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Ostrager A, Bentley RT, Lewis MJ, Moore GE. Survival in dogs with meningoencephalomyelitis of unknown etiology with and without lesions detected by magnetic resonance imaging. J Vet Intern Med 2024. [PMID: 38804716 DOI: 10.1111/jvim.17109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/02/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The prognosis of individual dogs with meningoencephalomyelitis of unknown etiology (MUE) remains difficult to predict. MUE cases with no lesions detected by magnetic resonance imaging (MRI) occur, but it is unknown whether this finding is associated with prognosis. HYPOTHESIS MUE cases without detectable lesions on MRI have a better outcome than cases with detectable lesions. ANIMALS Study included 73 client-owned dogs with MUE presenting to Purdue University Veterinary Hospital from 2010 to 2020. METHODS Retrospective study. Dogs with a clinical diagnosis of MUE were identified by medical record search. MRI reports were reviewed for presence or absence of lesions consistent with MUE. Clinical findings at presentation, treatment, disease-specific survival, and outcomes including rates of remission and relapse were compared between cases with normal MRI or abnormal MRI. RESULTS Overall, 54 dogs (74%) were classified as abnormal MRI, and 19 dogs (26%) were classified as normal MRI cases. Death caused by MUE occurred in 1/19 (5%) normal MRI dogs and 18/54 (33%) abnormal MRI dogs (P = .016). Median survival was >107 months in both groups, but survival was significantly longer in the normal MRI group (P = .019). On multivariate analysis, abnormal MRI was significantly related to death (hazard ratio, 7.71; 95% confidence interval 1.03-58.00, P = .0470), whereas significant relationships with death were not identified for either the use of secondary immunosuppressive medications or cerebrospinal fluid nucleated cell count. CONCLUSIONS MUE dogs with no detectable lesions on MRI have reduced disease-related death compared with dogs with abnormal MRI. The presence or absence of MRI lesions in MUE dogs is prognostically relevant.
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Affiliation(s)
- Arielle Ostrager
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - R Timothy Bentley
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Melissa J Lewis
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - George E Moore
- Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
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Sung J, Chae Y, Yun T, Koo Y, Lee D, Kim H, Yang MP, Kang BT. Use of neurofilament light chain to identify structural brain diseases in dogs. J Vet Intern Med 2024. [PMID: 38778568 DOI: 10.1111/jvim.17110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Neurofilament light chain (NfL) is released into the peripheral circulation by damaged axons. OBJECTIVES To evaluate the diagnostic value of serum NfL concentration in dogs with intracranial diseases. ANIMALS Study included 37 healthy dogs, 31 dogs with idiopathic epilepsy (IE), 45 dogs with meningoencephalitis of unknown etiology (MUE), 20 dogs with hydrocephalus, and 19 dogs with brain tumors. METHODS Cohort study. Serum NfL concentrations were measured in all dogs using single-molecule array technology. RESULTS Serum NfL concentration in dogs with each structural disease was significantly higher than in healthy dogs and dogs with IE (P = .01). The area under the receiver operating characteristic curve of NfL for differentiating between dogs with structural diseases and IE was 0.868. An optimal cutoff value of the NfL 27.10 pg/mL had a sensitivity of 86.67% and a specificity of 74.19% to differentiate the dogs with IE from those with structural brain diseases. There were significant correlations between NfL concentrations and lesion size: (1) MUE, P = .01, r = 0.429; (2) hydrocephalus, P = .01, r = 0.563. CONCLUSIONS AND CLINICAL IMPORTANCE Serum NfL could be a useful biomarker for distinguishing IE from structural diseases in dogs and predicting the lesion sizes of MUE and hydrocephalus.
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Affiliation(s)
- Jookyung Sung
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Yeon Chae
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Taesik Yun
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Yoonhoi Koo
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Dohee Lee
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Hakhyun Kim
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Mhan-Pyo Yang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Byeong-Teck Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
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Yun T, Kim S, Koo Y, Chae Y, Lee D, Kim H, Yang MP, Kang BT, Kim S. Expression of sphingosine-1-phosphate receptor 1 in neuroinflammation of canine brains. Top Companion Anim Med 2024; 60:100847. [PMID: 38182045 DOI: 10.1016/j.tcam.2024.100847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/24/2023] [Accepted: 01/02/2024] [Indexed: 01/07/2024]
Abstract
Sphingosine-1-phosphate (S1P) is a signaling lipid mediator that is involved in multiple biological processes. The S1P/S1P receptor (S1PR) signaling pathway has an important role in the central nervous system. It contributes to physiologic cellular homeostasis and is also associated with neuroinflammation. Therefore, this study was performed to evaluate the expression of S1PR in dogs with meningoencephalitis of unknown etiology (MUE) and experimental autoimmune encephalomyelitis (EAE). The analysis used 12 brain samples from three neurologically normal dogs, seven dogs with MUE, and two canine EAE models. Anti-S1PR1 antibody was used for immunohistochemistry. In normal brain tissues, S1PR1s were expressed on neurons, astrocytes, oligodendrocytes, and endothelial cells. In MUE and EAE lesions, there was positive staining of S1PR1 on leukocytes. Furthermore, the expression of S1PR1 on neurons, astrocytes, oligodendrocytes, and endothelial cells was upregulated compared to normal brains. This study shows that S1PR1s are expressed in normal brain tissues and leukocytes in inflammatory lesions, and demonstrates the upregulation of S1PR1 expression on nervous system cells in inflammatory lesions of MUE and EAE. These findings indicate that S1P/S1PR signaling pathway might involve physiologic homeostasis and neuroinflammation and represent potential targets for S1PR modulators to treat MUE.
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Affiliation(s)
- Taesik Yun
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644, South Korea
| | - Sanggu Kim
- Laboratory of Veterinary Pathology, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644, South Korea
| | - Yoonhoi Koo
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644, South Korea; College of Veterinary Medicine, Kyungpook National University, Daegu 41566, South Korea
| | - Yeon Chae
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644, South Korea
| | - Dohee Lee
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644, South Korea
| | - Hakhyun Kim
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644, South Korea
| | - Mhan-Pyo Yang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644, South Korea
| | - Byeong-Teck Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644, South Korea.
| | - Soochong Kim
- Laboratory of Veterinary Pathology, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk 28644, South Korea.
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Jones BS, Liebel FX, Fadda A, Martin S, Lawn R, Lazzerini K, Harcourt‐Brown T. Corticosteroid monotherapy versus combined cytarabine continuous rate infusion and corticosteroid therapy in dogs with meningoencephalitis of unknown origin: A blinded, randomized, controlled trial. J Vet Intern Med 2024; 38:1618-1625. [PMID: 38700360 PMCID: PMC11099798 DOI: 10.1111/jvim.17088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/10/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Treatment options available for meningoencephalitis of unknown origin (MUO) in dogs are suboptimal, and currently, no single treatment protocol appears to be superior. OBJECTIVES Compare neurological deterioration rates at 7 days between dogs with MUO treated with corticosteroids alone or combined with cytosine arabinoside (CA) continuous rate infusion (CRI) and compare clinical deterioration and survival at 30 and 100 days. ANIMALS Sixty-nine dogs with magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) features or both compatible with MUO. METHODS Parallel, blinded, randomized controlled trial. Simple randomization into 2 treatment groups: 4 mg/kg/day prednisolone (or dexamethasone equivalent) for 2 days or 200 mg/m2 CA CRI over 8 hours plus 2 mg/kg/day prednisolone. Blinding of the treatment protocol was carried out using reversible redaction of clinical records, and treatment failure was defined as deterioration of neurological assessment or death. Using intention-to-treat analysis, proportions failing treatment at 7, 30, and 100 days were compared using Fisher's exact test. All-cause mortality at 100 days was compared using Kaplan-Meier survival curves. RESULTS Thirty-five dogs were allocated to corticosteroid only, and 34 dogs were allocated to combined CA CRI and corticosteroid. Proportions failing treatment at 7, 30, and 100 days were 7/35 (20%), 9/35 (26%), and 15/35 (43%) in the corticosteroid-only group and 8/34 (24%), 11/34 (32%), and 23/34 (68%) in the corticosteroid and CA CRI group. All-cause mortality at 100 days was not significantly different between groups (P = .62). Clinically relevant treatment-related adverse effects were not observed. CONCLUSIONS AND CLINICAL IMPORTANCE We found no difference in outcome between corticosteroid monotherapy and combined cytarabine CRI and corticosteroid therapy at 7, 30, and 100 days after diagnosis in dogs with MUO.
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Affiliation(s)
| | | | - Angela Fadda
- Langford Vets Small Animal HospitalBristolUnited Kingdom
| | - Sophie Martin
- Langford Vets Small Animal HospitalBristolUnited Kingdom
| | - Richard Lawn
- Langford Vets Small Animal HospitalBristolUnited Kingdom
| | - Kali Lazzerini
- Langford Vets Small Animal HospitalBristolUnited Kingdom
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Kim SH, Oh YI, Park SM, An JH, Kim TH, Kim SS, Ah JG, Seo KW, Youn HY. Retrospective evaluation of prognosis and survival with various immunosuppressants in 82 dogs diagnosed with meningoencephalitis of unknown etiology (2010-2021). BMC Vet Res 2023; 19:269. [PMID: 38087262 PMCID: PMC10714563 DOI: 10.1186/s12917-023-03800-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Meningoencephalomyelitis of unknown etiology (MUE) is a comprehensive term for non-infectious inflammatory brain diseases of the central nervous system (CNS) caused by abnormal autoimmune responses. This study aims to compare the differences in survival and clinical response of MUE according to the adjuvant immunosuppressant use. Medical records of 82 dogs diagnosed with MUE were reviewed retrospectively. RESULTS The overall survival time was 769 days (range 14-2687 days). The median survival time for each adjunctive was: leflunomide 1035 days (range 126-2163 days), mycophenolate mofetil 865 days (range 39-2191 days), cyclosporin 441 days (range 11-2176 days), cytosine arabinoside 754 days (range 6-1898 days) and a combination of mycophenolate mofetil and cytosine arabinoside 132 days (range 23-1227 days). There was no significant difference in the incidence rate of adverse events according to the immunosuppressants, but moderate to severe anemia was confirmed in 3 patients (18.7%) in the leflunomide group. CONCLUSIONS The survival time and response rate of MUE dogs differed depending on which adjunctive immunosuppressants were used. Leflunomide showed a long survival time and a relatively good response rate in dogs with MUE. However, a large-scale further study with standardized doses of immunosuppressants and supportive treatment and constant monitoring interval is needed.
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Affiliation(s)
- So-Hee Kim
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 00826, Republic of Korea
| | - Ye-In Oh
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Kyungpook National University, Daegu, 41566, Republic of Korea
| | - Su-Min Park
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 00826, Republic of Korea
| | - Ju Hyun An
- Department of Veterinary Emergency and Critical Care Medicine and Institute of Veterinary Science, College of Veterinary Medicine, Kangwon National University, Chuncheon-si, 24341, Republic of Korea
| | - Tae-Hee Kim
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 00826, Republic of Korea
| | - Sung-Soo Kim
- VIP Animal Medical Center KR, Seoul, 02830, Republic of Korea
| | - Jae-Gon Ah
- VIP Animal Medical Center KR, Seoul, 02830, Republic of Korea
| | - Kyoung-Won Seo
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 00826, Republic of Korea
| | - Hwa-Young Youn
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 00826, Republic of Korea.
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Bentley RT, Fan TM, Lowrie M. Editorial: Chemotherapy and other pharmacotherapies for canine neurological disorders. Front Vet Sci 2023; 10:1323496. [PMID: 38026655 PMCID: PMC10643126 DOI: 10.3389/fvets.2023.1323496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- R. Timothy Bentley
- Department of Veterinary Clinical Sciences, Purdue University, West Lafayette, IN, United States
- Department of Small Animal Clinical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Timothy M. Fan
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Mark Lowrie
- Neurology, Movement Referrals, Runcorn, United Kingdom
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Bach FS, Cray C, Burgos AP, Junior JAV, Montiani-Ferreira F. A comparison between neurological clinical signs, cerebrospinal fluid analysis, cross-sectional CNS imaging, and infectious disease testing in 168 dogs with infectious or immune-mediated meningoencephalomyelitis from Brazil. Front Vet Sci 2023; 10:1239106. [PMID: 38026652 PMCID: PMC10630916 DOI: 10.3389/fvets.2023.1239106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023] Open
Abstract
This retrospective study evaluated canine patients with presumptively diagnosed meningoencephalomyelitis (ME) based on neurological clinical signs, cerebrospinal fluid (CSF) analysis, cross-sectional imaging, and infectious disease testing with a limited neurological-focused polymerase chain reaction (PCR) panel performed on blood and CSF. The first goal was to determine the proportion of dogs where the condition was caused by an infectious agent versus a probable immune-mediated etiology (i.e., meningoencephalomyelitis of unknown origin; MUO) in our geographic region. The secondary goals of this study were to examine and define associations between abnormal CSF test results and cross-sectional neuroimaging findings, in addition to defining the age and most common neurological clinical signs in each group of ME. A total of 168 dogs matched the inclusion criteria with magnetic resonance imaging (MRI) performed in 130 dogs and computed tomography (CT) performed in 38 dogs. Presumptive MUO was observed in 152/168 (90.5%) of dogs and infectious ME was identified in 16/168 (9.5%) of dogs (p < 0.0001). Canine distemper virus (CDV) was the most common cause of infectious ME in 10/16 dogs (62.5%). Of the total cases with a positive infectious disease result, 3/16 (18.7%) had normal CSF results and 13/16 (81.3%) had abnormal CSF results (p = 0.0078). MRI and CT abnormalities in the brain were detected in 74 and 39% of dogs with inflammatory CSF, respectively. MRI and CT abnormalities in the spinal cord were detected in 90 and 57% of dogs with inflammatory CSF results, respectively. Age was not significantly different between infectious ME and presumptive MUO groups (p = 0.15). Seizures were the most common clinical sign reported for both MUO (36.8% of cases) and infectious ME (31.2% of cases). In conclusion, presumptive MUO is significantly more common than infectious ME in this population of dogs. Furthermore, although normal CSF results were uncommon in dogs with infectious ME, this finding occurred in several patients (3/16), suggesting that infectious disease testing should be considered even in the face of normal CSF results. Finally, MRI was more sensitive than CT in the detection of abnormalities when dogs with ME had inflammatory CSF results but was not 100% sensitive, suggesting CSF analysis should be performed to rule out inflammation even when no abnormalities are detected on MRI or CT.
