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van Renen J, Kehl A, Buhmann G, Matiasek LA, Zablotski Y, Fischer A. Allele frequency of a genetic risk variant for necrotizing meningoencephalitis in pug dogs from Europe and association with the clinical phenotype. Front Vet Sci 2024; 11:1407288. [PMID: 38840637 PMCID: PMC11150678 DOI: 10.3389/fvets.2024.1407288] [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: 03/26/2024] [Accepted: 04/30/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Necrotizing meningoencephalitis (NME) in pugs is a potentially fatal disease, which needs lifelong treatment with immunosuppressive or immunomodulatory drugs and shares parallels with acute fulminating multiple sclerosis. Genetic variants of the DLA class II gene are associated with an increased risk for NME. Genetic testing is recommended prior to breeding. The aim of this study was to describe the current allele frequency of a previously identified NME risk variant in the European pug population. A secondary aim was to investigate the association of the NME risk variant with the clinical phenotype in pugs. Methods Results of genetic testing for the CFA12:2605517delC variant in European pugs between 2012 and 2020 were retrieved (n = 5,974). A validated questionnaire was mailed to all submitters of samples for further information on neurological signs, diagnostic tests, and disease course. Results The allele frequency of the CFA12 NME risk variant was 25.7% in the European pug population dogs; 7.4% of the dogs were homozygous and 36.7% were heterozygous for the NME risk variant on CFA12. Completed questionnaires were available in 203 dogs including 25 dogs with epileptic seizures or other neurological signs. The clinical phenotype was consistent with NME in 3.9% with a median age of onset of 1.0 years, and indicative of idiopathic epilepsy in 2.9% with a median onset of 2.5 years. Eleven dogs remained unclassified. Pugs with the NME phenotype were significantly more frequently homozygous for the NME risk variant on CFA12 compared to pugs ≥6 years without neurological signs or seizures (p = 0.008). Discussion The CFA12:2605517delC genetic risk variant is widely distributed in the European pug population and frequently homozygous in pugs with a NME phenotype. The data support the clinical relevance of the CFA12:2605517delC genetic risk variant.
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Affiliation(s)
- Jana van Renen
- Small Animal Clinic, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Alexandra Kehl
- Laboklin, Bad Kissingen, Germany
- Comparative Experimental Pathology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Gesine Buhmann
- Small Animal Clinic, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Lara A. Matiasek
- Small Animal Clinic, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Yury Zablotski
- Small Animal Clinic, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Andrea Fischer
- Small Animal Clinic, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
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Gonçalves R, De Decker S, Walmsley G, Maddox TW. Prognosis in meningoencephalitis of unknown origin in dogs: Risk factors associated with survival, clinical relapse, and long-term disability. J Vet Intern Med 2024; 38:1583-1590. [PMID: 38483069 PMCID: PMC11099754 DOI: 10.1111/jvim.17037] [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: 09/13/2023] [Accepted: 02/26/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Meningoencephalitis of unknown origin (MUO) comprises a group of noninfectious inflammatory diseases affecting the central nervous system of dogs. Previous studies have reported individual risk factors for survival but prognostication for MUO remains challenging. OBJECTIVES Identify clinical prognostic variables in dogs with MUO. ANIMALS A retrospective study of 447 dogs presented to 2 UK referral hospitals and diagnosed with MUO. METHODS Medical records of dogs diagnosed with MUO were retrospectively reviewed. Multivariable logistic regression was used for the identification of risk factors for survival and Cox proportional hazards analysis for the identification of risk factors for clinical relapse. RESULTS Eighty-two percent (366/447) of dogs with presumptive MUO survived to discharge and 63.5% (284/447) were alive at 6 months; 36% of the latter (103/284) had persistent neurological deficits. Breed (pugs; P = .03), epileptic seizures (P < .001), paresis (P < .001), and higher neurodisability scale (NDS) score (P < .001) at presentation were negatively associated with survival to 6 months. Dogs with persistent deficits had higher NDS scores on presentation (P = .001). Median follow-up time was 11 months (interquartile range [IQR], 1-24) and 50.6% (160/316) relapsed during treatment (median time to relapse, 7 months; IQR, 2-15). Incomplete resolution of the clinical signs during the 6 months after diagnosis (P < .001), higher NDS score (P < .001), and longer duration of the clinical signs (P < .001) were associated with relapse. CONCLUSIONS AND CLINICAL IMPORTANCE Knowledge of risk factors associated with survival, incomplete recovery and clinical relapse in MUO can help guide monitoring and treatment and improve owner communications regarding prognosis for this debilitating disease.
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Affiliation(s)
- Rita Gonçalves
- Department of Veterinary ScienceSmall Animal Teaching Hospital, University of LiverpoolNestonUK
- Department of Musculoskeletal and Ageing ScienceInstitute of Lifecourse and Medical Sciences, University of LiverpoolNestonUK
| | - Steven De Decker
- Department of Clinical Science and ServicesRoyal Veterinary College, University of LondonHatfieldUK
| | - Gemma Walmsley
- Department of Veterinary ScienceSmall Animal Teaching Hospital, University of LiverpoolNestonUK
- Department of Musculoskeletal and Ageing ScienceInstitute of Lifecourse and Medical Sciences, University of LiverpoolNestonUK
| | - Thomas W. Maddox
- Department of Veterinary ScienceSmall Animal Teaching Hospital, University of LiverpoolNestonUK
- Department of Musculoskeletal and Ageing ScienceInstitute of Lifecourse and Medical Sciences, University of LiverpoolNestonUK
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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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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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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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Brady SL, Woodward AP, le Chevoir M. Survival time and relapse in dogs with meningoencephalomyelitis of unknown origin treated with prednisolone and ciclosporin: a retrospective study. Aust Vet J 2020; 98:491-498. [PMID: 32794230 DOI: 10.1111/avj.12994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To analyse outcome in dogs with a presumptive diagnosis of meningoencephalomyelitis of unknown origin (MUO) treated with prednisolone and ciclosporin and to assess the effect of a number of patient variables on survival time and rate of relapse. DESIGN Retrospective case series. METHODS Medical records of 40 client-owned dogs with a diagnosis of MUO treated with prednisolone and ciclosporin at one institution between June 2010 and January 2018 were reviewed retrospectively to assess survival times and prognostic indicators for death and/or relapse. The minimum follow-up time was 11 months post-diagnosis. RESULTS Median survival was 1345 days (95% confidence interval: 487-∞). No associations with hazard of death or relapse were detected for the presence of multifocal magnetic resonance imaging (MRI) abnormalities, caudal fossa location of MRI abnormalities, value of cerebrospinal fluid total nucleated cell count or total protein at time of diagnosis, or suspected elevation in intracranial pressure at time of diagnosis. CONCLUSION Protracted survival time may be achieved with a treatment combination of prednisolone and ciclosporin. Suspected elevation in intracranial pressure at the time of diagnosis did not affect long-term outcome in this cohort.
