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Alcoverro E, Schofield I, Spinillo S, Tauro A, Ruggeri M, Lowrie M, Gomes SA. Thoracolumbar hydrated nucleus pulposus extrusion and intervertebral disc extrusion in dogs: Comparison of clinical presentation and magnetic resonance imaging findings. Vet J 2024; 306:106178. [PMID: 38906413 DOI: 10.1016/j.tvjl.2024.106178] [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: 03/03/2024] [Revised: 05/29/2024] [Accepted: 06/13/2024] [Indexed: 06/23/2024]
Abstract
Thoracolumbar hydrated nucleus pulposus extrusion (TL-HNPE) is an increasingly recognised pathology with a substantial lack of literature describing its features. The aim of this retrospective case-control study was to analyse the clinical and magnetic resonance imaging (MRI) features of dogs with TL-HNPE compared to dogs affected with thoracolumbar intervertebral disc extrusion (TL-IVDE). Data from dogs diagnosed with TL-HNPE and TL-IVDE via MRI at two referral hospitals, were retrospectively collected and compared in terms of clinical signs and MRI features. Cases diagnosed with TL-IVDE were deemed controls. The MRI features of the affected IVD space, herniated IVD material, affected overlying spinal cord and local epaxial musculature were evaluated for each group. Fifty-one cases with TL-HNPE and 105 randomly selected cases of TL-IVDE were included. Several signalment and neurological signs were identified as statistically distinct between groups in univariate analysis. Multivariate analysis identified that dogs affected with TL-HNPE were typically older, less likely to be chondrodystrophic (62.2 % vs. 91 %), more frequently experiencing a peracute onset (90.2 % vs. 61.9 %) often attributed to a suspected trauma linked with exercise (37.3 % vs. 10.5 %), being less frequently progressive (41.2 % vs. 86.5 %) and with herniated disc material less frequently lateralised (72.6 % vs. 89.5 %) than cases with TL-IVDE. MRI-identifiable intervertebral disc degeneration was found in every TL-IVDE case but only in 60 % of TL-HNPE cases. TL-HNPEs were associated to significantly less spinal cord compression and less hyperalgesia than TL-IVDE.
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Affiliation(s)
- E Alcoverro
- ChesterGates Veterinary Specialists, Chester, Cheshire CH1 6LT, UK; Anicura Ars Veterinària Hospital Veterinari, Barcelona, Catalonia 08340, Spain.
| | | | - S Spinillo
- ChesterGates Veterinary Specialists, Chester, Cheshire CH1 6LT, UK
| | - A Tauro
- ChesterGates Veterinary Specialists, Chester, Cheshire CH1 6LT, UK; Department of Clinical Sciences, College of Veterinary Medicine, NC State University, Raleigh, NC 27606, USA
| | - M Ruggeri
- ChesterGates Veterinary Specialists, Chester, Cheshire CH1 6LT, UK; Department of Clinical Sciences, College of Veterinary Medicine, NC State University, Raleigh, NC 27606, USA
| | - M Lowrie
- Dovecote Veterinary Hospital, Castle Donington, Derbyshire DE74 2LJ, UK; Movement Referrals: Independent Veterinary Specialists, Preston Brook, Cheshire WA7 3GH, UK
| | - S A Gomes
- Dovecote Veterinary Hospital, Castle Donington, Derbyshire DE74 2LJ, UK
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Capasso M, Canal S, Balducci F. Prevalence of neurological diseases associated with cervical pain and/or signs of cervical myelopathy in French bulldogs: a retrospective analysis of 105 cases. Front Vet Sci 2024; 11:1431358. [PMID: 39021406 PMCID: PMC11252003 DOI: 10.3389/fvets.2024.1431358] [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: 05/11/2024] [Accepted: 06/19/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction French bulldogs can be affected by several neurological diseases, with myelopathies representing the most frequent cause of neurological signs. Studies focusing on the epidemiology of cervical diseases in this breed are lacking. This study aims to describe the prevalence of neurological pathologies responsible for cervical pain and/or signs of cervical myelopathy, assuming that intervertebral disc herniation represents the most common disease; a second aim was to evaluate how often different pathologies coexist in this spinal region in French bulldogs. Materials and methods A retrospective analysis of medical records from the database of a single referral center (AniCura I Portoni Rossi Veterinary Hospital-Zola Predosa, Bologna, Italy) was