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Affiliation(s)
| | - Carolyn Cray
- Division of Comparative Pathology, Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ana Paula Burgos
- Small Animal Surgery Service, Catholic University of Paraná, Curitiba, Brazil
| | | | - Fabiano Montiani-Ferreira
- Division of Comparative Pathology, Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
- Comparative Ophthalmology Lab (LABOCO), Federal University of Paraná, Curitiba, Brazil
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Heidemann PL, Erhald B, Koch BC, Gredal H. Investigation of side effects to treatment and cause of death in 63 Scandinavian dogs suffering from meningoencephalitis of unknown origin: a retrospective study. Acta Vet Scand 2023; 65:46. [PMID: 37858113 PMCID: PMC10588026 DOI: 10.1186/s13028-023-00709-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Meningoencephalitis of unknown origin is a common cause of severe neurological disease in dogs. The term covers a heterogeneous group of noninfectious inflammatory diseases, with immune dysregulation widely accepted as the underlying disease mechanism. Current treatment consists of immunosuppression, with corticosteroids being the mainstay of virtually all treatment regimens. However, side effects of corticosteroids can be severe, and might be the cause of death in some patients. This retrospective, multi-centric study aimed at describing a population of Scandinavian dogs with meningoencephalitis of unknown origin in regards to reported side effects and cause of death, and to highlight possible differences in survival, when comparing corticosteroid monotherapy with other treatment regimens. RESULTS Within the 5-year study period, 63 dogs were included. Of these, 35 (49.3%) died or were euthanized during the study period. Median survival time from time of diagnosis based on Kaplan-Meier curves for the overall population was 714 days (equivalent to around 25 months, range 0-1678 days). There was no statistically significant difference (P = 0.31) in survival between dogs treated with corticosteroid monotherapy (n = 26, median survival time 716 days, equivalent to around 25 months, range 5-911 days), dogs receiving a combination of corticosteroids and ciclosporin (n = 15, median survival time 916 days, equivalent to around 31 months, range 35-1678 days), and dogs receiving corticosteroids combined with either cytosine arabinoside, leflunomide, or a combination of 2 or more add-on drugs (n = 13, median survival time 1186 days, equivalent to around 40 months, range 121-1640 days). Side effects were registered for 47/63 dogs. Polyphagia (n = 37/47), polyuria/polydipsia (n = 37/47), diarrhea (n = 29/47) and lethargy (n = 28/47) were most frequently reported. The most common cause for euthanasia was relapse (n = 15/35, 42.9%), followed by insufficient or lack of treatment response (n = 9, 25.7%). Side effects were the direct cause of euthanasia in 2/35 dogs (5.7%). CONCLUSIONS A large proportion of dogs in the overall population were euthanized due to relapse, emphasizing a need for treatment regimens aimed at specifically preventing relapse for an improved long-term survival. Side effects in dogs receiving corticosteroid monotherapy were rarely a direct cause of death, but were reported for all dogs. No statistically significant difference in survival was found when corticosteroid monotherapy was compared to other treatment regimens.
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Affiliation(s)
- Pernille Lindholm Heidemann
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Frederiksberg, 1870, Denmark.
| | - Bolette Erhald
- Evidensia Södra Djursjukhuset Kungens Kurva, Månskärsvägen 13, 141 75 Kungens, Kurva, Sweden
| | - Bodil Cathrine Koch
- Fredrikstad Dyrehospital (Fredrikstad Small Animal Hospital), Wilbergjordet 2, Fredrikstad, 1605, Norway
| | - Hanne Gredal
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Frederiksberg, 1870, Denmark
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Lemke L, Carlson R, Warzecha K, Volk AV, Tipold A, Nessler J. Elevated Interleukin-31 Levels in Serum, but Not CSF of Dogs with Steroid-Responsive Meningitis-Arteritis Suggest an Involvement in Its Pathogenesis. Animals (Basel) 2023; 13:2676. [PMID: 37627467 PMCID: PMC10451616 DOI: 10.3390/ani13162676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Steroid-responsive meningitis-arteritis (SRMA) is a predominantly Th-2 immune-mediated disease, but the exact pathomechanism remains unclear. Interleukin-31 (IL-31) is predominantly produced by T cells with a Th-2 phenotype during proinflammatory conditions. We hypothesize that IL-31 might be involved in the pathogenesis of SRMA. IL-31 was measured in archived samples (49 serum and 52 CSF samples) of dogs with SRMA, meningoencephalitis of unknown origin (MUO), infectious meningoencephalitis, and atopic dermatitis, and of healthy control dogs using a competitive canine IL-31 ELISA. The mean serum IL-31 level in dogs with SRMA (n = 18) was mildly higher compared to dogs with atopic dermatitis (n = 3, p = 0.8135) and MUO (n = 15, p = 0.7618) and markedly higher than in healthy controls (n = 10, p = 0.1327) and dogs with infectious meningoencephalitis (n = 3, no statistics). Dogs with SRMA in the acute stage of the disease and without any pre-treatment had the highest IL-31 levels. The mean CSF IL-31 value for dogs with SRMA (n = 23) was quite similar to that for healthy controls (n = 8, p = 0.4454) and did not differ markedly from dogs with MUO (n = 19, p = 0.8724) and infectious meningoencephalitis. Based on this study, an involvement of IL-31 in the pathogenesis of the systemic Th-2 immune-mediated immune response in SRMA can be assumed as a further component leading to an aberrant immune reaction.
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Affiliation(s)
| | | | | | | | | | - Jasmin Nessler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, 30559 Hannover, Germany; (L.L.); (K.W.); (A.V.V.); (A.T.)
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Cocchetto A, Zoia A, Aragão R, Ventura L, Menchetti M. Predictive Value of Acute Phase Proteins for the Short-Term Outcome of Meningoencephalitis of Unknown Origin in Dogs. Animals (Basel) 2023; 13:2575. [PMID: 37627366 PMCID: PMC10451645 DOI: 10.3390/ani13162575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Meningoencephalitis of unknown origin (MUO) is one of the most common inflammatory diseases of the central nervous system (CNS). The study evaluates the possible increase and the potential role of acute phase proteins (APPs) and other inflammatory serum parameters as biomarkers predicting the short-term outcome of dogs with meningoencephalitis of unknown origin (MUO). A retrospective cohort study was designed. The APP profile and other markers of systemic inflammation of forty-eight client-owned dogs with a new diagnosis of MUO were compared between 7-day survival and non-survival dogs diagnosed with MUO. Thirty-nine (81%) dogs were alive at the end of the 7-day follow-up period, while 9 (19%) dogs died or were euthanized because of MUO. None of the 11 markers of inflammation studied were different between the survived and non-survived dogs; for this reason, none of them could be used as a predictor of the short-term outcome based on the results of the present study. This confirms that even though MUO is often associated with a severe inflammatory status of the central nervous system (CNS), this condition is probably isolated exclusively to the CNS.
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Affiliation(s)
- Aurora Cocchetto
- Division of Neurology and Neurosurgery, San Marco Veterinary Clinic, Viale dell’Industria 3, 35030 Veggiano, Italy
| | - Andrea Zoia
- Division of Internal Medicine, San Marco Veterinary Clinic, Viale dell’Industria 3, 35030 Veggiano, Italy
| | - Rita Aragão
- Division of Neurology and Neurosurgery, San Marco Veterinary Clinic, Viale dell’Industria 3, 35030 Veggiano, Italy
| | - Laura Ventura
- Department of Statistical Sciences, University of Padova, Via Cesare Battisti 241, 35121 Padova, Italy
| | - Marika Menchetti
- Division of Neurology and Neurosurgery, San Marco Veterinary Clinic, Viale dell’Industria 3, 35030 Veggiano, Italy
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11
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Raposo M, de la Fuente C, Pumarola M, Ríos J, Añor S. Immunohistochemical evaluation of fibrin/fibrinogen, d-dimers, and intravascular thrombosis in brains of dogs with meningoencephalitis of unknown origin. Vet J 2023; 298-299:106018. [PMID: 37532174 DOI: 10.1016/j.tvjl.2023.106018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/17/2023] [Accepted: 07/30/2023] [Indexed: 08/04/2023]
Abstract
Granulomatous meningoencephalitis (GME) and necrotizing encephalitides (NE) are the most common immune-mediated inflammatory diseases of the central nervous system in dogs. Activation of the fibrinolytic system in multiple sclerosis, a similar immune-mediated disease affecting the central nervous system in humans, seems to be related to disease progression. The aim of this study was to identify fibrin/fibrinogen and D-dimer deposition, as well as presence of intravascular thrombosis (IVT) in brains of dogs with a diagnosis of GME or NE. Immunohistochemical studies using antibodies against fibrin/fibrinogen and D-dimers were performed. Statistical analyses were performed to determine whether there were differences in the presence and location of fibrin/fibrinogen, D-dimers deposits, and IVT between GME and NE. Samples from sixty-four dogs were included in the study: 32 with a diagnosis of GME and 32 with a diagnosis of NE. Fibrin/fibrinogen depositions were detected in all samples and d-dimers were detected in 43/64 samples. IVT was present in 29/64 samples, with a significantly higher score in samples from dogs with NE than in samples from dogs with GME (P = 0.001). These data support hemostatic system activation in both diseases, especially NE. This finding might be related to the origin of the necrotic lesions seen in NE, which could represent chronic ischemic lesions. Further studies are needed to investigate the association between vascular lesions and the histopathological differences between GME and NE and the hemostatic system as a potential therapeutic target.
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Affiliation(s)
- M Raposo
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain; Fundació Hospital Clínic Veterinari, Facultad de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - C de la Fuente
- Fundació Hospital Clínic Veterinari, Facultad de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - M Pumarola
- Unitat de Patologia Murina i Comparada (UPMiC) and Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - J Ríos
- Unitat de Bioestadística, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - S Añor
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain; Fundació Hospital Clínic Veterinari, Facultad de Veterinària, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain.
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12
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Yun T, Koo Y, Chae Y, Lee D, Kim H, Yang MP, Kang BT. Association between neurofilament light chain concentration and lesion size in dogs with meningoencephalitis of unknown origin. Vet Med Sci 2023. [PMID: 37248819 DOI: 10.1002/vms3.1155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/08/2023] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Neurofilament light chain (NfL) is an axonal cytoplasmic protein in neurons. Recently, NfL has shown potential as a diagnostic biomarker in dogs with meningoencephalitis of unknown origin (MUO). However, there have been no studies on the biomarkers of lesion progression and resolution in MUO. OBJECTIVES To identify the potential of NfL as a biomarker for predicting changes in lesions. METHODS Seven dogs with MUO who had undergone two magnetic resonance imaging (MRI) scans were included. The serum NfL levels were measured using a single-molecule array. The relationship between the rate of change in lesion size and the rate of change in serum NfL level was analysed using simple linear regression. To investigate the effect of changes in lesion size on NfL levels, the dogs were divided into two groups depending on the change in lesion size: decreased lesion size group (n = 5) and increased lesion size group (n = 2). Trends in lesion size change were identified in the second MRI compared with the first MRI. RESULTS A significant positive relationship between the rate of lesion size change and the rate of NfL level change was identified (R2 = 0.9239, p = 0.0006). In the decreased lesion size group (n = 5), all NfL levels in each dog decreased, and in the increased lesion size group (n = 2), all NfL levels in each dog increased. CONCLUSIONS This preliminary study showed a positive relationship between the rate of change in lesion size and rate of change in serum NfL levels. Therefore, the serum NfL level may be a promising biomarker of lesion progression and resolution in MUO.
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Affiliation(s)
- Taesik Yun
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Yoonhoi Koo
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Yeon Chae
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Dohee Lee
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Hakhyun Kim
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Mhan-Pyo Yang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Byeong-Teck Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
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13
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Beasley MJ, Shores A. Perspectives on pharmacologic strategies in the management of meningoencephalomyelitis of unknown origin in dogs. Front Vet Sci 2023; 10:1167002. [PMID: 37234070 PMCID: PMC10205981 DOI: 10.3389/fvets.2023.1167002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023] Open
Abstract
There are many non-infectious inflammatory diseases, assumed to be immune-mediated in origin, recognized to affect the nervous system in canine patients. Concentrating on meningoencephalomyelitis of unknown origin, we will discuss the medications used to treat the underlying disease process, focusing on their adverse effects, therapeutic monitoring when necessary and effectiveness. The literature overwhelmingly supports the use of a steroid/ Cytosar® or steroid/ cyclosporine treatment protocol with the steroid tapered after the acute phase of the disease, leaving the secondary medication to control the disease long term. The decision on when and how quickly to taper the steroid is clinician dependent as a best practices has not been established in the literature. Also discussed will be the supportive care treatments often needed in the acute phase of these patients' diagnosis and treatment such as anti-edema and anti-epileptic agents.