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Affiliation(s)
- S L Brady
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia.,The Queen's Veterinary School Hospital, University of Cambridge, Cambridge, United Kingdom
| | - A P Woodward
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
| | - Mar le Chevoir
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia.,Veterinary Emergency and Specialty Hospital, Singapore
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Posporis C, Beltran E, Dunning M, Espadas I, Gillespie S, Barry AT, Wessmann A. Prognostic Factors for Recovery of Vision in Canine Optic Neuritis of Unknown Etiology: 26 Dogs (2003-2018). Front Vet Sci 2019; 6:415. [PMID: 31824972 PMCID: PMC6882734 DOI: 10.3389/fvets.2019.00415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 11/07/2019] [Indexed: 12/03/2022] Open
Abstract
Optic neuritis (ON) is a recognized condition, yet factors influencing recovery of vision are currently unknown. The purpose of this study was to identify prognostic factors for recovery of vision in canine ON of unknown etiology. Clinical databases of three referral hospitals were searched for dogs with presumptive ON based on clinicopathologic, MRI/CT, and fundoscopic findings. Twenty-six dogs diagnosed with presumptive ON of unknown etiology, isolated (I-ON) and MUE-associated (MUE-ON), were included in the study. Their medical records were reviewed retrospectively, and the association of complete recovery of vision with signalment, clinicopathologic findings, and treatment was investigated. Datasets were tested for normality using the D'Agostino and Shapiro-Wilk tests. Individual datasets were compared using the Chi-squared test, Fisher's exact test, and the Mann-Whitney U-test. For multiple comparisons with parametric datasets, the one-way analysis of variance (ANOVA) was performed, and for non-parametric datasets, the Kruskal-Wallis test was performed to test for independence. For all data, averages are expressed as median with interquartile range and significance set at p < 0.05. Twenty-six dogs met the inclusion criteria. Median follow-up was 230 days (range 21–1901 days, mean 496 days). Six dogs (23%) achieved complete recovery and 20 dogs (77%) incomplete or no recovery of vision. The presence of a reactive pupillary light reflex (p = 0.013), the absence of fundoscopic lesions (p = 0.0006), a younger age (p = 0.038), and a lower cerebrospinal fluid (CSF) total nucleated cell count (TNCC) (p = 0.022) were statistically associated with complete recovery of vision. Dogs with I-ON were significantly younger (p = 0.046) and had lower CSF TNCC (p = 0.030) compared to the MUE-ON group. This study identified prognostic factors that may influence complete recovery of vision in dogs with ON. A larger cohort of dogs is required to determine whether these findings are robust and whether additional parameters aid accurate prognosis for recovery of vision in canine ON.
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Affiliation(s)
| | - Elsa Beltran
- Queen Mother Hospital for Animals, Royal Veterinary College, Hatfield, United Kingdom
| | - Mark Dunning
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, United Kingdom.,Willows Veterinary Centre and Referral Service, Shirley, United Kingdom
| | - Irene Espadas
- Neurology/Neurosurgery Service, Pride Veterinary Centre, Derby, United Kingdom.,Small Animal Teaching Hospital, School of Veterinary Sciences, University of Liverpool, Neston, United Kingdom
| | - Sabrina Gillespie
- Queen Mother Hospital for Animals, Royal Veterinary College, Hatfield, United Kingdom
| | - Amy Teresa Barry
- Queen Mother Hospital for Animals, Royal Veterinary College, Hatfield, United Kingdom
| | - Annette Wessmann
- Neurology/Neurosurgery Service, Pride Veterinary Centre, Derby, United Kingdom
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Vitale S, Foss K. Immune-Mediated Central Nervous System Disease-Current Knowledge and Recommendations. Top Companion Anim Med 2019; 34:22-29. [PMID: 30808493 PMCID: PMC7185457 DOI: 10.1053/j.tcam.2018.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/10/2018] [Accepted: 11/29/2018] [Indexed: 01/05/2023]
Abstract
Immune-mediated inflammation is responsible for about 25% of central nervous system disease in dogs. The disease can affect all ages and breeds, but young to middle-aged small breed dogs are over-represented for most forms. Diagnosis consists of advanced imaging (MRI), cerebrospinal fluid analysis, and infectious disease testing, but biopsy is required for definitive diagnosis and classification of the disease into one of the many subtypes. Treatment consists of immunosuppressive medication with the goal being to control and/or improve clinical signs. Current literature shows that prognosis is variable.
