Page 553 - ONLINE PROCEEDING BOOK WSAVA 2017
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WSVA7-0401
DSAVA: NEUROLOGY
INFLAMMATORY CNS DISEASE- A PRACTICAL APPROACH
H. Gredal1
1University of Copenhagen, Dept. of Veterinary Clinical Sciences, Copenhagen, Denmark
INFLAMMATORY CNS DISEASE – PRACTICAL APPROACH
Hanne Gredal
DVM, PhD, Associate professor
Dept. of Veterinary Clinical Sciences, University of Copenhagen
Dyrlægevej 16, 1870 Frederiksberg C, Denmark Email: hbg@sund.ku.dk
In ammatory conditions of the central nervous system may be categorised according to their anatomical localisation as 1) meningitis, i.e. in ammation of the meninges 2) encephalitis, i.e. in ammation of the brain, and, 3) myelitis, i.e. in ammation of the spinal cord. However, very often the in ammatory condition affect more than just one structure, resulting in a meningoencephalitis, a meningomyelitis, or even a meningoencephalomyelitis.
The focus of this presentation will be on in ammatory diseases of the central nervous system (CNS) in dogs.
Aetiology
In ammatory disease of the central nervous system may be caused by infectious agents, including bacterial, viral, protozoal and fungal infections, but in fact most in ammatory CNS conditions in dogs have a non- infectious aetiology, and are presumably immune- mediated1.
Non-infectious in ammatory CNS diseases in dogs may be further categorised into steroidresponsive meningitis- arteritis (SRMA), granulomatous meningoencephalitis (GME), necrotising encephalitis (NE), and necrotising leukoencephalitis (NLE). Whereas SRMA has a
fairly distinct clinical pattern and primarily affects
the meninges, distinguishing between the different non-in ammatory conditions affecting the brain parenchyma (GME, NE, and NLE) requires post-mortem histopathology, and the overall term ‘Meningoencephalitis of unknown origin’ (MUO) thus seems more relevant from a clinical perspective. In the following, SRMA and MUO will be presented separately.
Steroid-responsive meningitis-arteritis (SRMA)
Steroid-responsive meningitis-arteritis (also known
as aseptic meningitis, necrotizing vasculitis, poly- or panarteritis, or beagle pain syndrome is characterised by in ammatory changes of the leptomeninges and the associated arteries2,3.
The disease is typically seen in young dogs (6-18 months), although it may occur at any age. Any
breed can get SRMA, but the disease appears to
be more common in e.g. Boxers, Beagles, Bernese Mountain dogs, Nova Scotia duck tolling retrievers and Weimaraners.
Dogs with acute SRMA typically present with a stiff and painful gait, cervical rigidity and a lowered head carriage, hyperaesthesia along the spinal cord, and pyrexia4. Most appear mentally depressed, hiding away and unwilling to play, and some in such pain that even the slightest manipulation will elicit a clearly painful response.
The diagnostic work-up of a suspected SRMA case includes routine haematology and biochemistry, serum C-reactive protein (CRP) measurements, magnetic resonance imaging (MRI) of the brain, and cerebrospinal  uid (CSF) analysis. Blood results may reveal signs of
a systemic in ammatory response with an increase in white blood cell (WBC) count and serum CRP, although it should be emphasised that the absence of these changes does not rule out SRMA5,6. MRI may reveal subtle contrast enhancement of the meninges, but is usually otherwise unremarkable.
The most important diagnostic tool in the work-
up of SRMA patients is the CSF analysis, which is characterised by pleocytosis, usually >50 WBC/mL (normal reference <5 WBC/mL), often dominated by neutrophils, and increased amounts of protein (>30 mg/ dl if collected from the atlantooccipital site)2. However, mononuclear cells are also a common  nding5.
As indicated by the name, SRMA responds positively to treatment with steroids (prednisolone). A standard treatment protocol cannot be established, as this must be carefully tailored for the individual patient to optimise control of the disease while at the same time aiming at reducing side effects to a minimum. However, overall guidelines include2,5:
Prednisolone:
• 2 mg/kg BID for 2 days, followed by • 1 mg/kg BID for 1-2 weeks
• 0.5-0.75 mg/kg BID for 2 weeks
• 0.5 mg/kg BID for 2-4 weeks
• Then the dosage is gradually reduced over months to 0.5 mg/kg every 48 to 72 hours
An Urban Experience
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