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Affiliation(s)
- Michaela J. Beasley
- College of Veterinary Medicine, Mississippi State University, Starkville, MS, United States
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14
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Mármol-Sánchez E, Heidemann PL, Gredal H, Cirera S. MicroRNA profiling of cerebrospinal fluid from dogs with steroid responsive meningitis-arteritis and meningoencephalitis of unknown origin. Front Vet Sci 2023; 10:1144084. [PMID: 37215481 PMCID: PMC10196361 DOI: 10.3389/fvets.2023.1144084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/28/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Non-infectious inflammatory diseases of the central nervous system in dogs, such as steroid responsive meningitis-arteritis (SRMA) and meningoencephalitis of unknown origin (MUO), represent a common clinical challenge that needs extensive and multimodal work-up to reach a presumptive diagnosis. Both diseases are presumably caused by dysregulations of the immune system, but further research is needed in order to understand the molecular mechanisms behind each disease and to optimize treatment. Methods By next-generation sequencing and subsequent quantitative real-time PCR (qPCR) verification, we designed a prospective case-control pilot study to analyze the small RNA profiles of cerebrospinal fluid from dogs suffering from MUO (N = 5), dogs suffering from SRMA (N = 8), and healthy dogs (N = 5) presented for elective euthanasia used as the Control group. Results Our results showed an overall enrichment in Y-RNA fragments across all samples, followed by microRNAs (miRNAs) and ribosomal RNAs as the major findings. Additional traces of short RNA reads mapped to long non-coding RNAs and protein-coding genes were also found. From the detected canine miRNAs, miR-21, miR-486, miR-148a, miR-99a, miR-191 and miR-92a were among the most abundant. Dogs with SRMA showed higher differences in miRNA abundance than dogs with MUO when compared to healthy dogs, and miR-142-3p was consistently detected as differentially upregulated in both diseases, although at a low concentration. Moreover, miR-405-5p and miR-503-5p showed different profiles between SRMA and MUO dogs. Subsequent qPCR analyses confirmed miR-142-5p, miR-191-5p and miR-92a-3p as significantly upregulated miRNAs in dogs with SRMA and/or MUO. Discussion Cerebrospinal fluid is a challenging biological material to use for profiling miRNAs due to the low content of circulating RNAs. Despite this, we could confirm several miRNAs being differentially abundant when comparing healthy dogs and dogs with MUO and SRMA, respectively. The results of this study indicate a potential role of miRNAs in the underlying molecular mechanisms of these diseases and establish the basis for further studies.
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Affiliation(s)
- Emilio Mármol-Sánchez
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
- Centre for Paleogenetics, Stockholm University, Stockholm, Sweden
| | - Pernille Lindholm Heidemann
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Gredal
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Susanna Cirera
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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15
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Gonçalves R, Maddox TW, Phillipps S, Nagendran A, Cooper C, Orlandi R, Fentem R, Walmsley GL. Development of a reliable clinical assessment tool for meningoencephalitis in dogs: The neurodisability scale. J Vet Intern Med 2023; 37:1111-1118. [PMID: 37092590 DOI: 10.1111/jvim.16717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/06/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Meningoencephalitis of unknown origin (MUO) comprises a group of debilitating inflammatory diseases affecting the central nervous system of dogs. Currently, no validated clinical scale is available for the objective assessment of MUO severity. OBJECTIVES Design a neurodisability scale (NDS) to grade clinical severity and determine its reliability and whether or not the score at presentation correlates with outcome. ANIMALS One hundred dogs with MUO were included for retrospective review and 31 dogs were subsequently enrolled for prospective evaluation. METHODS Medical records were retrospectively reviewed for 100 dogs diagnosed with MUO to identify the most frequent neurological examination findings. The NDS was designed based on these results and evaluated for prospective and retrospective use in a new population of MUO patients (n = 31) by different groups of independent blinded assessors, including calculation of interobserver agreement and association with outcome. RESULTS The most common clinical signs in MUO patients were used to inform categories for scoring in the NDS: seizure activity, ambulatory status, posture and cerebral, cerebellar, brainstem, and visual functions. The intraclass correlation coefficient (ICC) for prospective use of the NDS was 0.83 (95% confidence interval [CI], 0.68-0.91) indicating good agreement, and moderate agreement was found between prospective and retrospective assessors (ICC, 0.71; 95% CI, 0.56-0.83). No association was found between NDS score and long-term outcome. CONCLUSIONS AND CLINICAL IMPORTANCE The NDS is a novel clinical measure for objective assessment of neurological dysfunction and showed good reliability when used prospectively in MUO patients but, in this small population, no association with outcome could be identified.
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Affiliation(s)
- Rita Gonçalves
- Department of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Leahurst, Neston, Cheshire, United Kingdom
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Thomas W Maddox
- Department of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Leahurst, Neston, Cheshire, United Kingdom
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Stephanie Phillipps
- Department of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Leahurst, Neston, Cheshire, United Kingdom
| | - Aran Nagendran
- Department of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Leahurst, Neston, Cheshire, United Kingdom
| | - Camilla Cooper
- Department of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Leahurst, Neston, Cheshire, United Kingdom
| | - Rocio Orlandi
- Department of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Leahurst, Neston, Cheshire, United Kingdom
| | - Rory Fentem
- Department of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Leahurst, Neston, Cheshire, United Kingdom
| | - Gemma L Walmsley
- Department of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Leahurst, Neston, Cheshire, United Kingdom
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
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Jeffery N, Granger N. New insights into the treatment of meningoencephalomyelitis of unknown origin since 2009: A review of 671 cases. Front Vet Sci 2023; 10:1114798. [PMID: 37008358 PMCID: PMC10050685 DOI: 10.3389/fvets.2023.1114798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/17/2023] [Indexed: 03/17/2023] Open
Abstract
“Meningoencephalomyelitis of unknown origin” (MUO)—a collective term for a group of clinically-indistinguishable (but pathologically distinct) autoimmune diseases of the CNS—has become increasingly commonly recognized throughout the world. In the 1960s−1980s the focus was primarily on the pathological description of these conditions and, largely anecdotally, their response to glucocorticoids. The subsequent availability of magnetic resonance imaging for companion animals led to a focus on imaging characteristics and response of MUO to various immunosuppressive medications. Previous reviews have not found clear evidence of superiority of any specific treatment regimen. Here, we review outcomes in a further 671 dogs treated with various combinations of glucocorticoids and immunosuppressive drugs and reported since 2009, aiming to determine whether recommendations can be drawn from the material published during more recent decades. We observe that: (i) there is more complete information on outcome of MUO-affected dogs solely receiving glucocorticoids and these reports provide evidence to undermine the dogma that MUO inevitably requires treatment with glucocorticoids plus an immunosuppressive drug; (ii) there is far more information on the pharmacokinetics of cytarabine delivered by a variety of routes, revealing that previous dosing and duration of administration in dogs with MUO may not have been optimal; and, (iii) there is a large number of cases that could be available for entry into multi-institutional randomized controlled trials. Finally, we suggest new research avenues that might aid future clinical trials in MUO through improved understanding of etiological triggers and individual patterns of immune response, such as the impact of the gut microbiome, the potential of CSF flow cytometry, and the establishment of robust clinical scores for evaluation of treatment success.
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Affiliation(s)
- Nick Jeffery
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, United States
- *Correspondence: Nick Jeffery
| | - Nicolas Granger
- Bristol Vet Specialists, CVS Referrals & Bristol Translational Health Sciences, University of Bristol, Bristol, United Kingdom
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17
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Kajin F, Schuwerk L, Beineke A, Volk HA, Meyerhoff N, Nessler J. Teach an old dog new tricks: Meningoencephalitis of unknown origin (MUO) in Australian shepherd dogs. VETERINARY RECORD CASE REPORTS 2023. [DOI: 10.1002/vrc2.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Affiliation(s)
- Filip Kajin
- Small Animal Medicine and Surgery University of Veterinary Medicine Hannover Hannover Germany
| | - Lukas Schuwerk
- Institute for Pathology University of Veterinary Medicine Hannover Hannover Germany
| | - Andreas Beineke
- Institute for Pathology University of Veterinary Medicine Hannover Hannover Germany
| | - Holger A. Volk
- Small Animal Medicine and Surgery University of Veterinary Medicine Hannover Hannover Germany
| | - Nina Meyerhoff
- Small Animal Medicine and Surgery University of Veterinary Medicine Hannover Hannover Germany
| | - Jasmin Nessler
- Small Animal Medicine and Surgery University of Veterinary Medicine Hannover Hannover Germany
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Majercikova R, Rütgen BC, Luckschander-Zeller N, Lörincz BA, Pakozdy A. Diagnostic value of cerebrospinal fluid analysis in epileptic cats with unremarkable brain MRI or hippocampal signal changes only. J Feline Med Surg 2023; 25:1098612X231158573. [PMID: 36995228 PMCID: PMC10812015 DOI: 10.1177/1098612x231158573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVES Cerebrospinal fluid (CSF) analysis is used in the diagnostic investigation of cats with epileptic seizures. The aim of this retrospective study was to evaluate the diagnostic value of CSF analysis in cats with epileptic seizures that have unremarkable brain MRI or only hippocampal signal changes. METHODS Unremarkable brain MRI or MRI studies with signal alterations in the hippocampus only in cats with suspected epilepsy and CFS analysis performed at the Small Animal Internal Department or Diagnostic Imaging Department at Vetmeduni Vienna, Austria, between 2011 and 2017 were reviewed. Total nucleated cell count, total protein, blood contamination and cytology data from CSF analysis were evaluated. RESULTS In total, 87 cats were included. Seventy cats (80.5%) had unremarkable MRI, five (5.7%) had hippocampal signal changes with contrast enhancement and 12 (13.8%) had hippocampal signal changes without contrast enhancement. Overall, four cats (4.6%) had abnormalities on CSF analysis; all (100%) had an increased total nucleated cell count (22 cells/μl, 7 cells/μl, 6 cells/μl and 6 cells/μl, respectively), and no cat had increased total protein (100%), although in one cat total protein was not evaluated. Three of these cats had unremarkable MRI and one had hippocampal signal changes without contrast enhancement. The median duration of epileptic signs prior to the MRI study was 2 days. CONCLUSIONS AND RELEVANCE Our results show that, in our cohort of epileptic cats with unremarkable brain MRI or with hippocampal signal changes, CSF analysis was usually normal. This should be considered before performing a CSF tap.
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Affiliation(s)
- Rozalia Majercikova
- Clinical Unit of Internal Medicine Small Animals, Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Barbara C Rütgen
- Clinical Pathology, Department of Pathobiology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Nicole Luckschander-Zeller
- Clinical Unit of Internal Medicine Small Animals, Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Borbala A Lörincz
- Clinical Unit of Diagnostic Imaging, Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Akos Pakozdy
- Clinical Unit of Internal Medicine Small Animals, Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
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Lowrie M. In search of the best analysis regarding treatment for meningoencephalitis of unknown origin in dogs. Front Vet Sci 2023; 9:1062114. [PMID: 36686177 PMCID: PMC9846519 DOI: 10.3389/fvets.2022.1062114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
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Prümmer JK, Stein VM, Marti E, Lutterotti A, Jelcic I, Schüpbach-Regula G, Buch T, Maiolini A. Assessment of oligoclonal bands in cerebrospinal fluid and serum of dogs with meningoencephalitis of unknown origin. PLoS One 2023; 18:e0280864. [PMID: 36696385 PMCID: PMC9876372 DOI: 10.1371/journal.pone.0280864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Meningoencephalitis of unknown origin (MUO) is an inflammatory disease of the canine central nervous system (CNS) that shares several features with multiple sclerosis (MS) in humans. In approximately 95% of MS patients, ≥ two immunoglobulin G (IgG) oligoclonal bands (OCBs) are detectable exclusively in the cerebrospinal fluid (CSF). HYPOTHESIS/OBJECTIVES To investigate OCBs in CSF and serum in dogs affected by MUO, intervertebral disc disease (IVDD), idiopathic epilepsy (IE), intracranial neoplasia (IN), steroid-responsive meningitis-arteritis (SRMA), and diseases outside the CNS. We hypothesize that the highest prevalence of CSF-specific OCBs (≥ two OCBs uniquely in the CSF) would be found in dogs affected by MUO. ANIMALS Client-owned dogs (n = 121) presented to the neurology service due to neurological deficits. METHODS Prospective study. Measurement of IgG concentration in CSF and serum via a canine IgG ELISA kit. OCB detection via isoelectric focusing (IEF) and immunoblot. RESULTS Presence of CSF-specific OCBs was significantly higher in dogs with MUO (57%) compared to 22% in IN, 6% in IE, 15% in SRMA, 13% in IVDD, and 0% in the non-CNS group (p < .001). Dogs with MUO were 9.9 times more likely to show CSF-specific OCBs than all other diseases together (95% confidence interval, 3.7-26.4; p < .001). CONCLUSIONS AND CLINICAL IMPORTANCE MUO showed the highest prevalence of CSF-specific OCBs, indicating an inflammatory B cell response. Future studies are needed to evaluate the prevalence in the specific MUO subtypes and a possible similarity with human MS.