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Affiliation(s)
- Samantha Vitale
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana, IL, USA.
| | - Kari Foss
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana, IL, USA
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9
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Clinical presentation, diagnostic findings, prognostic factors, treatment and outcome in dogs with meningoencephalomyelitis of unknown origin: A review. Vet J 2018; 244:37-44. [PMID: 30825893 DOI: 10.1016/j.tvjl.2018.12.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 09/29/2018] [Accepted: 12/07/2018] [Indexed: 11/22/2022]
Abstract
Meningoencephalomyelitis of unknown origin (MUO) encompasses a group of idiopathic, most likely immune mediated, inflammatory central nervous system diseases that cause clinical, diagnostic and treatment challenges to veterinary neurologists. Clinical criteria for obtaining this presumptive diagnosis are currently available, and multiple treatment protocols have previously been investigated in small (prospective or retrospective) case series. As this group of diseases is considered fatal if left untreated, the identification of clinically usable prognostic indices could be of great value. This review provides an overview of recent developments in the clinical presentation, diagnostic findings, possible prognostic factors, treatment and outcome in dogs diagnosed with MUO.
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10
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Lake BB, Rossmeisl JH, Cecere J, Stafford P, Zimmerman KL. Immunosignature Differentiation of Non-Infectious Meningoencephalomyelitis and Intracranial Neoplasia in Dogs. Front Vet Sci 2018; 5:97. [PMID: 29868618 PMCID: PMC5958519 DOI: 10.3389/fvets.2018.00097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/20/2018] [Indexed: 11/13/2022] Open
Abstract
A variety of inflammatory conditions of unknown cause (meningoencephalomyelitis of unknown etiology-MUE) and neoplastic diseases can affect the central nervous system (CNS) of dogs. MUE can mimic intracranial neoplasia both clinically, radiologically and even in some cases, histologically. Serum immunosignature protein microarray assays have been used in humans to identify CNS diseases such as Alzheimer's and neoplasia, and in dogs, to detect lymphoma and its progression. This study evaluated the effectiveness of immunosignature profiles for distinguishing between three cohorts of dogs: healthy, intracranial neoplasia, and MUE. Using the learned peptide patterns for these three cohorts, classification prediction was evaluated for the same groups using a 10-fold cross validation methodology. Accuracy for classification was 100%, as well as 100% specific and 100% sensitive. This pilot study demonstrates that immunosignature profiles may help serve as a minimally invasive tool to distinguish between MUE and intracranial neoplasia in dogs.
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Affiliation(s)
- Bathilda B. Lake
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, United States
| | - John Henry Rossmeisl
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, United States
| | - Julie Cecere
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, United States
| | - Phillip Stafford
- Biodesign Institute, Center for Innovations in Medicine, Arizona State University, Tempe, AZ, United States
| | - Kurt L. Zimmerman
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, United States
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11
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Flegel T. Breed-Specific Magnetic Resonance Imaging Characteristics of Necrotizing Encephalitis in Dogs. Front Vet Sci 2017; 4:203. [PMID: 29255715 PMCID: PMC5723069 DOI: 10.3389/fvets.2017.00203] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/17/2017] [Indexed: 11/13/2022] Open
Abstract
Diagnosing necrotizing encephalitis, with its subcategories of necrotizing leukoencephalitis and necrotizing meningoencephalitis, based on magnetic resonance imaging alone can be challenging. However, there are breed-specific imaging characteristics in both subcategories that allow establishing a clinical diagnosis with a relatively high degree of certainty. Typical breed specific imaging features, such as lesion distribution, signal intensity, contrast enhancement, and gross changes of brain structure (midline shift, ventriculomegaly, and brain herniation) are summarized here, using current literature, for the most commonly affected canine breeds: Yorkshire Terrier, French Bulldog, Pug, and Chihuahua.
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Affiliation(s)
- Thomas Flegel
- Department of Small Animal Medicine, University of Leipzig, Leipzig, Germany
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12
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Oliphant BJ, Barnes Heller HL, White JM. RETROSPECTIVE STUDY EVALUATING ASSOCIATIONS BETWEEN MIDLINE BRAIN SHIFT ON MAGNETIC RESONANCE IMAGING AND SURVIVAL IN DOGS DIAGNOSED WITH MENINGOENCEPHALITIS OF UNKNOWN ETIOLOGY. Vet Radiol Ultrasound 2016; 58:38-43. [PMID: 27774741 DOI: 10.1111/vru.12434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 08/31/2016] [Accepted: 09/04/2016] [Indexed: 12/01/2022] Open
Abstract
Difficulty has been encountered when trying to identify ante mortem prognostic indicators for dogs with meningoencephalitis of unknown etiology (MUE). Identifying MRI imaging parameters associated with prognosis may impact treatment decision-making for clinician and owner. Our hypotheses for this retrospective cohort study are that dogs diagnosed with MUE that had midline shift on brain MRI would have a poorer survival compared to dogs without midline shift; and that younger age, lower weight, and low cerebrospinal fluid (CSF) cell count would be correlated with improved survival. Medical records were reviewed from two institutions. Inclusion criteria included: clinical signs referable to intracranial disease, brain MRI at presentation, abnormal CSF analysis, and negative infectious disease testing. Magnetic resonance imaging scans were evaluated for midline shift using the T2-weighted transverse image at the interthalamic adhesion and at the site of maximal deviation. Fifty-two dogs met the inclusion criteria. Median midline deviation was 0.12 cm. Median survival for dogs with no shift was 906 days and with shift was 84 days. Survival was not significantly different between groups (P = 0.11). This remained true when correcting for age (P = 0.22) and CSF TNCC (total nucleated cell count) (P = 0.12). Age at the time of diagnosis (P = 0.02) and CSF TNCC (P = 0.03) were significantly associated with survival. Cerebrospinal fluid protein value (P = 0.84) and weight (P = 0.82) were not significantly associated with survival. In this study of 52 dogs with MUE, MRI evidence of midline brain shift between 0.04 and 0.3 cm at the level of the interthalamic adhesion was not associated with shorter survival.
