull with head trauma in the horse?
Adults: petrous temporal bone, basi-occipital bone and basi-sphenoid bone are all common areas of fracture due to rearing up and hitting the back of the head
Foals: entire skull due to being kicked by the foal
What are the clinical signs associated with head trauma in the horse?
- Neurological signs are usually immediate
- Cerebral signs: depression, dementia, excitation or recumbent
+/- brain stem/ cranial nerve signs: head tilt or facial nerve paralysis
- Epistaxis: bleeding into guttural pouches or sinus trauma
- Bleeding from the ear
- Seizures: can be facial grimacing, twitching, rapid eye movements or blinking, paddling, tonic posturing or extensor rigidity
You notice a horse is having seizures (anything including facial grimacing, twitching, rapid eye movements or blinking, paddling, tonic posturing or extensor rigidity), what is the treatment of choice for seizures in the horse?
What are the other treatments available?
Treatment of choice:
- Diazepam: 0.02 - 0.2 mg/kg IV
Other:
- Phenobarbital: 12-20 mg/kg IV in 30mls saline, then 2.2-11 mg/kg PO SID-BID
- NSAIDs or Steroids
- Stall padding to prevent further injury
Caution: NO Acepromazine or Ketamine!
What is the prognosis of seizures in horses?
Prognosis is guarded in adult horses as they are difficult to manage, and involvement of the cranial nerves worsens the prognosis, especially if chewing or swallowing is affected
What are the most common causes of brain ischemia in the adult horse?
1) Anesthesia/ Post-anesthesia due to hypoxic or hypercapnic periods
note: damage can be focal or extensive
2) Intra-carotid Injection: the common carotid artery is very close to the jugular vein (reactions will occur in 5-30 seconds post-injection)
What are the clinical signs associated with brain ischemia in the horse following anesthesia?
- Blindness
- Abnormal behavior: altered mentation/ behaviour
- Seizures
What is the treatment for suspected brain ischemia in the adult horse, due to hypoxia/ hypercapnia post-anesthesia?
- Supportive: provide oxygen, and stall padding
- Control seizures with Diazepam
What is the prognosis associated with brain ischemia in the adult horse?
Guarded to poor- depending on the areas of the brain affected and if there is cranial nerve involvement, especially if chewing and swallowing is affected
Intra-carotid injection with:
- Xylazine (water-soluble): the horse generally regains consciousness within an hour and recovers completely in a week = good prognosis
- Procaine penicillin (oil-based): may warrant euthanasia due to cerebral damage
What is the treatment for suspected brain ischemia in the adult horse, due to intra-carotid injection?
- Supportive: provide oxygen, and stall padding
- Control seizures with Diazepam
What is the most common cause of meningitis in the adult horse?
What is the prevalence of meningitis in the adult horse?
Usually bacterial spread hematogenously from another site of infection
Prevalence: uncommon in adults
What are the clinical signs associated with meningitis in horses?
- Depression
- Coma
- Cervical stiffness
- Seizures
How can Meningitis be diagnosed in the horse?
- Blood-work
- CSF cytology + culture
- Blood culture
How can Meningitis be treated in the horse?
- IV broad-spectrum antibiotics (4-6 weeks minimum) based on culture + sensitivity
- NSAIDs or steroids + supportive care + Control seizures with Diazepam
What infectious agents can cause Encephalomyelitis in horses?
- Eastern, Western and Venezuelan Equine Encephalitis viruses
- West Nile Virus
- Rabies
- Borna Disease Virus
- Equine Herpes Virus-1
What are the clinical signs associated with Encephalomyelitis in horses?
- Fever, anorexia, stiffness
- Paralysis of larynx, pharynx and tongue
- Propulsive walking and depression
- Dog-sitting leading to recumbency
note: Equine Herpes Virus-1 is usually ascending, thus will start in the hind end with urinary incontinence and work its way up
What is the treatment for Encephalomyelitis in horses?
What is the prognosis of Encephalomyelitis in horses?
- Supportive care
- Anticonvulsants
- Steroids
- Anti-viral drugs can be tried: acyclovir and valacyclovir
Depends on the offending agent:
- WNV and EHV = guarded to poor
- Others = guarded to grave
What are the usual causes of Space-occupying masses in the equine skull/ brian?
- Abscess: usually a form of bastard Strangles
- Granuloma
- Neoplasia: lymphosarcoma or melanomas
+/- Hydrocephalus if the space-occupying lesion obstructs the flow of CSF
How can space-occupying masses be diagnosed in the equine skull/ brain?
CT or MRI
What are the toxins that can lead to neurological signs in the horse?
- Ragwort poisoning: leading to hepatic encephalopathy
- Mycotoxins: leading to grass staggers
- Fusarium B: leading to Mouldy Corn Disease
- Yellow Star Thistle
- Lead
How can toxicity be treated in the adult horse?
- Remove the offending toxin by removing it from the diet/ pasture
- Supportive care
What is the cause of Narcolepsy in horses?