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Affiliation(s)
- Julia K. Prümmer
- Division of Clinical Neurology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
- * E-mail:
| | - Veronika M. Stein
- Division of Clinical Neurology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Eliane Marti
- Division of Neurological Sciences, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | | | - Ilijas Jelcic
- Department of Neurology, University of Zurich, Zurich, Switzerland
| | - Gertraud Schüpbach-Regula
- Department of Clinical Research and Public Health, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Thorsten Buch
- Institute of Laboratory Animal Science, University of Zurich, Zurich, Switzerland
| | - Arianna Maiolini
- Division of Clinical Neurology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Herzig R, Beckmann K, Körner M, Steffen F, Rohrer Bley C. A shortened whole brain radiation therapy protocol for meningoencephalitis of unknown origin in dogs. Front Vet Sci 2023; 10:1132736. [PMID: 37020978 PMCID: PMC10069678 DOI: 10.3389/fvets.2023.1132736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/28/2023] [Indexed: 04/07/2023] Open
Abstract
Introduction A variety of treatment options have been described for canine meningoencephalitis of unknown origin (MUO). Few studies focused on radiation therapy as a second line immunomodulating treatment, implicating its effective use. However, a standard radiation therapy protocol is lacking, and further research will help to evaluate the effect of different dose regimens. Methods Ten dogs diagnosed with MUO based on MRI and CSF findings were prospectively enrolled. The dogs were treated with a shortened whole brain radiation therapy protocol (5 × 4 Gy) in combination with prednisolone. Neurologic changes were quantified using an established scoring scheme. Follow-up MRI and CSF examination was scheduled three months after radiation therapy. Overall survival and time to progression were calculated. Histopathology of the brain was performed in case of death. Results Seven dogs were diagnosed de novo and three had a history of relapsing MUO. Neurological status improved in all 10 dogs during radiation therapy, with 4/10 returning to normal shortly after radiation therapy. Three dogs died within the first three months after radiation therapy. At follow-up MRI lesions completely resolved in two dogs, partially resolved in five dogs, and progressed in one dog. After follow-up MRI, dogs were further treated with prednisolone monotherapy (two dogs) and additional immunosuppressant drugs (five dogs). Overall, four dogs showed disease progression, with a mean time to progression of 691 days (95%CI: 396-987) and mean overall survival for all dogs was 723 days (95%CI: 436-1011) (both medians not reached). Histopathology confirmed MUO in three dogs but was suggestive for oligodendroglioma in one dog. Radiation induced side effects were not seen. Conclusion Shortened whole-brain radiation therapy could be an additional treatment option for MUO in conjunction to prednisolone, specifically for cases that require rapid relief of symptoms and with relapsing history.
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Affiliation(s)
- Robert Herzig
- Division of Neurology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
- *Correspondence: Robert Herzig
| | - Katrin Beckmann
- Division of Neurology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Maximilian Körner
- Division of Radiation Oncology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Frank Steffen
- Division of Neurology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Carla Rohrer Bley
- Division of Radiation Oncology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
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OSHIMA A, ITO D, KATAKURA F, MIYAMAE J, OKANO M, NAKAZAWA M, KANAZONO S, MORITOMO T, KITAGAWA M. Dog leukocyte antigen class II alleles and haplotypes associated with meningoencephalomyelitis of unknown origin in Chihuahuas. J Vet Med Sci 2023; 85:62-70. [PMID: 36418080 PMCID: PMC9887217 DOI: 10.1292/jvms.22-0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Idiopathic non-infectious meningoencephalomyelitis (NIME), which is thought to be an immune-mediated disease, is a common inflammatory disease in dogs. Meningoencephalomyelitis of unknown origin (MUO), a subgroup of NIME, consists of necrotizing meningoencephalitis (NME), necrotizing leukoencephalitis, and granulomatous meningoencephalomyelitis. Recent studies have shown associations between disease development and dog leukocyte antigen (DLA) class II genes in NME in Pugs and in NIME in Greyhounds. This study focused on Chihuahuas, which have a high incidence of MUO and are one of the most common dog breeds in Japan. Because the development of MUO seems to be associated with DLA class II genes, we aimed to evaluate the association between DLA class II genes and MUO development in Chihuahuas. Blood samples were obtained from 22 Chihuahuas with MUO (MUO group) and 46 without neurological diseases (control). The allele sequences of three DLA class II loci were determined, and haplotypes were estimated from these data. In total, 23 haplotypes were detected. The frequency of one haplotype (DLA-DRB1*015:01--DQA1*006:01--DQB1*023:01) was significantly higher in the MUO group than in the control group (odds ratio, 7.11; 95% confidence interval, 1.37-36.81; P=0.0141). The results suggest that the development of MUO in Chihuahuas may be associated with DLA class II genes. Because the identified risk haplotypes differed from those of other breeds, the pathogenesis of NIME-related diseases may differ among dog breeds.
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Affiliation(s)
- Ayaka OSHIMA
- Laboratory of Veterinary Neurology, Department of Veterinary Medicine, College of Bioresource Science, Nihon University, Kanagawa, Japan
| | - Daisuke ITO
- Laboratory of Veterinary Neurology, Department of Veterinary Medicine, College of Bioresource Science, Nihon University, Kanagawa, Japan,Correspondence to: Ito D: , Laboratory of Veterinary Neurology, Department
of Veterinary Medicine, College of Bioresource Science, Nihon University, 1866 Kameino, Fujisawa, Kanagawa 252-0880, Japan
| | - Fumihiko KATAKURA
- Laboratory of Comparative Immunology, Department of Veterinary Medicine, College of Bioresource Science, Nihon University, Kanagawa, Japan
| | - Jiro MIYAMAE
- Faculty of Medicine, Okayama University of Science, Ehime, Japan
| | - Masaharu OKANO
- Department of Legal Medicine, Nihon University School of Dentistry, Tokyo, Japan
| | - Megu NAKAZAWA
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Medicine, College of Bioresource Science, Nihon University, Kanagawa, Japan
| | - Shinichi KANAZONO
- Neurology and Neurosurgery Service, Veterinary Specialists and Emergency Center, Saitama, Japan
| | - Tadaaki MORITOMO
- Laboratory of Comparative Immunology, Department of Veterinary Medicine, College of Bioresource Science, Nihon University, Kanagawa, Japan
| | - Masato KITAGAWA
- Laboratory of Veterinary Neurology, Department of Veterinary Medicine, College of Bioresource Science, Nihon University, Kanagawa, Japan
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Nessler JN, Oevermann A, Schawacht M, Gerhauser I, Spitzbarth I, Bittermann S, Steffen F, Schmidt MJ, Tipold A. Concomitant necrotizing encephalitis and granulomatous meningoencephalitis in four toy breed dogs. Front Vet Sci 2022; 9:957285. [PMID: 36118343 PMCID: PMC9477003 DOI: 10.3389/fvets.2022.957285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022] Open
Abstract
The term “meningoencephalitis of unknown origin” (MUO) describes a group of different encephalitides in dogs in which no infectious agent can be identified and a multifactorial etiology is suspected. Among others, genetic factors and unknown triggers seem to be involved. Included are necrotizing leukoencephalitis (NLE), necrotizing meningoencephalitis (NME), and granulomatous meningoencephalitis (GME). In this case series, we describe the histopathological findings of four toy breed dogs with focal or multifocal necrotizing encephalitis and mainly lymphocytic perivascular infiltrates on histopathological examination. At the same time, however, in all dogs, focal or multifocal high-grade angiocentric granulomatous inflammatory lesions were evident with focal histiocytic perivascular infiltrates in the brain. The former changes are typical for NLE and NME. In contrast, the latter changes are indicative of GME. This case series shows that the boundaries between the necrotizing and granulomatous variants of MUO might be smooth and suggests that NLE, NME, and GME are not as distinct as previously described. This finding could be a crucial piece of the puzzle in the study of the pathogenesis of MUO as individual susceptibility and specific triggers could be responsible for the manifestation of the different MUO subtypes.
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Affiliation(s)
- Jasmin Nicole Nessler
- Department for Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
- *Correspondence: Jasmin Nicole Nessler
| | - Anna Oevermann
- Department of Clinical Research and Veterinary Public Health, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Marina Schawacht
- Department for Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Ingo Gerhauser
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Ingo Spitzbarth
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Sophie Bittermann
- Department of Clinical Research and Veterinary Public Health, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Frank Steffen
- Department of Clinical Neurology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Martin Jürgen Schmidt
- Clinic for Small Animal-Surgery, Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, Justus-Liebig-University, Giessen, Germany
| | - Andrea Tipold
- Department for Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
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Zdora I, Raue J, Söbbeler F, Tipold A, Baumgärtner W, Nessler JN. Case report: Lympho-histiocytic meningoencephalitis with central nervous system vasculitis of unknown origin in three dogs. Front Vet Sci 2022; 9:944867. [PMID: 36090171 PMCID: PMC9449415 DOI: 10.3389/fvets.2022.944867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022] Open
Abstract
Meningoencephalitis of unknown origin (MUO) is an umbrella term for a variety of subtypes of meningoencephalitis of dogs and cats with no identifiable infectious agent. In dogs, granulomatous meningoencephalitis (GME), necrotizing meningoencephalitis (NME), and necrotizing leukoencephalitis (NLE) are the most commonly reported subtypes. However, sporadically there are reports about other subtypes such as greyhound encephalitis or eosinophilic meningoencephalitis. The following case series presents three dogs with peracute to acute progressive signs of encephalopathy. The magnetic resonance imaging (MRI) of two dogs (post mortem n = 1/2) showed severe, diffuse swelling of the cortical gray matter with increased signal intensity in T2weighted (w) and fluid-attenuated inversion recovery (FLAIR) and decreased signal intensity in T1w. Additionally, focal to multifocal areas with signal void in both dogs and caudal transforaminal herniation of the cerebellum in one dog was observed. Post mortem histopathological examination revealed lympho-histiocytic encephalitis and central nervous system (CNS) vasculitis in all dogs. No infectious agents were detectable by histopathology (hematoxylin and eosin stain), periodic acid-Schiff reaction (PAS), Ziehl-Neelsen stain and immunohistochemistry for Canine adenovirus-1, Parvovirus, Listeria monocytogenes, Parainfluenzavirus, Toxoplasma gondii, Herpes-suis virus, Pan-Morbillivirus, Tick born encephalitis virus, Severe acute respiratory syndrome coronavirus (SARS-CoV) 2. Furthermore, two dogs were tested negative for rabies virus. To the best of the authors' knowledge, this is the first report of a lympho-histiocytic encephalitis with CNS vasculitis with no identifiable infectious agent. It is suggested to consider this as an additional subtype of MUO with severe clinical signs.
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Affiliation(s)
- Isabel Zdora
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
- Center of Systems Neuroscience, Hannover, Germany
| | - Jonathan Raue
- Department for Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Franz Söbbeler
- Department for Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Andrea Tipold
- Center of Systems Neuroscience, Hannover, Germany
- Department for Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Wolfgang Baumgärtner
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
- Center of Systems Neuroscience, Hannover, Germany
| | - Jasmin Nicole Nessler
- Department for Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
- *Correspondence: Jasmin Nicole Nessler
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Remelli C, Martello A, Valentini A, Contiero B, Bernardini M. Magnetic resonance imaging highlights the meningeal involvement in steroid responsive meningitis-arteritis and suggests the inflammation of the surrounding tissues (70 cases). Front Vet Sci 2022; 9:957278. [PMID: 36061118 PMCID: PMC9439657 DOI: 10.3389/fvets.2022.957278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Steroid-responsive meningitis-arteritis (SRMA) is an immune-mediated disorder of young dogs for which there is no definitive ante-mortem diagnostic test. Magnetic Resonance Imaging (MRI) can be used to explore other differentials and extensive reports about its usefulness in the diagnosis of SRMA are lacking. The aims of this study were to retrospectively investigate the characteristics of MRI studies of the cervical spine of dogs diagnosed with SRMA and to compare the diagnostic capability of MRI obtained with low-field and high-field units. Materials and methods This is a double center, retrospective case series. Databases were searched between 2008 and 2021 for dogs with a diagnosis of SRMA. Dogs were included if the following criteria were fulfilled: a diagnosis of cervical SRMA, results of CSF analysis, and MRI of the cervical spine available for re-evaluation. Results Seventy cases were selected. MRI abnormalities were found in 69 cases (98.6%). 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, respectively, when considering all MRI. In the low-field MRI, enhancement of these structures was present in 45 (90%), 4 (8%), 21 (42%) and 23 (46%) cases, respectively. In the high-field MRI, enhancement of these structures was present in 16 (80%), 6 (30%), 13 (65%) and 11 (55%) cases, respectively. Fat suppressed T1W images showed meningeal enhancement better than T1W images. When all the MRIs were considered, a significant increase in cell count of the cerebrospinal fluid was found between the three groups based on the meningeal MRI score (p = 0.001). In cases with no meningeal enhancement but enhancement of synovium of the articular facets and/or muscles a significantly lower cerebrospinal fluid cell count was present (p = 0.043), when considering all MRIs. Conclusions The most frequent detection on cervical MRI of dogs affected by SRMA is meningeal enhancement, often accompanied by enhancement of the synovium of the articular facets and/or muscular enhancement. Both low-field and high-field MRI have good diagnostic capability but the latter enables a more thorough investigation thanks to specific sequences. MRI is useful as a complementary tool to cerebrospinal fluid analysis.