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Affiliation(s)
- Bonnie J Oliphant
- Department of Medical Sciences, University of Wisconsin, Madison, WI, 53706
| | | | - Jennifer M White
- Department of Veterinary Specialty and Emergency Hospital, San Diego, CA, 92121
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13
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Dirrig H, Lamb CR. MAGNETIC RESONANCE IMAGING OF INTRACRANIAL INFLAMMATORY CONDITIONS IN DOGS: SENSITIVITY OF SUBTRACTION IMAGES VERSUS PRE- AND POST-GADOLINIUM T1-WEIGHTED IMAGE PAIRS. Vet Radiol Ultrasound 2016; 57:410-6. [PMID: 27144775 DOI: 10.1111/vru.12371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 03/15/2016] [Indexed: 01/17/2023] Open
Abstract
Ante mortem diagnosis of canine meningoencephalitis is usually based on the results of neurologic examination, cerebrospinal fluid analysis and magnetic resonance (MR) imaging. It has been hypothesized that subtraction MR imaging may increase the sensitivity of MR for intracranial inflammatory lesions compared to conventional post-gadolinium T1-weighted imaging. Sensitivity of pre- and post-gadolinium (C-/C+) image pairs and dynamic subtraction (DS) images was compared in a retrospective diagnostic accuracy study of 52 dogs with inflammatory cerebrospinal fluid and 67 dogs with idiopathic epilepsy. Series of transverse C-/C+ and DS images were reviewed independently for signs of abnormal enhancement affecting the pachymeninges, leptomeninges or intra-axial structures. Sensitivity of C-/C+ image pairs and DS images was 48% (95% CI: 35-61%) and 65% (95% CI: 52-77%), respectively (P = 0.01). Intra-axial lesions were observed more frequently than meningeal lesions in both C-/C+ (43% vs. 31%) and DS images (61% vs. 22%). The difference in sensitivities of C-/C+ and DS series was entirely due to increased sensitivity of DS images for intra-axial lesions. Eight (12%) dogs with epilepsy had evidence of intra-axial gadolinium accumulation affecting the cerebral cortex in DS images. This finding may represent a false-positive result or a true sign of pathology, possibly associated with a leaky blood-brain barrier in areas of the brain affected by neovascularization secondary to repeated seizures. Results suggest that DS imaging has higher sensitivity than comparison of pre- and post-gadolinium image pairs for inflammatory intra-axial lesions.
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Affiliation(s)
- Helen Dirrig
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, AL9 7TA, UK
| | - Christopher R Lamb
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, AL9 7TA, UK
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Estey CM, Scott SJ, Cerda-Gonzalez S. Necrotizing meningoencephalitis in a large mixed-breed dog. J Am Vet Med Assoc 2015; 245:1274-8. [PMID: 25406708 DOI: 10.2460/javma.245.11.1274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 4-year-old 26-kg (57.2-lb) spayed female Staffordshire Bull Terrier mix was evaluated because of a 24-hour history of cluster seizures. CLINICAL FINDINGS Neurologic examination revealed altered mentation and multifocal intracranial signs; MRI was performed. The MRI findings included multifocal, asymmetric forebrain lesions affecting both the gray and white matter, an area suggestive of focal necrosis, and loss of corticomedullary distinction. A midline shift and caudal transtentorial herniation were noted, suggestive of greater than normal intracranial pressure. TREATMENT AND OUTCOME Because the dog's clinical signs worsened despite medical treatment and additional evidence of increased intracranial pressure, bilateral craniectomy and durectomy were performed. Histologic evaluation of a brain biopsy specimen revealed bilateral and asymmetric areas of necrosis in the subcortical white matter and adjacent gray matter. At the periphery of the necrotic areas, there was increased expression of glial fibrillary acidic protein and Virchow-Robin spaces were expanded by CD3+ lymphocytes. Results of immunohistochemical analysis of brain tissue were negative for canine distemper virus, Neospora canis, and Toxoplasma gondii. These clinical, imaging, and histopathologic findings were compatible with necrotizing meningoencephalitis. The dog's neurologic status continued to worsen following surgery. Repeated MRI revealed ongoing signs of increased intracranial pressure, despite the bilateral craniectomy. The owners elected euthanasia. CLINICAL RELEVANCE To the author's knowledge, this is the first report of necrotizing meningoencephalitis in a large mixed-breed dog. Necrotizing meningoencephalitis should be considered as a differential diagnosis in dogs other than small or toy breeds that have signs suggestive of inflammatory disease.
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Affiliation(s)
- Chelsie M Estey
- Neurology Service, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
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Schrauwen I, Barber RM, Schatzberg SJ, Siniard AL, Corneveaux JJ, Porter BF, Vernau KM, Keesler RI, Matiasek K, Flegel T, Miller AD, Southard T, Mariani CL, Johnson GC, Huentelman MJ. Identification of novel genetic risk loci in Maltese dogs with necrotizing meningoencephalitis and evidence of a shared genetic risk across toy dog breeds. PLoS One 2014; 9:e112755. [PMID: 25393235 PMCID: PMC4231098 DOI: 10.1371/journal.pone.0112755] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 10/14/2014] [Indexed: 12/02/2022] Open
Abstract
Necrotizing meningoencephalitis (NME) affects toy and small breed dogs causing progressive, often fatal, inflammation and necrosis in the brain. Genetic risk loci for NME previously were identified in pug dogs, particularly associated with the dog leukocyte antigen (DLA) class II complex on chromosome 12, but have not been investigated in other susceptible breeds. We sought to evaluate Maltese and Chihuahua dogs, in addition to pug dogs, to identify novel or shared genetic risk factors for NME development. Genome-wide association testing of single nucleotide polymorphisms (SNPs) in Maltese dogs with NME identified 2 regions of genome-wide significance on chromosomes 4 (chr4:74522353T>A, p = 8.1×10−7) and 15 (chr15:53338796A>G, p = 1.5×10−7). Haplotype analysis and fine-mapping suggests that ILR7 and FBXW7, respectively, both important for regulation of immune system function, could be the underlying associated genes. Further evaluation of these regions and the previously identified DLA II locus across all three breeds, revealed an enrichment of nominal significant SNPs associated with chromosome 15 in pug dogs and DLA II in Maltese and Chihuahua dogs. Meta-analysis confirmed effect sizes the same direction in all three breeds for both the chromosome 15 and DLA II loci (p = 8.6×10–11 and p = 2.5×10−7, respectively). This suggests a shared genetic background exists between all breeds and confers susceptibility to NME, but effect sizes might be different among breeds. In conclusion, we identified the first genetic risk factors for NME development in the Maltese, chromosome 4 and chromosome 15, and provide evidence for a shared genetic risk between breeds associated with chromosome 15 and DLA II. Last, DLA II and IL7R both have been implicated in human inflammatory diseases of the central nervous system such as multiple sclerosis, suggesting that similar pharmacotherapeutic targets across species should be investigated.
