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Beckwith-Cohen B, Petersen-Jones SM. Manifestations of systemic disease in the retina and fundus of cats and dogs. Front Vet Sci 2024; 11:1337062. [PMID: 38444779 PMCID: PMC10912207 DOI: 10.3389/fvets.2024.1337062] [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: 11/12/2023] [Accepted: 01/15/2024] [Indexed: 03/07/2024] Open
Abstract
The fundus is unique in that it is the only part of the body that allows for a noninvasive and uninterrupted view of vasculature and nervous tissue. Utilization of this can be a powerful tool in uncovering salient incidental findings which point to underlying systemic diseases, and for monitoring response to therapy. Retinal venules and arterioles allow the clinician to assess changes in vascular color, diameter, outline, and tortuosity. The retina and optic nerve may exhibit changes associated with increased or decreased thickness, inflammatory infiltrates, hemorrhages, and detachments. While some retinal manifestations of systemic disease may be nonspecific, others are pathognomonic, and may be the presenting sign for a systemic illness. The examination of the fundus is an essential part of the comprehensive physical examination. Systemic diseases which may present with retinal abnormalities include a variety of disease classifications, as represented by the DAMNIT-V acronym, for Degenerative/Developmental, Anomalous, Metabolic, Neoplastic, Nutritional, Inflammatory (Infectious/Immune-mediated/ischemic), Toxic, Traumatic and Vascular. This review details systemic illnesses or syndromes that have been reported to manifest in the fundus of companion animals and discusses key aspects in differentiating their underlying cause. Normal variations in retinal anatomy and morphology are also considered.
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Affiliation(s)
- Billie Beckwith-Cohen
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
| | - Simon M. Petersen-Jones
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
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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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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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Muñiz Moris L, Cherubini GB, Caine A. Low-Field Magnetic Resonance Imaging Findings in 18 Dogs With Presumed Optic Neuritis. Front Vet Sci 2021; 7:585828. [PMID: 33490127 PMCID: PMC7817917 DOI: 10.3389/fvets.2020.585828] [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: 07/21/2020] [Accepted: 12/10/2020] [Indexed: 11/23/2022] Open
Abstract
Canine optic neuritis has been attributed to a focal or disseminated form of granulomatous meningoencephalitis (GME) amongst other etiologies. Magnetic resonance imaging (MRI) has been proven to help differentiate the structures within the optic nerve sheath and therefore could aid the diagnosis of optic neuritis in dogs. The objectives of this study were to describe and compare the MRI abnormalities affecting the optic nerve sheath complex and optic chiasm in dogs with clinically suspected optic neuritis as a component of meningoencephalitis of unknown etiology (MUE) or as an isolated form (I-ON). Retrospective evaluation of patient details, clinical signs, cerebrospinal fluid (CSF) analysis, and MRI findings of dogs with clinically suspected optic neuritis between January 2011 and May 2018 was performed. Eighteen dogs met the inclusion criteria. MRI findings included contrast enhancement of both optic nerves (11/18) and optic chiasm (6/18), changes within the CSF volume surrounding the optic nerve (10/18), changes to the optic disc (10/18), changes of size or signal affecting the optic chiasm (10/18), changes in the Short TI inversion recovery (STIR) signal of the optic nerve (7/15), retrobulbar changes (3/18), and concurrent brain lesions (13/18). A variety of subtle MRI features may indicate optic nerve involvement and low-field MRI is a sensitive method to detect changes within the optic nerve sheath complex in dogs with optic neuritis as an isolated form (I-ON) or as an extension of MUE.
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Affiliation(s)
| | | | - Abby Caine
- Dick White Referrals, Cambridgeshire, United Kingdom
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Levitin HA, Lampe R, Hecht S. Case Report: Meningoencephalomyelitis of Unknown Etiology Manifesting as a Bilateral Cranial Polyneuropathy in 3 Dogs. Front Vet Sci 2020; 7:326. [PMID: 32596270 PMCID: PMC7303259 DOI: 10.3389/fvets.2020.00326] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/11/2020] [Indexed: 11/13/2022] Open
Abstract
A bilateral cranial polyneuropathy was the primary magnetic resonance imaging (MRI) finding in three medium to large breed dogs diagnosed with meningoencephalomyelitis of unknown etiology. All three dogs presented with a progressive history of vestibular ataxia with either central vestibular or multifocal central nervous system (CNS) neuroanatomical localization. Brain MRI revealed variable degree of bilateral enlargement and/or increased contrast enhancement of the optic, oculomotor, trigeminal, facial, and vestibulocochlear nerves, as well as enhancement of the orbital fissure (oculomotor, trochlear, ophthalmic branch of trigeminal, and abducens nerves). There was evidence of intracranial and cranial cervical meningeal contrast enhancement in all three dogs and of cervical spinal cord lesions in 2. In all cases, more cranial nerves were affected than indicated by neurological examination. Cerebrospinal fluid (CSF) analysis was consistent with a mononuclear pleocytosis in 2 cases and a mixed cell (predominantly lymphocytic) pleocytosis in 1 case. All dogs were treated with immune suppressing medications and showed clinical improvement, although some cranial nerve deficits were persistent at follow up 2 months later. These are the first known cases of MUE diagnosed ante-mortem in a canine population documenting bilaterally symmetrical lesions affecting multiple cranial nerves. While MUE is a common cause of non-infectious inflammatory disease in dogs, it likely encompasses more classifications than have previously been reported, and should remain a differential for dogs of all ages and sizes presenting with cranial nerve deficits.
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Affiliation(s)
- Hilary A Levitin
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, Veterinary Urbana, University of Illinois, Urbana, IL, United States
| | - Rachel Lampe
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, Veterinary Urbana, University of Illinois, Urbana, IL, United States
| | - Silke Hecht
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Knoxville, TN, United States
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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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