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Affiliation(s)
- Carlotta Remelli
- Department of Animal Medicine, Productions and Health, University of Padua, Legnaro, Italy
- *Correspondence: Carlotta Remelli
| | - Alba Martello
- Department of Animal Medicine, Productions and Health, University of Padua, Legnaro, Italy
| | - Alessia Valentini
- Department of Animal Medicine, Productions and Health, University of Padua, Legnaro, Italy
| | - Barbara Contiero
- Department of Animal Medicine, Productions and Health, University of Padua, Legnaro, Italy
| | - Marco Bernardini
- Department of Animal Medicine, Productions and Health, University of Padua, Legnaro, Italy
- Anicura I Portoni Rossi Veterinary Hospital, Zola Predosa, Bologna, Italy
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Lawn RW, Harcourt-Brown TR. Risk factors for early death or euthanasia within 100 days of diagnosis in dogs with meningoencephalitis of unknown origin. Vet J 2022; 287:105884. [PMID: 35987308 DOI: 10.1016/j.tvjl.2022.105884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/27/2022] [Accepted: 08/13/2022] [Indexed: 10/15/2022]
Abstract
Meningoencephalitis of unknown origin (MUO) in the dog is an inflammatory condition of the central nervous system with variable short- and long-term prognosis. Previous studies have attempted to identify risk factors for early death; however, the findings were inconsistent and prognostication and treatment selection remain difficult for cases of MUO. The aim of this study was to compare the influence of putative prognostic factors on early survival in dogs with MUO. Logistic regression was used to analyse the effect of clinical and magnetic resonance imaging (MRI) features at diagnosis and type of immune-suppressive treatment received on survival at three-time points; 7 days, 30 days, and 100 days post-diagnosis. Ninety eight dogs were included. Dogs that were obtunded at presentation had a 6.6 times increased odds of death in the first 7 days after diagnosis, a 2.1 times increased risk of death 8-30 days after diagnosis, and a 1.9 times increased risk of death 31-100 days after diagnosis. No other clinical, MRI feature, or treatment was found to have a significant influence on survival. Obtundation at presentation was found to increase risk of early euthanasia in dogs with MUO, while the addition of an IV infusion of cytarabine to immune-suppressive corticosteroid therapy (prednisolone and/or dexamethasone) at initial treatment did not improve the odds of survival at 7, 30, or 100 days after diagnosis.
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Affiliation(s)
- R W Lawn
- Langford Vets Small Animal Referral Hospital, Langford House, Langford, Bristol BS40 5DU, UK.
| | - T R Harcourt-Brown
- Langford Vets Small Animal Referral Hospital, Langford House, Langford, Bristol BS40 5DU, UK
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Park J, Lee D, Yun T, Koo Y, Chae Y, Kim H, Yang MP, Kang BT. Evaluation of the blood neutrophil-to-lymphocyte ratio as a biomarker for meningoencephalitis of unknown etiology in dogs. J Vet Intern Med 2022; 36:1719-1725. [PMID: 35929724 PMCID: PMC9511057 DOI: 10.1111/jvim.16512] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/19/2022] [Indexed: 12/14/2022] Open
Abstract
Background The neutrophil‐to‐lymphocyte ratio (NLR) has been identified as a biomarker in several inflammatory and autoimmune diseases. Multiple sclerosis (MS) has been found to be associated with changes in the NLR in humans. Objectives To examine the diagnostic value of the NLR in meningoencephalitis of unknown etiology (MUE) in dogs. Animals Thirty‐eight MUE dogs, 20 hydrocephalic dogs, 10 brain tumor (BT) dogs, 32 idiopathic epilepsy (IE) dogs, and 41 healthy dogs. Methods Retrospective study. Medical records were reviewed to identify dogs with a diagnosis of neurologic disease. The NLR was determined in all dogs. Results The median NLR was significantly higher in MUE dogs (6.08) than in healthy (1.78, P < .001), IE (2.50, P < .05), and hydrocephalic dogs (1.79, P < .05). The area under the receiver operating characteristic curve of the NLR for differentiation between MUE and healthy dogs was 0.96, and between the MUE dogs and dogs with other forebrain diseases was 0.86. An optimal cutoff of 4.16 for the NLR had a sensitivity of 71.1% and specificity of 83.9% to differentiate the MUE dogs from the dogs with other forebrain diseases. Conclusions and Clinical Importance The NLR could be a biomarker for diagnosing MUE and distinguishing it from other intracranial diseases in dogs.
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Affiliation(s)
- Jooyoung Park
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Dohee Lee
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Taesik Yun
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Yoonhoi Koo
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Yeon Chae
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Hakhyun Kim
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Mhan-Pyo Yang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Byeong-Teck Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
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Barber R, Barber J. Differential T-cell responses in dogs with meningoencephalomyelitis of unknown origin compared to healthy controls. Front Vet Sci 2022; 9:925770. [PMID: 35990273 PMCID: PMC9386037 DOI: 10.3389/fvets.2022.925770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Meningoencephalomyelitis of unknown origin (MUO) is a common disorder in dogs that results in mononuclear inflammation in the brain and/or spinal cord. MUO is presumed to be autoimmune but specific immunological aberrations have not been identified. This exploratory study aimed to evaluate T cell production of two cytokines commonly implicated in autoimmune disease, interferon-gamma (IFNg) and interleukin-17 (IL17). Peripheral blood mononuclear cells were obtained from 12 dogs with MUO and 10 healthy controls, stimulated to activate intracellular signaling pathways, and stained with a cluster of differentiation 4 (CD4), cluster of differentiation eight (CD8), IFNg, and IL17 antibodies prior to analysis by flow cytometry. Mean differences in absolute cell numbers are represented as MUO cases minus healthy controls, and 95% Cis are reported. Overall IFNg-producing lymphocytes (mean difference = 241.8 cells/ul, 95% CI = 65.6 to 418.1) and CD4+ IFNg-producing T-cells (mean difference = 188.4, 95% CI = 77.3 to 299.5) were fewer in MUO cases. Additionally, CD4+ IL17-producing T-cells were greater in MUO cases (mean difference −34.9, 95% CI = −50.54 to −19.17) and CD8+ IL17-producing T-cells were fewer in MUO cases (mean difference = 73.5, 95% CI = 6.8 to 140.1). These results support that immunological changes can be identified in peripheral blood cells of dogs with MUO and suggest that T-helper type 17 (Th17) cells may play a role in pathogenesis.
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Affiliation(s)
- Renee Barber
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
- *Correspondence: Renee Barber
| | - James Barber
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
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Barber R, Downey Koos L. Treatment With Cytarabine at Initiation of Therapy With Cyclosporine and Glucocorticoids for Dogs With Meningoencephalomyelitis of Unknown Origin Is Not Associated With Improved Outcomes. Front Vet Sci 2022; 9:925774. [PMID: 35754543 PMCID: PMC9226772 DOI: 10.3389/fvets.2022.925774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Meningoencephalomyelitis of unknown origin (MUO) is a common disorder of dogs that results in significant morbidity and mortality. The ideal treatment regimen is not known but a second immunosuppressive agent is often utilized in combination with glucocorticoids to increase efficacy and reduce side effects. Recently, a benefit to using a cytosine arabinoside (CA) constant rate infusion (CRI) at the time of diagnosis has been demonstrated. Here, a retrospective study was performed to determine if administration of CA at the time of diagnosis would alter prognosis in dogs receiving cyclosporine and prednisone for treatment of MUO. Medical records of 51 client-owned dogs diagnosed with MUO at one institution were reviewed (2009-2019). All dogs were treated with cyclosporine and a tapering course of prednisone. Twenty-one dogs received a single initial 200 mg/m2 treatment with CA either as a CRI or subcutaneously. Significantly more patients in the CA treatment group were obtunded on presentation but all other baseline parameters were similar between groups. No differences in success (defined as sustained improvement on neurological exam with owner perceived good quality of life), relapse, or death were identified at 1-, 3-, 6-, 9-, 12-, 18-, or 36-month time points. These results do not support treatment with CA (either as a CRI or subcutaneously) at the time of diagnosis in dogs treated with cyclosporine and prednisone.
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Affiliation(s)
- Renee Barber
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
| | - Lauren Downey Koos
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
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Huenerfauth EI, Bien CG, Bien C, Volk HA, Meyerhoff N. Case Report: Anti-GABAA Receptor Encephalitis in a Dog. Front Vet Sci 2022; 9:886711. [PMID: 35812851 PMCID: PMC9262380 DOI: 10.3389/fvets.2022.886711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/25/2022] [Indexed: 01/21/2023] Open
Abstract
Autoantibodies against neurotransmitter receptors detected in cerebrospinal fluid (CSF) and serum are increasingly recognized in people with human autoimmune encephalitis causing severe neurological deficits, such as seizures and behavioral abnormalities. This case report describes the first encephalitis associated with antibodies against the γ-aminobutyric acid-A receptor (GABAAR) in a dog. A young male intact Cavalier King Charles Spaniel was presented with recent onset of initial multiple generalized tonic-clonic seizures progressing into a status epilepticus. Interictally, he showed alternating stupor and hyperexcitability, ataxia, pleurothotonus and circling behavior to the left side. Magnetic resonance imaging (MRI) of the brain showed breed-specific anatomical abnormalities. Standard CSF analysis was unremarkable. Despite treatment with multiple antiseizure medications (ASMs) seizures and behavior abnormalities sustained. Immunotherapy with dexamethasone was started on the fifth day after disease manifestation. This led to rapid improvement of clinical signs. An extensive antibody search in CSF and serum demonstrated a neuropil staining pattern on a tissue-based assay compatible with GABAAR antibodies. The diagnosis was confirmed by binding of serum and CSF antibodies to GABAAR transfected Human Embryonic Kidney cells. The serum titer was 1:320, the CSF titer 1:2. At the control visit 4.5 weeks after start of immunotherapy, the dog was clinically normal. The GABAAR antibody titer in serum had strongly decreased. The antibodies were no longer detectable in CSF. Based on clinical presentation and testing for GABAAR binding antibodies, this describes the first veterinary patient with an anti-GABAAR encephalitis with a good outcome following ASM and corticosteroid treatment.
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Affiliation(s)
- Enrice I. Huenerfauth
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Foundation, Hannover, Germany
- *Correspondence: Enrice I. Huenerfauth
| | | | | | - Holger A. Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Foundation, Hannover, Germany
| | - Nina Meyerhoff
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Foundation, Hannover, Germany
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Barber RM, Li Q, Levine JM, Ruone SJ, Levine GJ, Kenny P, Tong S, Schatzberg SJ. Screening for Viral Nucleic Acids in the Cerebrospinal Fluid of Dogs With Central Nervous System Inflammation. Front Vet Sci 2022; 9:850510. [PMID: 35400093 PMCID: PMC8987525 DOI: 10.3389/fvets.2022.850510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/16/2022] [Indexed: 01/17/2023] Open
Abstract
Central nervous system (CNS) inflammation is a common cause of neurological dysfunction in dogs. Most dogs with CNS inflammation are diagnosed with presumptive autoimmune disease. A smaller number are diagnosed with an infectious etiology. Additionally, at necropsy, a subset of dogs with CNS inflammation do not fit previously described patterns of autoimmune disease and an infectious cause is not readily identifiable. Because viral infection is a common cause of meningoencephalitis in people, we hypothesize that a subset of dogs presented with CNS inflammation have an occult viral infection either as a direct cause of CNS inflammation or a trigger for autoimmunity. The goal of this research was to screen cerebrospinal fluid from a large number dogs with CNS inflammation for occult viral infection. One hundred seventy-two dogs with neurological dysfunction and cerebrospinal fluid (CSF) pleocytosis were identified. Of these, 42 had meningoencephalitis of unknown origin, six had steroid-responsive meningitis-arteritis, one had eosinophilic meningoencephalitis, five had documented infection, 21 had and undetermined diagnosis, and 97 had a diagnosis not consistent with primary inflammatory disease of the CNS (e.g., neoplasia). CSF samples were subsequently screened with broadly reactive PCR for eight viral groups: adenovirus, bunyavirus, coronavirus, enterovirus, flavivirus, herpesvirus, paramyxovirus, and parechovirus. No viral nucleic acids were detected from 168 cases screened for eight viral groups, which does not support occult viral infection as a cause of CNS inflammation in dogs. La Crosse virus (LACV) nucleic acids were detected from four cases in Georgia. Subclinical infection was supported in two of these cases but LACV could not be ruled-out as a cause of infection in the other two cases, suggesting further research is warranted to determine if LACV is an occult cause of CNS inflammation in dogs.
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Affiliation(s)
- Renee M. Barber
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA, United States
- *Correspondence: Renee M. Barber
| | - Qiang Li
- Becker Animal Hospital, Veterinary Centers of America, San Antonio, TX, United States
| | - Jonathan M. Levine
- Department of Small Animal Clinical Sciences, Texas A&M University College of Veterinary Medicine and Biomedical Sciences, College Station, TX, United States
| | - Susan J. Ruone
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Gwendolyn J. Levine
- Department of Veterinary Pathobiology, Texas A&M University College of Veterinary Medicine and Biomedical Sciences, College Station, TX, United States
| | - Patrick Kenny
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, University of London, Hertfordshire, United Kingdom
| | - Suxiang Tong
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Scott J. Schatzberg
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA, United States
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Hanael E, Baruch S, Chai O, Nir Z, Rapoport K, Ruggeri M, Eizenberg I, Peery D, Friedman A, Shamir MH. Detection of blood‐brain barrier dysfunction using advanced imaging methods to predict seizures in dogs with meningoencephalitis of unknown origin. J Vet Intern Med 2022; 36:702-712. [PMID: 35285550 PMCID: PMC8965229 DOI: 10.1111/jvim.16396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 12/01/2022] Open
Abstract
Background The blood‐brain barrier (BBB), which separates the intravascular and neuropil compartments, characterizes the vascular bed of the brain and is essential for its proper function. Recent advances in imaging techniques have driven the development of methods for quantitative assessment of BBB permeability. Hypothesis/Objectives Permeability of the BBB can be assessed quantitatively in dogs with meningoencephalitis of unknown origin (MUO) and its status is associated with the occurrence of seizures. Animals Forty dogs with MUO and 12 dogs without MUO. Methods Retrospective, prospective cohort study. Both dynamic contrast enhancement (DCE) and subtraction enhancement analysis (SEA) methods were used to evaluate of BBB permeability in affected (DCE, n = 8; SEA, n = 32) and control dogs (DCE, n = 6; SEA, n = 6). Association between BBB dysfunction (BBBD) score and clinical characteristics was examined. In brain regions where BBBD was identified by DCE or SEA magnetic resonance imaging (MRI) analysis, immunofluorescent staining for albumin, glial fibrillary acidic protein, ionized calcium binding adaptor molecule, and phosphorylated mothers against decapentaplegic homolog 2 were performed to detect albumin extravasation, reactive astrocytes, activated microglia, and transforming growth factor beta signaling, respectively. Results Dogs with BBBD had significantly higher seizure prevalence (72% vs 19%; P = .01) when compared to MUO dogs with no BBBD. The addition of SEA to routine MRI evaluation increased the identification rate of brain pathology in dogs with MUO from 50% to 72%. Conclusions and Clinical Importance Imaging‐based assessment of BBB integrity has the potential to predict risk of seizures in dogs with MUO.