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Affiliation(s)
- Isabelle Schrauwen
- Neurogenomics Division, Translational Genomics Research Institute, Phoenix, Arizona, United States of America
- Department of Medical Genetics, University of Antwerp, Antwerp, Belgium
| | - Renee M. Barber
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - Scott J. Schatzberg
- The Animal Neurology and Imaging Center, Algodones, New Mexico, United States of America
| | - Ashley L. Siniard
- Neurogenomics Division, Translational Genomics Research Institute, Phoenix, Arizona, United States of America
| | - Jason J. Corneveaux
- Neurogenomics Division, Translational Genomics Research Institute, Phoenix, Arizona, United States of America
| | - Brian F. Porter
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, United States of America
| | - Karen M. Vernau
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, United States of America
| | - Rebekah I. Keesler
- Department of Pathobiology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Kaspar Matiasek
- Section of Clinical & Comparative Neuropathology, Ludwig Maximilians University Munich, Munich, Germany
| | - Thomas Flegel
- Department of Small Animal Medicine, University of Leipzig, Leipzig, Germany
| | - Andrew D. Miller
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America
| | - Teresa Southard
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America
| | - Christopher L. Mariani
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Gayle C. Johnson
- Department of Veterinary Pathobiology, Veterinary Medical Diagnostic Laboratory, University of Missouri, Columbia, Missouri, United States of America
| | - Matthew J. Huentelman
- Neurogenomics Division, Translational Genomics Research Institute, Phoenix, Arizona, United States of America
- * E-mail:
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Coates JR, Jeffery ND. Perspectives on Meningoencephalomyelitis of Unknown Origin. Vet Clin North Am Small Anim Pract 2014; 44:1157-85. [DOI: 10.1016/j.cvsm.2014.07.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Young BD, Fosgate GT, Holmes SP, Wolff CA, Chen-Allen AV, Kent M, Platt SR, Savage MY, Schatzberg SJ, Levine JM. Evaluation of standard magnetic resonance characteristics used to differentiate neoplastic, inflammatory, and vascular brain lesions in dogs. Vet Radiol Ultrasound 2014; 55:399-406. [PMID: 24467341 DOI: 10.1111/vru.12137] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/25/2013] [Indexed: 12/01/2022] Open
Abstract
Magnetic resonance (MR) imaging characteristics are commonly used to help predict intracranial disease categories in dogs, however, few large studies have objectively evaluated these characteristics. The purpose of this retrospective study was to evaluate MR characteristics that have been used to differentiate neoplastic, inflammatory, and vascular intracranial diseases in a large, multi-institutional population of dogs. Medical records from three veterinary teaching hospitals were searched over a 6-year period for dogs that had diagnostic quality brain MR scans and histologically confirmed intracranial disease. Three examiners who were unaware of histologic diagnosis independently evaluated 19 MR lesion characteristics totaling 57 possible responses. A total of 75 dogs with histologically confirmed intracranial disease were included in analyses: 51 with neoplasia, 18 with inflammatory disease, and six with cerebrovascular disease. Only strong contrast enhancement was more common in neoplasia than other disease categories. A multivariable statistical model suggested that extra-axial origin, T2-FLAIR mixed intensity, and defined lesion margins were also predictive of neoplasia. Meningeal enhancement, irregular lesion shape, and multifocal location distinguished inflammatory diseases from the other disease categories. No MR characteristics distinguished vascular lesions and these appeared most similar to neoplasia. These results differed from a previous report describing seven MR characteristics that were predictive of neoplasia in dogs and cats. Findings from the current study indicated that the high performance of MR for diagnosing canine intracranial diseases might be due to evaluator recognition of combinations of MR characteristics vs. relying on any one MR characteristic alone.
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Affiliation(s)
- Benjamin D Young
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843
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Leclerc MK, d'Anjou MA, Blond L, Carmel ÉN, Dennis R, Kraft SL, Matthews AR, Parent JM. Interobserver agreement and diagnostic accuracy of brain magnetic resonance imaging in dogs. J Am Vet Med Assoc 2014; 242:1688-95. [PMID: 23725432 DOI: 10.2460/javma.242.12.1688] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate interobserver agreement and diagnostic accuracy of brain MRI in dogs. DESIGN Evaluation study. ANIMALS 44 dogs. PROCEDURES 5 board-certified veterinary radiologists with variable MRI experience interpreted transverse T2-weighted (T2w), T2w fluid-attenuated inversion recovery (FLAIR), and T1-weighted-FLAIR; transverse, sagittal, and dorsal T2w; and T1-weighted-FLAIR postcontrast brain sequences (1.5 T). Several imaging parameters were scored, including the following: lesion (present or absent), lesion characteristics (axial localization, mass effect, edema, hemorrhage, and cavitation), contrast enhancement characteristics, and most likely diagnosis (normal, neoplastic, inflammatory, vascular, metabolic or toxic, or other). Magnetic resonance imaging diagnoses were determined initially without patient information and then repeated, providing history and signalment. For all cases and readers, MRI diagnoses were compared with final diagnoses established with results from histologic examination (when available) or with other pertinent clinical data (CSF analysis, clinical response to treatment, or MRI follow-up). Magnetic resonance scores were compared between examiners with κ statistics. RESULTS Reading agreement was substantial to almost perfect (0.64 < κ < 0.86) when identifying a brain lesion on MRI; fair to moderate (0.14 < κ < 0.60) when interpreting hemorrhage, edema, and pattern of contrast enhancement; fair to substantial (0.22 < κ < 0.74) for dural tail sign and categorization of margins of enhancement; and moderate to substantial (0.40 < κ < 0.78) for axial localization, presence of mass effect, cavitation, intensity, and distribution of enhancement. Interobserver agreement was moderate to substantial for categories of diagnosis (0.56 < κ < 0.69), and agreement with the final diagnosis was substantial regardless of whether patient information was (0.65 < κ < 0.76) or was not (0.65 < κ < 0.68) provided. CONCLUSIONS AND CLINICAL RELEVANCE The present study found that whereas some MRI features such as edema and hemorrhage were interpreted less consistently, radiologists were reasonably constant and accurate when providing diagnoses.