The current thought is due to a lack of sleep
- Perhaps a dominant animal in a group feels it can’t fall asleep to protect the group
- Maybe the animal has pain and is unable to sleep or lie down
What are the clinical signs associated with Narcolepsy in the horse?
- Episodes up to 10 minutes: usually occurring during grooming, hosing down after exercise, eating/ drinking, or being pet
- Most remain standing with a low hanging head and closed eyelids
- Horses may buckle to their knees or fetlocks and develop pressure sores here
What is the treatment of Narcolepsy in the horse?
What is the prognosis of Narcolepsy in horses?
- No real treatment, but if the cause of the sleep deprivation is pain, then a Bute trial can be done
Prognosis:
- Young horses may grow out of it
- Life long problem in adults and thus safety for both the horse and the owner need to be considered e.g. don’t want the horse to fall on you while you are grooming it
What is the treatment for Facial Nerve Paralysis in the adult horse, post recumbency?
- Topical anti-inflammatory: Voltarol
- Eye lube IF the lacrimal nerve has been affected too
What causes Horner’s Syndrome in the horse?
Damage to the ascending sympathetic nerves in the vago-sympathetic trunk (sits in the jugular groove)
Most commonly associated with:
- Perivascular injections, where the injection is accidentally placed around the jugular vein, putting pressure or blocking the impulses along the vago-sympathetic trunk
- Guttural pouch disease, where the cranial-cervical ganglia sits on top of the dorsal part of the guttural pouch
What are the clinical signs of Horner’s Syndrome in the horse?
- Miosis: pupil constriction
- Enopthalmos: posterior displacement of the eyeball
- -> + prolapsed 3rd eyelid in these cases
- Ptosis
- Sweating of the neck of the side of the lesion
What is the cause of Tempero-hyoid osteopathy in horses?
- We used to think it was due to an extending infection from the otitis media
- We now believe it is due to Degenerative Joint Disease in the Tempero-hyoid joint with bony proliferations forming
What are the clinical signs associated with Tempero-hyoid Osteopathy in horses?
- Behaviour changes: head shaking, ear rubbing, and avoiding the bit
- If a stress fracture forms because of it, this can lead to facial nerve paralysis, corneal ulceration (lacrimal nerve involvement), and peripheral vestibular syndrome
How can Tempero-hyoid Osteopathy in horses be diagnosed?
- Radiography of the Tempero-hyoid joint
- Endoscopy of the Guttural Pouch
- CT
What is the treatment of Tempero-hyoid Osteopathy in horses?
- If the cause is due to DJD of the Tempero-hyoid joint + Boney proliferation: NSAIDs + Prophylactic surgery of the hyoid apparatus may be indicated to prevent a stress fracture from occurring
- If the lacrimal nerve branch of the facial nerve is involved, then eye lubrication will be needed
What is the prognosis of Tempero-hyoid Osteopathy in horses?
- Fair to guarded for athletic performance
- May get residual deficits of CN 7 and 8 and therefore even casual riding may be risky
What is Cauda equina neuritis (aka polyneuritis equi)?
A chronic granulomatous inflammation of the cauda equina, thought to be due to an immune-mediated condition.
This condition can involve more nerves than just the cauda equina (such as the cranial nerves/ brachial plexus) and therefore was renamed Polyneuritis equi
What are the clinical signs/ presentations of horses with Polyneuritis equi?
- Hyperesthesia, analgesia or areflexia of the perineal area
- Paralysis of the tail, anus and perineum
- Paralysis of the rectum + bladder: leading to impactions and chronic cystitis
+/- CN signs of 5, 7 and 8 or the brachial plexus
+/- Pelvic limb ataxia, weakness or muscle atrophy: uncommon
How can Polyneuritis equi be diagnosed?
There is no Ante-mortem tests available, so the diagnosis is based on clinical signs and ruling out other conditions (e.g. Sacral fracture)
How is Polyneuritis equi treated?
What is the prognosis of Polyneuritis equi?
Tx: Supportive and non-specific, treat the horse depending on the signs e.g. treat the incontinence or UTI’s
Prognosis:
- Poor: this is a progressive disease and may progress rapidly or slowly
What are the DDx of the spinal cord diseases in the horse?
- Trauma
- Infection: Osteomyelitis
- Cervical vertebral malformation/ cervical stenotic myelopathy (Wobbler’s Syndrome)
- Verminous Meningoencephalomyelitis
- Equine herpesvirus-1 myeloencephalopathy
- Equine Degenerative Myeloencephalopathy
What are the common sites of trauma along the spine of the horse?
1) Occipito-atlanto-axial region: due to rearing up and falling back, or neck hyper-flexion, leading to fractures or avulsions of the rectus capitus muscle, where it attaches to the occipital bone
2) Caudal cervical region: due to neck hyper-flexion
3) Mid-thoracic to cranial lumbar back: due to falling on its back (usually due to jumping accidents)
4) Sacral region: due to a fall after rearing up, or running backwards into a wall