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Affiliation(s)
- Erez Hanael
- Hebrew University Koret School of Veterinary Medicine‐Veterinary Teaching Hospital Rehovot Israel
| | - Shelly Baruch
- Hebrew University Koret School of Veterinary Medicine‐Veterinary Teaching Hospital Rehovot Israel
| | - Orit Chai
- Hebrew University Koret School of Veterinary Medicine‐Veterinary Teaching Hospital Rehovot Israel
| | - Zohar Nir
- Hebrew University Koret School of Veterinary Medicine‐Veterinary Teaching Hospital Rehovot Israel
| | - Kira Rapoport
- Hebrew University Koret School of Veterinary Medicine‐Veterinary Teaching Hospital Rehovot Israel
| | - Marco Ruggeri
- Hebrew University Koret School of Veterinary Medicine‐Veterinary Teaching Hospital Rehovot Israel
| | - Itzhak Eizenberg
- Hebrew University Koret School of Veterinary Medicine‐Veterinary Teaching Hospital Rehovot Israel
| | - Dana Peery
- Hebrew University Koret School of Veterinary Medicine‐Veterinary Teaching Hospital Rehovot Israel
| | - Alon Friedman
- Departments of Physiology and Cell Biology, Brain, and Cognitive Sciences, Zlotowski Center for Neuroscience Ben‐Gurion University of the Negev Beer Sheva Israel
- Department of Medical Neuroscience, Faculty of Medicine Dalhousie University Halifax NS Canada
| | - Merav H. Shamir
- Hebrew University Koret School of Veterinary Medicine‐Veterinary Teaching Hospital Rehovot Israel
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Prümmer JK, Moioli M, Richard OK, Maiolini A. Clinical, imaging and histopathological features of concurrent malignancies in a dog: Meningoencephalitis of unknown origin and a malignant parotid gland carcinoma. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Julia Katrin Prümmer
- Division of Clinical Neurology Vetsuisse Faculty University of Bern Bern Switzerland
| | - Melania Moioli
- Division of Clinical Radiology Vetsuisse Faculty University of Bern Bern Switzerland
- Clinica Veterinaria Orobica Bergamo Italy
| | - Olivia Kristina Richard
- Institute of Animal Pathology Vetsuisse Faculty University of Bern Bern Switzerland
- Pathovet Tagelswangen Germany
| | - Arianna Maiolini
- Institute of Animal Pathology Vetsuisse Faculty University of Bern Bern Switzerland
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Benito MB, Fuentes MP, Manso‐Diaz G, Madonado BS, Diaz CP. Clinical signs, diagnostic imaging and histopathology in a dog with granulomatous meningoencephalitis manifested as a polyneuropathy. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Miguel Benito Benito
- Small Animal Medicine and Surgery Department Complutense University of Madrid Madrid Spain
- Neurology and Neurosurgery Service Hamilton Specialists Referrals High Wycombe UK
| | - Miriam Portero Fuentes
- Small Animal Medicine and Surgery Department Complutense University of Madrid Madrid Spain
| | - Gabriel Manso‐Diaz
- Small Animal Medicine and Surgery Department Complutense University of Madrid Madrid Spain
| | - Belén Sánchez Madonado
- Small Animal Medicine and Surgery Department Complutense University of Madrid Madrid Spain
| | - Carmen Pérez Diaz
- Small Animal Medicine and Surgery Department Complutense University of Madrid Madrid Spain
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Gonçalves R, De Decker S, Walmsley G, Butterfield S, Maddox TW. Inflammatory Disease Affecting the Central Nervous System in Dogs: A Retrospective Study in England (2010–2019). Front Vet Sci 2022; 8:819945. [PMID: 35155652 PMCID: PMC8829331 DOI: 10.3389/fvets.2021.819945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022] Open
Abstract
The epidemiology of inflammatory diseases affecting the central nervous system (CNS) in dogs is largely unknown. We aimed to report the relative proportion of different causes of inflammatory disease affecting the CNS in dogs and identify predictors for infectious vs. immune-mediated conditions and predictors for the most common diseases affecting the brain and the spinal cord. This was a retrospective cohort study over a 10-year period in 2 referral institutions using multivariable and multinomial logistic regression for identification of risk factors. In total, 1,140 client-owned dogs diagnosed with inflammatory disease affecting the CNS were included. Fifteen different diagnoses were identified, with immune-mediated (83.6%) disease being more common than infectious conditions (16.4%). The most common immune-mediated conditions diagnosed were meningoencephalitis of unknown origin (47.5%) and steroid-responsive meningitis–arteritis (30.7%), and the most common infectious conditions were discospondylitis (9.3%) and otogenic intracranial infection (2.2%). Older age (p < 0.001, OR = 1.019, 95% CI: 1.014–1.024), higher body weight (p < 0.001, OR = 1.049, 95% CI: 1.025–1.074), male sex (p = 0.009, OR = 1.685, 95% CI: 1.141–2.488), longer duration of the clinical signs before presentation (p < 0.001, OR = 1.011, 95% CI: 1.006–1.017), progressive nature of the clinical signs (p < 0.001, OR = 2.295, 95% CI: 1.463–3.599), identification of a possibly associated preceding event (p = 0.0012, OR = 1.93, 95% CI: 1.159–3.213), and hyperesthesia on presentation (p < 0.001, OR = 2.303, 95% CI: 1.528–3.473) were associated with a diagnosis of infectious diseases. Our data shows that immune-mediated diseases are more common than infectious conditions as a cause for inflammatory CNS disease in dogs. The risk factors for the most common diagnoses were identified from signalment, history, and findings of the physical and neurological examinations to give valuable information that can guide clinicians with their investigations.
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Affiliation(s)
- Rita Gonçalves
- Department of Small Animal Clinical Science, Small Animal Teaching Hospital, University of Liverpool, Liverpool, United Kingdom
- Department of Musculoskeletal and Ageing Science, Institute of Lifecourse and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- *Correspondence: Rita Gonçalves
| | - Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, United Kingdom
| | - Gemma Walmsley
- Department of Small Animal Clinical Science, Small Animal Teaching Hospital, University of Liverpool, Liverpool, United Kingdom
- Department of Musculoskeletal and Ageing Science, Institute of Lifecourse and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Sarah Butterfield
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, United Kingdom
| | - Thomas W. Maddox
- Department of Small Animal Clinical Science, Small Animal Teaching Hospital, University of Liverpool, Liverpool, United Kingdom
- Department of Musculoskeletal and Ageing Science, Institute of Lifecourse and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
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36
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Nessler JN, Jo WK, Osterhaus ADME, Ludlow M, Tipold A. Canine Meningoencephalitis of Unknown Origin-The Search for Infectious Agents in the Cerebrospinal Fluid via Deep Sequencing. Front Vet Sci 2021; 8:645517. [PMID: 34950723 PMCID: PMC8688736 DOI: 10.3389/fvets.2021.645517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 11/15/2021] [Indexed: 01/02/2023] Open
Abstract
Meningoencephalitis of unknown origin (MUO) describes a group of meningoencephalitides in dogs with a hitherto unknown trigger. An infectious agent has been suggested as one possible trigger of MUO but has not been proven so far. A relatively new method to screen for viral RNA or DNA is next-generation sequencing (NGS) or deep sequencing. In this study, a metagenomics analysis of the virome in a sample is analyzed and scanned for known or unknown viruses. We examined fresh-frozen CSF of 6 dogs with MUO via NGS using a modified sequence-independent, single-primer amplification protocol to detect a possible infectious trigger. Analysis of sequencing reads obtained from the six CSF samples showed no evidence of a virus infection. The inability to detect a viral trigger which could be implicated in the development of MUO in the examined population of European dogs, suggests that the current techniques are not sufficiently sensitive to identify a possible virus infection, that the virus is already eliminated at the time-point of disease outbreak, the trigger might be non-infectious or that there is no external trigger responsible for initiating MUO in dogs.
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Affiliation(s)
- Jasmin Nicole Nessler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Foundation, Hannover, Germany
| | - Wendy Karen Jo
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Foundation, Hannover, Germany
| | - Albert D M E Osterhaus
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Foundation, Hannover, Germany
| | - Martin Ludlow
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Foundation, Hannover, Germany
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Foundation, Hannover, Germany
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37
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Jones BS, Harcourt-Brown T. Comparison of serum creatine kinase and aspartate aminotransferase activity in dogs with Neospora meningoencephalitis and noninfectious meningoencephalitis. J Vet Intern Med 2021; 36:141-145. [PMID: 34859908 PMCID: PMC8783338 DOI: 10.1111/jvim.16334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022] Open
Abstract
Background Creatine kinase (CK) and aspartate aminotransferase (AST) activity can be increased with myositis associated with Toxoplasma and Neospora infection in dogs. Hypothesis/Objectives Serum activity of CK and AST can be used as a rapid screen for predicting positive serology in meningoencephalitis caused by Toxoplasma gondii or Neospora caninum in dogs compared to dogs with noninfectious meningoencephalitis. Animals Eighty dogs with meningoencephalitis based on magnetic resonance imaging and cerebrospinal fluid analysis. Methods Retrospective case‐control study. Serological cutoffs (≥1:800 immunofluorescence for Neospora and ≥1:400 IgG or ≥1:64 IgM or both for Toxoplasma) categorized dogs as infected (n = 21, all neosporosis) or noninfected (n = 59). Activities of CK and AST between infected and noninfected groups were compared using a Mann‐Whitney U test and receiver operating characteristic curve analysis. Results No dogs were diagnosed with toxoplasmosis. Serum CK and AST activities were significantly increased (P < .001) in dogs with positive serology for Neospora (CK: median, 1334 U/L; range, 281‐3633 U/L and AST: median, 124 U/L; range, 59‐333 U/L) compared to noninfectious cases (CK: median, 215 U/L; range, 69‐683 U/L and AST: median, 36 U/L; range, 19‐139 U/L). A CK cutoff of 485 U/L had 95.24% sensitivity and 96.61% specificity with a negative predicative value of >99%. An AST cutoff of 57 U/L had 94.44% sensitivity and 85.71% specificity with an estimated negative predicative value of 99%. Conclusions and Clinical Importance High serum CK and AST activity can increase suspicion for neosporosis while awaiting serological tests for dogs with meningoencephalitis.
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Affiliation(s)
- Bethan S Jones
- Department of Neurology and Neurosurgery, Langford Vets Small Animal Hospital, Bristol, United Kingdom
| | - Tom Harcourt-Brown
- Department of Neurology and Neurosurgery, Langford Vets Small Animal Hospital, Bristol, United Kingdom
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Poad L, De Decker S, Fenn J. Acquired cervical scoliosis in two dogs with inflammatory central nervous system disease. J Vet Intern Med 2021; 35:2421-2426. [PMID: 34448505 PMCID: PMC8478057 DOI: 10.1111/jvim.16257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022] Open
Abstract
Acquired cervical scoliosis previously has been reported in dogs as a clinical sign associated with Chiari‐like malformation and syringomyelia but has not been described with inflammatory central nervous system disease. A 9‐month‐old Flat‐Coated Retriever was presented with an acute onset of cervical scoliosis with no other neurological deficits. Magnetic resonance imaging identified a focal, poorly defined intramedullary lesion within the cranial cervical spinal cord. Cerebrospinal fluid (CSF) analysis indicated mononuclear pleocytosis consistent with a diagnosis of meningomyelitis of unknown etiology. A second dog, a 3‐year‐old female spayed German Shepherd, developed an acute onset of cervical scoliosis with mild generalized proprioceptive ataxia 2 months after commencing immunosuppressive corticosteroid treatment for presumed steroid‐responsive meningitis‐arteritis. Magnetic resonance imaging at the time of diagnosis disclosed a similar intramedullary lesion within the cranial cervical spinal cord, with a neutrophilic pleocytosis on CSF analysis. Both dogs were treated with immunosuppressive dosages of prednisolone, along with cytosine arabinoside in the first dog, with resolution of cervical scoliosis seen in both. To our knowledge, this is the first report of acute onset acquired, reversible cervical scoliosis in dogs with presumed immune‐mediated meningomyelitis.