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Affiliation(s)
- Mylène-Kim Leclerc
- Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC J2S 7C6, Canada.
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Cooper JJ, Schatzberg SJ, Vernau KM, Summers BA, Porter BF, Siso S, Young BD, Levine JM. Necrotizing meningoencephalitis in atypical dog breeds: a case series and literature review. J Vet Intern Med 2013; 28:198-203. [PMID: 24428322 PMCID: PMC4895549 DOI: 10.1111/jvim.12233] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 08/23/2013] [Accepted: 09/17/2013] [Indexed: 12/04/2022] Open
Abstract
Background Canine necrotizing meningoencephalitis (NME) is a fatal, noninfectious inflammatory disease of unknown etiology. NME has been reported only in a small number of dog breeds, which has led to the presumption that it is a breed‐restricted disorder. Hypothesis/Objectives Our objective was to describe histopathologically confirmed NME in dog breeds in which the condition has not been reported previously and to provide preliminary evidence that NME affects a wider spectrum of dog breeds than previously reported. Animals Four dogs with NME. Methods Archives from 3 institutions and from 1 author's (BS) collection were reviewed to identify histopathologically confirmed cases of NME in breeds in which the disease has not been reported previously. Age, sex, breed, survival from onset of clinical signs, and histopathologic findings were evaluated. Results Necrotizing meningoencephalitis was identified in 4 small dog breeds (Papillon, Shih Tzu, Coton de Tulear, and Brussels Griffon). Median age at clinical evaluation was 2.5 years. Histopathologic abnormalities included 2 or more of the following: lymphoplasmacytic or histiocytic meningoencephalitis or encephalitis, moderate‐to‐severe cerebrocortical necrosis, variable involvement of other anatomic locations within the brain (cerebellum, brainstem), and absence of detectable infectious agents. Conclusions and Clinical Importance Until now, NME has only been described in 5 small dog breeds. We document an additional 4 small breeds previously not shown to develop NME. Our cases further illustrate that NME is not a breed‐restricted disorder and should be considered in the differential diagnosis for dogs with signalment and clinical signs consistent with inflammatory brain disease.
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Affiliation(s)
- J J Cooper
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
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Most commonly used sequences and clinical protocols for brain and spine magnetic resonance imaging allowing better identification of pathological changes in dogs. Pol J Vet Sci 2013; 16:157-63. [PMID: 23691592 DOI: 10.2478/pjvs-2013-0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Magnetic resonance imaging is the best imaging modality for the brain and spine. Quality of the received images depends on many technical factors. The most significant factors are: positioning the patient, proper coil selection, selection of appropriate sequences and image planes. The present contrast between different tissues provides an opportunity to diagnose various lesions. In many clinics magnetic resonance imaging has replaced myelography because of its noninvasive modality and because it provides excellent anatomic detail. There are many different combinations of sequences possible for spinal and brain MR imaging. Most frequently used are: T2-weighted fast spin echo (FSE), T1- and T2-weighted turbo spin echo, Fluid Attenuation Inversion Recovery (FLAIR), T1-weighted gradient echo (GE) and spin echo (SE), high-resolution three-dimensional (3D) sequences, fat-suppressing short tau inversion recovery (STIR) and half-Fourier acquisition single-shot turbo spin echo (HASTE). Magnetic resonance imaging reveals neurologic lesions which were previously hard to diagnose antemortem.
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Keenihan E, Summers B, David F, Lamb C. CANINE MENINGEAL DISEASE: ASSOCIATIONS BETWEEN MAGNETIC RESONANCE IMAGING SIGNS AND HISTOLOGIC FINDINGS. Vet Radiol Ultrasound 2013; 54:504-15. [DOI: 10.1111/vru.12055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 04/25/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- E.K. Keenihan
- Department of Clinical Sciences and Services; The Royal Veterinary College, University of London; Hertfordshire; AL9 7TA; United Kingdom
| | - B.A. Summers
- Department of Pathology and Pathogen Biology; The Royal Veterinary College, University of London; Hertfordshire; AL9 7TA; United Kingdom
| | - F.H. David
- Department of Clinical Sciences and Services; The Royal Veterinary College, University of London; Hertfordshire; AL9 7TA; United Kingdom
| | - C.R. Lamb
- Department of Clinical Sciences and Services; The Royal Veterinary College, University of London; Hertfordshire; AL9 7TA; United Kingdom
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Terzo E, McConnell JF, Shiel RE, McAllister H, Behr S, Priestnall SL, Smith KC, Nolan CM, Callanan JJ. Unique topographic distribution of greyhound nonsuppurative meningoencephalitis. Vet Radiol Ultrasound 2012; 53:636-42. [PMID: 22742427 DOI: 10.1111/j.1740-8261.2012.01963.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 05/13/2012] [Indexed: 11/26/2022] Open
Abstract
Greyhound nonsuppurative meningoencephalitis is an idiopathic breed-associated fatal meningoencephalitis with lesions usually occurring within the rostral cerebrum. This disorder can only be confirmed by postmortem examination, with a diagnosis based upon the unique topography of inflammatory lesions. Our purpose was to describe the magnetic resonance (MR) imaging features of this disease. Four Greyhounds with confirmed Greyhound nonsuppurative meningoencephalitis were evaluated by MR imaging. Lesions predominantly affected the olfactory lobes and bulbs, frontal, and frontotemporal cortical gray matter, and caudate nuclei bilaterally. Fluid attenuation inversion recovery (FLAIR) and T2 weighted spin-echo (T2W) sequences were most useful to assess the nature, severity, extension, and topographic pattern of lesions. Lesions were predominantly T2-hyperintense and T1-isointense with minimal or absent contrast enhancement.
