Immune-Mediated Nervous System Diseases (Small Animal)

Question 1

Signalement and presenting signs for Necrotizing Meningoencephalitis?

Answer 1

PUGS and other toy breeds. Pug Dog Encephalitis
- Juvenile to young adults

Forebrain signs (seizures, rapidly progressing signs)

Question 2

Multifocal/Disseminated GME : description + histopathologic findings

Answer 2

Acute, progressive condition
- Lower brain stem & cervical spinal cord and meninges
- Histopathology: perivascualr cuffing; granulamatous inflammation; large, coalescing lesions

Question 3

Focal GME : description + histopathologic findings

Answer 3

Chronic progressive condition

Clinical signs occur 2º to nodular granuloma formation and mimic the effects of space-occupying tumor/masses

Chronic inflamm. –> aggregation of MØ (Granuloma)

Question 4

Lesion? Clinical signs?

Answer 4

GME - Ocular
Severely swollen optic disc (left image = affected optic disc, right image = normal optic disc)

OPTIC NERVE EXITS THROUGH THE OPTIC DISC! –> DAMAGE OPTIC DISC => ACUTE BLINDESS

Question 5

Signalement and clinical signs for Granulomatous Meningoencephalitis?

Answer 5

• Female, small/toy breed dogs
• 4.5 years old = median age
• Lesions in white matter of the brainstem AND spinal cord (cervical region)
• Clinical signs reflect lesion location (ocular, focal, or multifocal/disseminated)

Question 6

MUE diagnosis?

Answer 6

Necrotizing Meningoencephalitis

Lesion is in the GRAY matter of the brain!

Question 7

MUE diagnosis?

Answer 7

Necrotizing Leukoencephalitis –> Lesions in NLE are usually hyperintense on T2-weighted / FLAIR images and hypointense to isointense on T1-weighted sequences.

Lesion is in the brain’s WHITE matter !

Question 8

Signalement and clinical signs for Necrotizing Leukoencephalitis?

Answer 8

Yorkshire terriers, chihuahuas, bulldogs

Affects cerebrum & brainstem (-> multifocal brain symptoms). WHITE MATTER AFFECTED!

Question 9

Cranial Neuropathy:
Bilateral dropped jaw, hyper-salivating, or unilateral dropped jaw with normal MRI? Tx?

Answer 9

Idiopathic Trigeminal neuropathy - gauze or tape muzzle + corticosteroid therapy

Question 10

Cranial Neuropathy:
Unilateral dropped jaw -> Unilateral Trigeminal Neuropathy. Etiology? Diagnostics?

Answer 10

Etiology:
Nerve sheath tumors, meningiomas, lymphomas

Diagnostics: MRI of head

Question 11

Dog with bilateral Facial Nerve Paralysis cranial nerve exam findings?

Answer 11

Bilateral absent menace (optic -> lat genic nuclei -> thalamus -> primary sensory -> primary motor -> facial motor parasymp -> orbicularis occuli m. -> blink) & palpebral responses (opthalmic br. trigem)

Question 12

Etiologies of facial nerve paralysis?

Answer 12

Idiopathic (75%, dogs); otitis media/interna; hypothyroidism (polyneuropathy)

Question 13

Acute signs of dogs with facial paralysis?

Answer 13

lip droop, drooling on affected side, widened palpebral fissure (unilateral = 60% of cases)

Question 14

Signalement of dog with idiopathic vestibular neuropathy

Answer 14

older dog, relatively healthy, peracute onset of severe vestibular dysfunction

Question 15

What is the etiology of 50% of Vestibular neuropathy cases?

Answer 15

otis media/interna (chronic)

Question 16

Clinical signs for vestibular neuritis?

Answer 16

head tilt, nystagmus, vestibular ataxia
(cats: 25% present bilaterally)

Question 17

Dog with pain on palpation, pyrexic, tachycardic, lethargy for 2 days DDx?

Answer 17

Discospondylitis (take rads) v. Meningitis v. polymyositis v. polyarthritis

Question 18

Juvenile boxer, bernese mountain dog, etc. presents with Pyrexia (waxing & waning), neck pain, lethargy. Diagnostic test // dx?

Answer 18

Steroid Responsive Meningitis Arteritis (SRMA)
tests:
CSF (non-degenerative, non-toxic neutrophils)

Question 19

DDx for dog with suspected Eosinophilic Meningoencephalitis (EME)?

Answer 19

Eosinophilic pleocytosis (>50% TNCC) -> ddx with fungal v. protozoal encephalitis, v. aberrnant parasitic larval migration

EME = rare! usually middle-aged, large-breed dogs

Question 20

What is the treatment for life-threatening MUE?

Answer 20

Combination of ABX (clindo for neosporosis, doxxy for rickettsia, enro for bartonellosis)

If ABX treatment fails, then Corticosteroids

Life-long therapy often required! -> CHRONIC CORTCOSTEROIDS CUSHINGS

Question 21

What are the most common cause and the clinical signs of Feline MUE?

Answer 21

Cause = infectious > immune-mediated

*Multi-focal clinical signs (systemic, spinal cord)

EXAMPLE = FIP!

Question 22

Steroid-Respinsive Tremor Syndrome - etiology treatment, ddx?

Answer 22

Etiology = idiopathic cerebellitis in YOUNG, SMALL BREEDS; acute onset!

Tx = Prednisone

DDx = Action-related tremors

AKA Little White Shaker’s Disease