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Affiliation(s)
- Lydia Poad
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, United Kingdom
| | - Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, United Kingdom
| | - Joe Fenn
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, United Kingdom
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39
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Yun T, Koo Y, Chae Y, Lee D, Kim H, Kim S, Chang D, Na K, Yang M, Kang B. Neurofilament light chain as a biomarker of meningoencephalitis of unknown etiology in dogs. J Vet Intern Med 2021; 35:1865-1872. [PMID: 34114244 PMCID: PMC8295659 DOI: 10.1111/jvim.16184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/08/2021] [Accepted: 05/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Neurofilament light chain (NfL) is a neuron-specific cytoskeletal protein expressed in axons. Damaged axons of the central nervous system release NfLs into the cerebrospinal fluid (CSF) and the blood. In humans with neurologic diseases, NfL is used as a biomarker. OBJECTIVES To identify the potential of NfL as a supportive tool for the diagnosis, prognosis, and monitoring of meningoencephalitis of unknown etiology (MUE) in dogs. ANIMALS Twenty-six client-owned healthy dogs, 10 normal Beagle dogs, and 38 client-owned MUE dogs. METHODS Cohort study. The concentrations of NfL in serum and CSF were measured using single-molecule array technology. RESULTS Median NfL concentration was significantly higher in MUE dogs (serum, 125 pg/mL; CSF, 14 700 pg/mL) than in healthy dogs (serum, 11.8 pg/mL, P < .0001; CSF, 1410 pg/mL, P = .0002). The areas under the receiver operating characteristic curves of serum and CSF NfL concentrations were 0.99 and 0.95, respectively. The cut-off values were 41.5 pg/mL (serum) and 4005 pg/mL (CSF) for differentiating between healthy and MUE dogs, with sensitivities of 89.19% and 90%, respectively, and specificities of 96.97% and 100%, respectively. The NfL concentration showed a significant decrease (pretreatment, 122 pg/mL; posttreatment, 36.6 pg/mL; P = .02) in the good treatment-response group and a significant increase (pretreatment, 292.5 pg/mL; posttreatment, 1880 pg/mL, P = .03) in the poor treatment-response group. CONCLUSIONS AND CLINICAL IMPORTANCE Neurofilament light chain is a potential biomarker for diagnosing MUE and evaluating response to treatment.
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Affiliation(s)
- Taesik Yun
- Laboratory of Veterinary Internal Medicine, College of Veterinary MedicineChungbuk National UniversityCheongjuChungbukRepublic of Korea
| | - Yoonhoi Koo
- Laboratory of Veterinary Internal Medicine, College of Veterinary MedicineChungbuk National UniversityCheongjuChungbukRepublic of Korea
| | - Yeon Chae
- Laboratory of Veterinary Internal Medicine, College of Veterinary MedicineChungbuk National UniversityCheongjuChungbukRepublic of Korea
| | - Dohee Lee
- Laboratory of Veterinary Internal Medicine, College of Veterinary MedicineChungbuk National UniversityCheongjuChungbukRepublic of Korea
| | - Hakhyun Kim
- Laboratory of Veterinary Internal Medicine, College of Veterinary MedicineChungbuk National UniversityCheongjuChungbukRepublic of Korea
| | - Soochong Kim
- Laboratory of Veterinary Pathology, College of Veterinary MedicineChungbuk National UniversityCheongjuChungbukRepublic of Korea
| | - Dongwoo Chang
- Section of Veterinary Medical Imaging, Veterinary Teaching Hospital, College of Veterinary MedicineChungbuk National UniversityCheongjuChungbukRepublic of Korea
| | - Ki‐Jeong Na
- Laboratory of Veterinary Laboratory Medicine, College of Veterinary MedicineChungbuk National UniversityCheongjuChungbukRepublic of Korea
| | - Mhan‐Pyo Yang
- Laboratory of Veterinary Internal Medicine, College of Veterinary MedicineChungbuk National UniversityCheongjuChungbukRepublic of Korea
| | - Byeong‐Teck Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary MedicineChungbuk National UniversityCheongjuChungbukRepublic of Korea
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40
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Church ME, Ceja G, McGeehan M, Miller MC, Farias P, Sánchez MD, Swain GP, Assenmacher CA, Stopa EG, Vite CH, Bar-Or A, Alvarez JI. Meningeal B Cell Clusters Correlate with Submeningeal Pathology in a Natural Model of Multiple Sclerosis. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2021; 207:44-54. [PMID: 34162727 PMCID: PMC8695639 DOI: 10.4049/jimmunol.2000514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 04/23/2021] [Indexed: 11/19/2022]
Abstract
Multiple sclerosis (MS) is an idiopathic demyelinating disease in which meningeal inflammation correlates with accelerated disease progression. The study of meningeal inflammation in MS has been limited because of constrained access to MS brain/spinal cord specimens and the lack of experimental models recapitulating progressive MS. Unlike induced models, a spontaneously occurring model would offer a unique opportunity to understand MS immunopathogenesis and provide a compelling framework for translational research. We propose granulomatous meningoencephalomyelitis (GME) as a natural model to study neuropathological aspects of MS. GME is an idiopathic, progressive neuroinflammatory disease of young dogs with a female bias. In the GME cases examined in this study, the meninges displayed focal and disseminated leptomeningeal enhancement on magnetic resonance imaging, which correlated with heavy leptomeningeal lymphocytic infiltration. These leptomeningeal infiltrates resembled tertiary lymphoid organs containing large B cell clusters that included few proliferating Ki67+ cells, plasma cells, follicular dendritic/reticular cells, and germinal center B cell-like cells. These B cell collections were confined in a specialized network of collagen fibers associated with the expression of the lympho-organogenic chemokines CXCL13 and CCL21. Although neuroparenchymal perivascular infiltrates contained B cells, they lacked the immune signature of aggregates in the meningeal compartment. Finally, meningeal B cell accumulation correlated significantly with cortical demyelination reflecting neuropathological similarities to MS. Hence, during chronic neuroinflammation, the meningeal microenvironment sustains B cell accumulation that is accompanied by underlying neuroparenchymal injury, indicating GME as a novel, naturally occurring model to study compartmentalized neuroinflammation and the associated pathology thought to contribute to progressive MS.
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Affiliation(s)
- Molly E Church
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Guadalupe Ceja
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Megan McGeehan
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Miles C Miller
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Priscilla Farias
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Melissa D Sánchez
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Gary P Swain
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Edward G Stopa
- Division of Neuropathology, Department of Pathology and Laboratory Medicine, Brown University, Providence, RI; and
| | - Charles H Vite
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Amit Bar-Or
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jorge I Alvarez
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA;
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41
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Mariani CL, Niman ZE, Boozer LB, Ruterbories LK, Early PJ, Muñana KR, Olby NJ. Vascular endothelial growth factor concentrations in the cerebrospinal fluid of dogs with neoplastic or inflammatory central nervous system disorders. J Vet Intern Med 2021; 35:1873-1883. [PMID: 34105831 PMCID: PMC8295675 DOI: 10.1111/jvim.16181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/06/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023] Open
Abstract
Background Vascular endothelial growth factor (VEGF) is a key molecular driver of angiogenesis and vascular permeability and is expressed by a wide variety of neoplasms. Although blood VEGF concentrations have been quantified in intracranial tumors of dogs, cerebrospinal fluid (CSF) VEGF concentration might be a more sensitive biomarker of disease. Objective Concentrations of VEGF in CSF are higher in dogs with central nervous system (CNS) neoplasia compared to those with meningoencephalomyelitis and other neurologic disorders. Animals One hundred and twenty‐six client‐owned dogs presented to a veterinary teaching hospital. Methods Case‐control study. Cerebrospinal fluid was archived from dogs diagnosed with CNS neoplasia and meningoencephalomyelitis. Control dogs had other neurological disorders or diseases outside of the CNS. A commercially available kit was used to determine VEGF concentrations. Results Detectable CSF VEGF concentrations were present in 49/63 (77.8%) neoplastic samples, 22/24 (91.7%) inflammatory samples, and 8/39 (20.5%) control samples. The VEGF concentrations were significantly different between groups (P < .0001), and multiple comparison testing showed that both neoplastic and inflammatory groups had significantly higher concentrations than did controls (P < .05), but did not differ from each other. Gliomas and choroid plexus tumors had significantly higher VEGF concentrations than did the control group (P < .05). Conclusions and Clinical Importance Cerebrospinal fluid VEGF concentrations may serve as a marker of neoplastic and inflammatory CNS disorders relative to other conditions.
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Affiliation(s)
- Christopher L Mariani
- Comparative Neuroimmunology and Neuro-oncology Laboratory, North Carolina State University, Raleigh, North Carolina, USA.,Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Zachary E Niman
- Comparative Neuroimmunology and Neuro-oncology Laboratory, North Carolina State University, Raleigh, North Carolina, USA.,Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Lindsay B Boozer
- Comparative Neuroimmunology and Neuro-oncology Laboratory, North Carolina State University, Raleigh, North Carolina, USA
| | - Laura K Ruterbories
- Comparative Neuroimmunology and Neuro-oncology Laboratory, North Carolina State University, Raleigh, North Carolina, USA.,Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Peter J Early
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Karen R Muñana
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
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42
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Danciu CG, Szladovits B, Crawford AH, Ognean L, De Decker S. Cerebrospinal fluid analysis lacks diagnostic specificity in dogs with vestibular disease. Vet Rec 2021; 189:e557. [PMID: 34101197 DOI: 10.1002/vetr.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 04/20/2021] [Accepted: 05/23/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although, vestibular syndrome is a common neurological presentation, little is known about the diagnostic value of cerebrospinal fluid (CSF) analysis in vestibular syndrome in dogs. METHODS Medical records were retrospectively reviewed, and dogs with vestibular disease that had undergone magnetic resonance imaging of the head, CSF analysis and were diagnosed with central or peripheral vestibular syndrome were included. Disorders affecting the central vestibular system included meningoencephalitis of unknown origin (MUO), brain neoplasia, ischaemic infarct, intracranial empyema or metronidazole toxicity. Disorders affecting the peripheral vestibular system included idiopathic vestibular disease, otitis media/interna or neoplasia affecting the inner ear structures. Total nucleated cell concentration (TNCC), total protein concentration (TP) and cytologic assessment were recorded. RESULTS A total of 102 dogs met the inclusion criteria. The sensitivity and specificity of increased CSF TNCC to differentiate central from peripheral vestibular syndrome was 49% and 90%, while the sensitivity and specificity of increased TP was 58% and 39%, respectively. The TNCC and TP in dogs with MUO were significantly higher than in dogs with idiopathic vestibular disease (p = 0.000 and p = 0.004). MUO was associated with lymphocytic pleocytosis, while idiopathic vestibular disease and ischaemic infarct were associated with the presence of activated macrophages or normal cytology (p = 0.000). CONCLUSION Although consistent CSF abnormalities were observed in dogs with MUO, CSF analysis did not allow reliable differentiation between central and peripheral vestibular syndrome. CSF analysis is not reliable as the sole diagnostic technique in dogs with vestibular disease.
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Affiliation(s)
- Cecilia Gabriella Danciu
- Department of Veterinary Preclinical and Clinical Science and Service, Faculty of Veterinary Medicine, University of Agricultural Science and Veterinary Medicine, Cluj-Napoca, Romania
| | - Balazs Szladovits
- Department of Pathobiology and Populations Sciences, Royal Veterinary College, University of London, Hatfield, UK
| | - Abbe Harper Crawford
- Department of Veterinary Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Laurentiu Ognean
- Department of Veterinary Preclinical and Clinical Science and Service, Faculty of Veterinary Medicine, University of Agricultural Science and Veterinary Medicine, Cluj-Napoca, Romania
| | - Steven De Decker
- Department of Veterinary Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
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43
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Levitin HA, Foss KD, Li Z, Reinhart JM, Hague DW, Fan TM. Pharmacokinetics of a cytosine arabinoside subcutaneous protocol in dogs with meningoencephalomyelitis of unknown aetiology. J Vet Pharmacol Ther 2021; 44:696-704. [PMID: 34080695 DOI: 10.1111/jvp.12980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 10/12/2020] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Abstract
Cytosine arabinoside (CA) is a commonly used treatment for dogs with meningoencephalomyelitis of unknown aetiology (MUE) with various proposed protocols, many requiring 24 hours (h) of hospitalization or two visits within 24 h. This is a unidirectional study evaluating the pharmacokinetics of a CA subcutaneous (SC) protocol and a standard constant rate infusion (CRI) protocol in 8 dogs with MUE. Dogs received the CRI (200 mg/m2 IV over 24 h), followed by a SC protocol (50 mg/m2 every 2 h for 4 treatments) four weeks later. Plasma CA concentrations were measured by high-pressure liquid chromatography-tandem mass spectrometry (HPLC-MS). Median peak CA concentration for the SC protocol (3.40 µg/ml, range 1.60-9.70 µg/ml) was significantly higher than the CRI (1.09 µg/ml, range 0.77-1.67 µg/ml; p = .02). Median concentration at 1h and 8h following initiation of treatment was significantly higher for the SC protocol (CA1 2.28 µg/ml, range 0.97-2.67; CA8 1.83 µg/ml, range 0.77-2.84) compared to the CRI (CA1 0.01 µg/ml, range 0-0.45; CA8 0.74 µg/ml, range 0.67-1.11; p = .01). While the PK properties of CA when administered as a CRI has been previously investigated, this study demonstrated that CA when administered via repeated 50 mg/m2 injections every 2 h over an 8-h period, provided sustained plasma levels above its therapeutic target and for a significantly longer duration of time than did a standard CRI protocol.