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Affiliation(s)
- Eloisa Terzo
- School of Veterinary Medicine, University Veterinary Hospital, University College, Dublin, Ireland.
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Singh JB, Oevermann A, Lang J, Vandevelde M, Doherr M, Henke D, Gorgas D. Contrast media enhancement of intracranial lesions in magnetic resonance imaging does not reflect histopathologic findings consistently. Vet Radiol Ultrasound 2012; 52:619-26. [PMID: 21777330 DOI: 10.1111/j.1740-8261.2011.01848.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Certain magnetic resonance (MR) enhancement patterns are often considered to be associated with a specific diagnosis but experience shows that this association is not always consistent. Therefore, it is not clear how reliably contrast enhancement patterns correlate with specific tissue changes. We investigated the detailed histomorphologic findings of intracranial lesions in relation to Gadodiamide contrast enhancement in 55 lesions from 55 patients, nine cats, and 46 dogs. Lesions were divided into areas according to their contrast enhancement; therefore 81 areas resulted from the 55 lesions which were directly compared with histopathology. In 40 of 55 lesions (73%), the histomorphologic features explained the contrast enhancement pattern. In particular, vascular proliferation and dilated vessels occurred significantly more often in areas with enhancement than in areas without enhancement (P = 0.044). In 15 lesions, there was no association between MR images and histologic findings. In particular, contrast enhancement was found within necrotic areas (10 areas) and ring enhancement was seen in lesions without central necrosis (five lesions). These findings imply that necrosis cannot be differentiated reliably from viable tissue based on postcontrast images. Diffusion of contrast medium within lesions and time delays after contrast medium administration probably play important roles in the presence and patterns of contrast enhancement. Thus, histologic features of lesions cannot be predicted solely by contrast enhancement patterns.
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Wolff CA, Holmes SP, Young BD, Chen AV, Kent M, Platt SR, Savage MY, Schatzberg SJ, Fosgate GT, Levine JM. Magnetic resonance imaging for the differentiation of neoplastic, inflammatory, and cerebrovascular brain disease in dogs. J Vet Intern Med 2012; 26:589-97. [PMID: 22404482 DOI: 10.1111/j.1939-1676.2012.00899.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 01/22/2012] [Accepted: 01/24/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The reliability and validity of magnetic resonance imaging (MRI) for detecting neoplastic, inflammatory, and cerebrovascular brain lesions in dogs are unknown. OBJECTIVES To estimate sensitivity, specificity, and inter-rater agreement of MRI for classifying histologically confirmed neoplastic, inflammatory, and cerebrovascular brain disease in dogs. ANIMALS One hundred and twenty-one client-owned dogs diagnosed with brain disease (n = 77) or idiopathic epilepsy (n = 44). METHODS Retrospective, multi-institutional case series; 3 investigators analyzed MR images for the presence of a brain lesion with and without knowledge of case clinical data. Investigators recorded most likely etiologic category (neoplastic, inflammatory, cerebrovascular) and most likely specific disease for all brain lesions. Sensitivity, specificity, and inter-rater agreement were calculated to estimate diagnostic performance. RESULTS MRI was 94.4% sensitive (95% confidence interval [CI] = 88.7, 97.4) and 95.5% specific (95% CI = 89.9, 98.1) for detecting a brain lesion with similarly high performance for classifying neoplastic and inflammatory disease, but was only 38.9% sensitive for classifying cerebrovascular disease (95% CI = 16.1, 67.0). In general, high specificity but not sensitivity was retained for MR diagnosis of specific brain diseases. Inter-rater agreement was very good for overall detection of structural brain lesions (κ = 0.895, 95% CI = 0.792, 0.998, P < .001) and neoplastic lesions, but was only fair for cerebrovascular lesions (κ = 0.299, 95% CI = 0, 0.761, P = .21). CONCLUSIONS AND CLINICAL IMPORTANCE MRI is sensitive and specific for identifying brain lesions and classifying disease as inflammatory or neoplastic in dogs. Cerebrovascular disease in general and specific inflammatory, neoplastic, and cerebrovascular brain diseases were frequently misclassified.
