Neuro-subacute progressive disorders Flashcards
What is the time course of subacute-progressive disorders
progresses over days to weeks
What are the disorders that cause subacute progressive disorders?
- inflammatory
2. neoplasia
What is a prominent feature of many of the same inflammatory and neoplastic conditions?
PAIN (some inflam conditions rarely cause neuro)
What are diseases that cause sub-acute progressive disorders +/- neck pain?
- diskospondylitis
- non-infectious inflammatory disease/meningitis
- infectious inflammatory disease/meningitis
- some neoplasms (metastatic_
What are non-infectious inflammatory diseases that cause subacute progressive neuro dz
- steroid responsive suppurative meningitis (aseptic mengitis)
- granulomatous meningoencephalitis (GME)
- necrotizing meningoencephalitis (NME)
- necrotizing leukoencephalitis (NLE)
What are infectious inflammatory diseases/meningitis that cause subacute progressive neuro dz?
- bacterial meningitis
- toxoplasma (dog, cat), neospora (dog)
- FIP meningitis/myelitits
- canine distemper menigoecenphalomyelitis
- rabies
- lyme meningitis
- fungal meningitis
- rickettsial meningitis/myelitis
What are the usual signs of steroid responsive suppurative meningitis? (aseptic meningitis)
usually just NECK PAIN and FEVER. Very rarely deficits
The signs of necrotizing meningoencephalitis are primarily what?
cortical
certain breeds
The signs for necrotizing leukoencephalitis are primarily what?
cortical and brainstem
certain breeds
Granulomatous meningoencephalitis primarily affects what?
- brain and or spinal cord
Pain in the neck is commonly associated with what?
compressive or inflammatory diseases of the cerbical spinal cord
What is the appearance of an animal with neck pain?
guarded horizontal neck carriage
unwilling to turn neck to side
What anatomic strucures can cause neck pain?
- meninges
- nerve roots
- joints
- bones
- muscles
- brain
forebrain mass lesions (intracranial disease) can cause what clinical symptom?
neck pain
What are muscular disorders that are associated with pain?
- immune mediated polymyositis
- masticatory myositis
- infectious myositis
- ischemic myopathy
What are two causes of muscle neck pain
myositis
muscle injury
What are 4 causes of bone neck pain?
- fracture/luxation
- diskospondylitis
- vertebral osteomyelitis
- neoplasia
What are 2 causes of joint neck pain
polyarthritis
degenerative joint dz
What are two causes of nerve root neck pain?
- neoplasia
2. compression
What are 3 causes of meninges neck pain
- neoplasia
- inflammation
- compression/traction
What is diskospondylitis?
an infection of the intervertebral disks with concurrent osteomyelitis in the adjacent end plates and vertebral bodies
Usually hematogenous
Who gets diskospondylitis?
medium to large breed dogs
german shepherd and labs may have increased prevalence M>F
What are the clinical features of diskospondylitis?
- SPINAL PAIN
- systemic signs in 30% of affected dogs
- reactive polyarthritis in some dogs
- neuro signs relatively uncommon (due to compression)
How is diskospondylitis diagnosed?
- physical exam
2. radiographic examination
What are radiographic changes of diskospondylitis?
- ventral endplate erosion
- focal lysis of one or both end plates
- collapse of disk space
- proliferative bony changes
- sclerosis at the margins of bone loss
Why are survey radiographs recommended with diskospondylitis?
common for diskospondylitis to affect more than one disk space
What is the most rewarding non-invasive method to isolate the organism responisble for diskospondylitis?
blood culture
What should be performed with a suspected diskospondylitis case?
- blood culture
- urine culture
- echocardiography looking for endocarditis
- percutaneous needle aspiration of disk if blood and urine culture unsuscessful and antibiotics not effective
- blastomycology in endemic areas
- brucella serology or PCR but low prevalence
What is the treatment for diskospondylitis?
- antibiotics
- cage rest
- analgesics
If an organism is not found for diskospondylitis, what should initial treatment be directed against?
staphyloccus
What kind of antimicrobials should be used with diskospondylitis?
- bactericidal
- spectrum against gram +
- ability to concentrate in bone
What antmicrobials are effective for diskispondylitis. what should be added if gram - drugs are suspected?
- cefazolin, cephalexin, amoxcillin with calvulanate
2. quinilones
How long is antimicrobial therapy continued for diskospondylitis?
8 weeks to 6 months
What is the most common form of meningitis diagnosed in most vet hospitals?
steroid-responsive suppurative meningitis (aseptic meningitis)
What animals are most often affected by steroid-responsive suppurative meningitis?
large dogs older than 2 years
beagles, bernese mountain dogs, boxers, german shorthaired points, nova scotia duck tolling retrievers
What are the clinical signs of steroid responsive suppurative meningitis?
- fever
- cervical rigidity
- vertebral pain
- neurologic deficits very uncommon
What are the lab findings of steroid responsive suppurative meningitis?
- peripheral neutrophilia
- CSF: increased protein, severe neutrophilic pleocytosis, negative culture, high IgA
- sometimes immune mediated polyarthritis
What is the treatment of steroid-responsive suppurative meningitis?
corticosteroids! (prednisone)
+/- azathioprine
How long are animals treated for steroid-responsive suppurative meningitis?
4-6 months
What are the gross and histological lesions of granulomatous meningoencephalitis?
- masses in white matter, occasionally grey matter, meninges and optic nerves
- histologically: perivascular cuffs of lymphocytes, macrophages, plasma cells
What are the 3 forms of granulomatous meningoencephalitis?
- ocular
- focal
- diffuse/disseminated
What is the least common form of granulomatou meningoencephalitis? What is the most common form?
- ocular
2. diffuse/disseminated
What are the features of ocular GME?
optic neuritis, acute onset of blindness, dilated pupils, hyperemic disk. often develops to disseminated
What are the features of focal GME?
neuro features similar to tumor