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Affiliation(s)
- Hilary A Levitin
- The Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
| | - Kari D Foss
- The Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
| | - Zhong Li
- The Metabolomics Center, Roy J. Carver Biotechnology Center, University of Illinois, Urbana, Illinois, USA
| | - Jennifer M Reinhart
- The Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
| | - Devon W Hague
- The Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA
| | - Timothy M Fan
- The Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA.,Cancer Center at Illinois, University of Illinois, Urbana, Illinois, USA
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44
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Santifort KM, Ives EJ, Fenn J, Raimondi F, Lourinho F, Mandigers PJJ, Bergknut N. Suspected acquired narcolepsy in 8 dogs. J Vet Intern Med 2021; 35:1448-1454. [PMID: 33960533 PMCID: PMC8162612 DOI: 10.1111/jvim.16116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 03/11/2021] [Accepted: 03/22/2021] [Indexed: 01/11/2023] Open
Abstract
Background Acquired narcolepsy has rarely been reported in veterinary medicine. Objective To describe the presentation, clinicopathological features, diagnostic imaging findings, and management of dogs with suspected‐acquired narcolepsy. Animals Eight dogs with clinical features consistent with acquired narcolepsy. Methods A call for suspected cases of acquired narcolepsy was made online, followed by a retrospective review of detailed medical records of potential cases. Dogs were included if episodes consistent with cataplexy were present during examination by a board‐certified veterinary neurologist and diagnostic work‐up included magnetic resonance imaging of the brain and analysis of cerebrospinal fluid. Results Seven French Bulldogs and 1 Chihuahua (age range, 9‐66 months) were included. Meningoencephalitis of unknown origin was diagnosed in 2 dogs, extracranial foci of inflammation were identified in 2 dogs (aspiration pneumonia, esophagitis, otitis media), and no abnormalities were found on diagnostic investigations in 4 dogs. Prednisolone was used in the management of all dogs, 6 dogs received imipramine, and 2 received cytosine arabinoside. An initial remission of signs was observed in all dogs, but a subsequent relapse of clinical signs was recorded for 4 dogs, of which 3 responded to adjustment or resumption of treatment. Conclusions and Clinical Importance The presence of cataplexy episodes should prompt a thorough diagnostic work‐up to exclude the presence of intracranial (and extracranial) pathology. The potential for both remission and relapse of signs in suspected acquired cases is important for clinicians and owners to be aware of.
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Affiliation(s)
- Koen M Santifort
- Evidensia Small Animal Hospital, Arnhem, The Netherlands.,Evidensia Small Animal Hospital 'Hart van Brabant', Waalwijk, The Netherlands
| | - Edward J Ives
- Anderson Moores Veterinary Specialists, Winchester, UK
| | - Joe Fenn
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | | | | | - Paul J J Mandigers
- Evidensia Small Animal Hospital, Arnhem, The Netherlands.,Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, University of Utrecht, Utrecht, The Netherlands
| | - Niklas Bergknut
- Evidensia Small Animal Hospital 'Hart van Brabant', Waalwijk, The Netherlands
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45
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Clinical Presentation, Diagnostic Findings, and Long-term Survival Time in 182 Dogs With Meningoencephalitis of Unknown Origin From Central Europe That Were Administered Glucocorticosteroid Monotherapy. Top Companion Anim Med 2021; 44:100539. [PMID: 33964477 DOI: 10.1016/j.tcam.2021.100539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022]
Abstract
Canine non-infectious inflammatory meningoencephalomyelitis is termed meningoencephalomyelitis of unknown origin (MUO) and may affect dogs of every breed at any age. Treatment with immunosuppressive medication, the survival time based on MRI, and cerebrospinal fluid (CSF) findings has been widely reported; however, these studies only included a small number of patients, or they are summaries from the literature. Therefore, the aim of this study was to compare the clinical presentation, diagnostic findings, treatment protocol and long-term survival time in many dogs diagnosed with MUO in one clinic with previously published studies. One hundred eighty-two dogs met the inclusion criteria. Age, sex, duration of clinical signs before diagnosis, presence of neurological signs, MRI and CSF analysis were similar to those in previous reports. Our study revealed that dogs with a brainstem lesion have a 60% lower chance of death before 1 year than dogs with multifocal brain lesions. A total of 55.56% of treated dogs survived for more than 1 year, and 10.55% survived for more than 5 years since diagnosis. The median survival time for all dogs was 540 days. Our findings support glucocorticosteroid monotherapy as a viable treatment option for dogs with MUO.
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Günther C, Steffen F, Alder DS, Beatrice L, Geigy C, Beckmann K. Evaluating the use of cytosine arabinoside for treatment for recurrent canine steroid-responsive meningitis-arteritis. Vet Rec 2021; 187:e7. [PMID: 33638531 PMCID: PMC7456679 DOI: 10.1136/vr.105683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/17/2019] [Accepted: 01/29/2020] [Indexed: 12/15/2022]
Abstract
Background Relapses in steroid-responsive meningitis-arteritis (SRMA) are frequently observed but specific treatment protocols to address this problem are sparsely reported. Standard treatment includes prolonged administration of glucocorticoids as monotherapy or in combination with immunosuppressive drugs. The aim of this study was to assess the safety and efficacy of cytosine arabinoside (CA) in combination with glucocorticoids for treatment of SRMA relapses in 12 dogs on a retrospective basis. Methods Dogs with recurrent episodes of SRMA and treated with a combination of CA and prednisolone were included. Information about clinical course, treatment response and adverse events was collected from medical records. Ethical approval was not required for this study. Results Ten dogs (10/12) responded well to the treatment with clinical signs being completely controlled. One dog is in clinical remission, but still under treatment. One dog (8%) showed further relapse. Mean treatment period was 51 weeks. Adverse events of variable severity (grade 1–4/5) were documented in all dogs during treatment according to the veterinary cooperative oncology group grading. Three dogs developed severe adverse events. Laboratory findings showed marked changes up to grade 4. Diarrhoea and anaemia were the most often observed adverse events (6), followed by dermatitis (4), alopecia (3) and pneumonia (3). Including blood chemistry changes (13), 50 adverse events were found in total. Conclusion Treatment with CA and glucocorticoids resulted in clinical remission in 10/12 dogs, but a high incidence of adverse events occurred requiring additional measures. All adverse events could be managed successfully in all cases.
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Affiliation(s)
- Christian Günther
- Clinic of Small Animal Surgery/Neurology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Frank Steffen
- Clinic of Small Animal Surgery/Neurology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Daniela S Alder
- Clinic of Small Animal Surgery/Neurology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Neurology/Neurosurgery, Southern Counties Veterinary Specialists LLP, Ringwood, Hampshire, UK
| | - Laura Beatrice
- Department fur Kleintiere, Oncology, Universitat Zurich, Zurich, Switzerland
| | - Caroline Geigy
- Department fur Kleintiere, Oncology, Universitat Zurich, Zurich, Switzerland.,Departmend of Internal Medicine, Marigin - Zentrum für Tiermedizin, Feusisberg, Switzerland
| | - Katrin Beckmann
- Clinic of Small Animal Surgery/Neurology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Department fur Kleintiere, Oncology, Universitat Zurich, Zurich, Switzerland
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47
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Stephen AA, Kent M, Barber RM. What Is Your Neurologic Diagnosis? J Am Vet Med Assoc 2021; 258:141-145. [PMID: 33405982 DOI: 10.2460/javma.258.2.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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48
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Andersen-Ranberg E, Berendt M, Gredal H. Biomarkers of non-infectious inflammatory CNS diseases in dogs - Where are we now? Part I: Meningoencephalitis of unknown origin. Vet J 2021; 273:105678. [PMID: 34148601 DOI: 10.1016/j.tvjl.2021.105678] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
Meningoencephalitides of Unknown Origin (MUO) comprises a group of non-infectious inflammatory brain conditions, which frequently cause severe neurological disease and death in dogs. Although multiple diagnostic markers have been investigated, a conclusive diagnosis, at present, essentially relies on postmortem histopathology. However, different groups of biomarkers, e.g. acute phase proteins, antibodies, cytokines, and neuro-imaging markers may prove useful in the diagnostic investigation of dogs with MUO. It appears from the current literature that acute phase proteins such as C-reactive protein are often normal in MUO, but may be useful to rule out steroid responsive meningitis-arteritis as well as other systemic inflammatory conditions. In antibody research, anti-glial fibrillary acidic protein (GFAP) may play a role, but further research is needed to establish this as a consistent marker of particularly Pug dog encephalitis. The proposed diagnostic markers often lack specificity to distinguish between the subtypes of MUO, but an increased expression of interferon-γ (IFN-γ) in necrotizing meningoencephalitis (NME) and interleukin-17 (IL-17) in granulomatous meningoencephalitis (GME) in tissue biopsies may indicate their potential as specific markers of NME and GME, respectively, suggesting further investigations of these in serum and CSF. While neuro-imaging is already an important part of the diagnostic work-up in MUO, further promising results have been shown with Positron Emission Tomography (PET) as well as proton resonance spectroscopy (1H MRS), which may be able to detect areas of necrosis and granulomas, respectively, with relatively high specificity. This review presents different groups of established and potential diagnostic markers of MUO assessing current results and future potential.
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Affiliation(s)
- Emilie Andersen-Ranberg
- Copenhagen University, Department of Veterinary Clinical Sciences, Dyrlægevej 16, DK-1870 Frederiksberg C, Denmark
| | - Mette Berendt
- Copenhagen University, Department of Veterinary Clinical Sciences, Dyrlægevej 16, DK-1870 Frederiksberg C, Denmark
| | - Hanne Gredal
- Copenhagen University, Department of Veterinary Clinical Sciences, Dyrlægevej 16, DK-1870 Frederiksberg C, Denmark.
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Portero M, Miró G, Checa R, Martínez de Merlo E, Fragío C, Benito M, Sainz Á, Pérez C. Role of Leishmania infantum in Meningoencephalitis of Unknown Origin in Dogs from a Canine Leishmaniosis Endemic Area. Microorganisms 2021; 9:microorganisms9030571. [PMID: 33802179 PMCID: PMC7998340 DOI: 10.3390/microorganisms9030571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 11/17/2022] Open
Abstract
The main hypothesis for the aetiology of meningoencephalitis of unknown origin (MUO) in dogs is an autoimmune or genetic cause that is associated with a triggering event (environmental factors/infectious agents). The aim of this ambispective cohort study was to test for Leishmania infantum infection in the blood and cerebrospinal fluid (CSF) of dogs with MUO in an endemic area of canine leishmaniosis. Dogs with MUO were selected amongst all dogs undergoing blood anti-L. infantum antibody testing (control group). The blood plasma or serum samples from all dogs were analysed for anti- L. infantum antibodies by a quantitative indirect fluorescent assay (IFAT). In dogs with MUO, CSF samples were obtained for analysed by PCR detection of L. infantum DNA. Forty-four percent and 22% of the dogs in the MUO group featured magnetic resonance imaging (MRI) findings and CSF cytology respectively, consistent with L. infantum infection. IFAT, PCR, and histological findings were negative for L. infantum. A significant difference in L. infantum infection prevalence was found between the control and MUO group (p = 0.0022). While it seems unlikely that L. infantum plays a role in the aetiology of MUO, in endemic areas, this pathogen should be included in the differential diagnosis of this neurological disorder.
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Affiliation(s)
- Miriam Portero
- Department of Small Animal Medicine and Surgery, Hospital Clinico Veterinario Complutense, Veterinary Faculty, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.M.d.M.); (C.F.); (M.B.); (Á.S.); (C.P.)
- Correspondence: (M.P.); (G.M.)
| | - Guadalupe Miró
- Department of Animal Health, Veterinary Faculty, Universidad Complutense de Madrid, 28040 Madrid, Spain;
- Correspondence: (M.P.); (G.M.)
| | - Rocío Checa
- Department of Animal Health, Veterinary Faculty, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Elena Martínez de Merlo
- Department of Small Animal Medicine and Surgery, Hospital Clinico Veterinario Complutense, Veterinary Faculty, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.M.d.M.); (C.F.); (M.B.); (Á.S.); (C.P.)
| | - Cristina Fragío
- Department of Small Animal Medicine and Surgery, Hospital Clinico Veterinario Complutense, Veterinary Faculty, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.M.d.M.); (C.F.); (M.B.); (Á.S.); (C.P.)
| | - Miguel Benito
- Department of Small Animal Medicine and Surgery, Hospital Clinico Veterinario Complutense, Veterinary Faculty, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.M.d.M.); (C.F.); (M.B.); (Á.S.); (C.P.)
| | - Ángel Sainz
- Department of Small Animal Medicine and Surgery, Hospital Clinico Veterinario Complutense, Veterinary Faculty, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.M.d.M.); (C.F.); (M.B.); (Á.S.); (C.P.)
| | - Carmen Pérez
- Department of Small Animal Medicine and Surgery, Hospital Clinico Veterinario Complutense, Veterinary Faculty, Universidad Complutense de Madrid, 28040 Madrid, Spain; (E.M.d.M.); (C.F.); (M.B.); (Á.S.); (C.P.)
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50
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Harrison E, Grapes NJ, Volk HA, De Decker S. Clinical reasoning in canine vestibular syndrome: Which presenting factors are important? Vet Rec 2021; 188:e61. [PMID: 33739504 DOI: 10.1002/vetr.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Although the use of clinical reasoning has been evaluated for several neurological presentations, this approach has not yet been investigated for dogs with vestibular syndrome. METHODS Two hundred and thirty-nine dogs presenting with vestibular syndrome were included in this retrospective study. Univariate analysis of variables (clinical history, signalment, clinical presentation and neurological examination findings) was performed. Variables with p < 0.3 were selected for logistic regression. RESULTS Ninety-five percent of dogs were represented by eight conditions: idiopathic vestibular disease (n = 78 dogs), otitis media interna (n = 54), meningoencephalitis of unknown origin (n = 35), brain neoplasia (n = 26), ischaemic infarct (n = 25), intracranial empyema (n = 4), metronidazole toxicity (n = 3) and neoplasia affecting the middle ear (n = 3). Idiopathic vestibular disease was associated with higher age, higher bodyweight, improving clinical signs, pathological nystagmus, facial nerve paresis, absence of Horner's syndrome and a peripheral localisation. Otitis media interna was associated with younger age, male gender, Horner's syndrome, a peripheral localisation and a history of otitis externa. Ischaemic infarct was associated with older age, peracute onset of signs, absence of strabismus and a central localisation. CONCLUSIONS Discrete clinical features can be used to identify the most likely diagnosis in dogs with vestibular syndrome.
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Affiliation(s)
- Eleanor Harrison
- Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Nick J Grapes
- Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Holger A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Steven De Decker
- Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
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