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Affiliation(s)
- C A Wolff
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
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d'Anjou MA, Carmel ÉN, Blond L, Beauchamp G, Parent J. EFFECT OF ACQUISITION TIME AND CHEMICAL FAT SUPPRESSION ON MENINGEAL ENHANCEMENT ON MR IMAGING IN DOGS. Vet Radiol Ultrasound 2011; 53:11-20. [DOI: 10.1111/j.1740-8261.2011.01864.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Marc-André d'Anjou
- Companion Animal Research Group; Faculté de Médecine Vétérinaire; Université de Montréal; Saint-Hyacinthe; Québec; Canada
| | - Éric Norman Carmel
- Companion Animal Research Group; Faculté de Médecine Vétérinaire; Université de Montréal; Saint-Hyacinthe; Québec; Canada
| | - Laurent Blond
- Companion Animal Research Group; Faculté de Médecine Vétérinaire; Université de Montréal; Saint-Hyacinthe; Québec; Canada
| | - Guy Beauchamp
- Département de Sciences Cliniques; Département de Pathologie; Faculté de Médecine Vétérinaire; Université de Montréal; Saint-Hyacinthe; Québec; Canada
| | - Joane Parent
- Companion Animal Research Group; Faculté de Médecine Vétérinaire; Université de Montréal; Saint-Hyacinthe; Québec; Canada
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Vite CH, Cross JR. Correlating magnetic resonance findings with neuropathology and clinical signs in dogs and cats. Vet Radiol Ultrasound 2011; 52:S23-31. [PMID: 21392153 DOI: 10.1111/j.1740-8261.2010.01782.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The histologic characteristics that are the basis for diagnosis of central nervous system conditions cannot be visualized directly using magnetic resonance (MR) methods, but clinical diagnosis may be based on the frequency and pattern of MR imaging signs, which represent predominantly the gross morphologic features of lesions. Additional quantitative MR measures of myelination, cell swelling, gliosis, and neuronal loss may also be used for more specific characterization of lesions. These measures include magnetization transfer ratio, apparent diffusion coefficient, and the concentrations or ratios of metabolites identified by spectroscopy. Confidence that an MR abnormality is responsible for the clinical signs depends primarily on the degree of correspondence between the site of the lesion and the neuroanatomical localization.
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Affiliation(s)
- Charles H Vite
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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YOUNG BENJAMIND, LEVINE JONATHANM, PORTER BRIANF, CHEN-ALLEN ANNIEV, ROSSMEISL JOHNH, PLATT SIMONR, KENT MARC, FOSGATE GEOFFREYT, SCHATZBERG SCOTTJ. MAGNETIC RESONANCE IMAGING FEATURES OF INTRACRANIAL ASTROCYTOMAS AND OLIGODENDROGLIOMAS IN DOGS. Vet Radiol Ultrasound 2010; 52:132-41. [DOI: 10.1111/j.1740-8261.2010.01758.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Shiel RE, Mooney CT, Brennan SF, Nolan CM, Callanan JJ. Clinical and clinicopathological features of non-suppurative meningoencephalitis in young greyhounds in Ireland. Vet Rec 2010; 167:333-7. [PMID: 20802187 DOI: 10.1136/vr.c4248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The clinical and clinicopathological features of non-suppurative meningoencephalitis in 30 greyhounds were reviewed. The dogs were from 21 separate litters, comprised both sexes (16 males and 14 females) and ranged in age from five to 18 months. In 14 (66.7 per cent) litters, more than one case was suspected or confirmed, and the number of siblings affected within individual litters ranged from one to seven. Clinical signs were progressive and varied from five days to 12 months in duration; 12 dogs had signs of two weeks' duration or less. The rate of progression of signs was variable. Common features included dullness or lethargy (22), altered behaviour (21), proprioceptive and postural reaction deficits (18), circling (17), ataxia (17), decreased appetite (15) and weight loss (13). No consistent haematological or biochemical abnormalities were identified and serology failed to implicate Toxoplasma gondii or Neospora caninum. Cerebrospinal fluid analysis revealed mild or moderate mononuclear pleocytosis in 12 (70.6 per cent) of 17 dogs. No definitive antemortem diagnosis could be made in any affected dog.
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Affiliation(s)
- R E Shiel
- Section of Veterinary Clinical Studies, University College Dublin, Belfield, Dublin 4, Ireland.
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Talarico LR, Schatzberg SJ. Idiopathic granulomatous and necrotising inflammatory disorders of the canine central nervous system: a review and future perspectives. J Small Anim Pract 2010; 51:138-49. [DOI: 10.1111/j.1748-5827.2009.00823.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nghiem PP, Schatzberg SJ. Conventional and molecular diagnostic testing for the acute neurologic patient. J Vet Emerg Crit Care (San Antonio) 2010; 20:46-61. [PMID: 20230434 PMCID: PMC7169320 DOI: 10.1111/j.1476-4431.2009.00495.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE The aim of this review is to describe and evaluate both conventional and molecular diagnostic testing utilized in dogs and cats with acute neurologic diseases. Various types of polymerase chain reaction (PCR) are explored along with novel molecular diagnostic testing that ultimately may prove useful in the critical care setting. DATA SOURCES PUBMED was searched to obtain relevant references material using keywords: 'canine OR feline meningitis AND meningoencephalitis,''feline infectious peritonitis,''canine distemper,''canine OR feline AND toxoplasma,''canine neospora,''canine OR feline AND rickettsia,''granulomatous meningoencephalitis,''steroid responsive meningitis arteritis,''necrotizing encephalitis,''novel neurodiagnostics,''canine OR feline AND CNS borrelia,''canine OR feline AND CNS bartonella,''canine OR feline AND CNS fungal,''nested OR multiplex OR degenerate OR consensus OR CODEHOP AND PCR.' Research findings from the authors' laboratory and current veterinary textbooks also were utilized. HUMAN DATA SYNTHESIS Molecular diagnostic testing including conventional, real-time, and consensus and degenerate PCR and microarray analysis are utilized routinely for the antemortem diagnosis of infectious meningoencephalitis (ME) in humans. Recently, PCR using consensus degenerate hybrid primers (CODEHOP) has been used to identify and characterize a number of novel human viruses. VETERINARY DATA SYNTHESIS Molecular diagnostic testing such as conventional and real-time PCR aid in the diagnosis of several important central nervous system infectious agents including canine distemper virus, Toxoplasma gondii, Neospora caninum, rickettsial species, and others. Recently, broadly reactive consensus and degenerate PCR reactions have been applied to canine ME including assays for rickettsial organisms, Borrelia spp. and Bartonella spp., and various viral families. CONCLUSIONS In the acute neurologic patient, there are several key infectious diseases that can be pursued by a combination of conventional and molecular diagnostic testing. It is important that the clinician understands the utility, as well as the limitations, of the various neurodiagnostic tests that are available.
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Affiliation(s)
- Peter P Nghiem
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30606, USA
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