performed, including French bulldogs presented for neck pain and/or neurological deficits consistent with cervical myelopathy. Clinical and imaging data were reviewed and used as inclusion criteria. Based on the number of MRI-diagnosed diseases, the eligible dogs were divided into three groups. Results One hundred five French bulldogs met the inclusion criteria. The most commonly diagnosed condition was an intervertebral disc herniation (66.9%), followed by C2 idiopathic hypertrophic ganglioneuritis (15.1%), cervical syringomyelia (11.5%), congenital osseous malformations (1.4%), spinal arachnoid diverticula (1.4%), neoplasms (1.4%), steroid-responsive meningitis-arteritis (0.7%), traumatic vertebral fractures (0.7%), and other (0.7%). For the vast majority of dogs (75/105) a single pathology was diagnosed, with intervertebral disc herniations accounting for 86.7% of cases, involving C3-C4 IVD most commonly. In the remaining 30 dogs, two or three different and concurrent diseases were detected. Among these 30 dogs, intervertebral disc herniations still remained the most diagnosed condition, in combination with C2 idiopathic hypertrophic ganglioneuritis and syringomyelia in 19 and seven cases, respectively. Conclusion The results of this study highlight that different pathologies can affect the cervical spinal cord in French bulldogs, with intervertebral disc herniations representing the most frequent condition, as previously described in the veterinary literature. In almost a third of cases, different pathologies can coexist at the cervical level. However, for cases in which different pathologies are present at the same time, it is not always possible to clearly establish their clinical significance.
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Affiliation(s)
- Michele Capasso
- Anicura I Portoni Rossi Veterinary Hospital, Zola Predosa, Bologna, Italy
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Farré Mariné A, López Beltran M, Ortiz Nisa S, Luján Feliu-Pascual A. Myelo-CT imaging findings in 15 dogs with surgically-treated cervical acute compressive hydrated nucleus pulposus extrusion. Vet Radiol Ultrasound 2024; 65:187-192. [PMID: 38349181 DOI: 10.1111/vru.13331] [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: 07/03/2023] [Revised: 11/30/2023] [Accepted: 12/28/2023] [Indexed: 05/12/2024] Open
Abstract
Compressive hydrated nucleus pulposus extrusion (HNPE) is a sudden extrusion of hydrated, nondegenerated nucleus pulposus material with well-known characteristic MRI findings. The appearance of compressive HNPE during contrast-enhanced CT has already been described, but never its myelo-CT characteristics. The aim of this retrospective multicenter case series is to describe the myelo-CT findings in 15 dogs with compressive HNPE confirmed with gross surgical findings. A distinctive and consistent myelo-CT appearance of cervical compressive HNPE in dogs that included a focal extradural "seagull"-shaped extradural compression dorsal to the annulus fibrosus combined with a narrowing of the affected intervertebral disc space was found. The extruded material was hypoattenuating in the soft tissue algorithm. Myelo-CT could be a useful diagnostic tool and influence the clinical decision to address cervical compressive HNPE conservatively or surgically when MRI is not available.
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Affiliation(s)
| | | | - Sonia Ortiz Nisa
- Hospital Veterinario Universidad Católica de Valencia (UCV), Valencia, Spain
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Kornmayer M, Fiedler S, Rosati M, Meyer‐Lindenberg A. Compressive hydrated nucleus pulposus extrusion in a dog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Matthias Kornmayer
- Clinic of Small Animal Surgery and Reproduction, Centre of Clinical Veterinary Science Ludwig‐Maximilians‐University Munich Germany
| | - Sonja Fiedler
- Section of Clinical & Comparative Neuropathology, Institute for Veterinary Pathology, Centre for Clinical Veterinary Medicine Ludwig‐Maximilians‐University Germany
| | - Marco Rosati
- Section of Clinical & Comparative Neuropathology, Institute for Veterinary Pathology, Centre for Clinical Veterinary Medicine Ludwig‐Maximilians‐University Germany
| | - Andrea Meyer‐Lindenberg
- Clinic of Small Animal Surgery and Reproduction, Centre of Clinical Veterinary Science Ludwig‐Maximilians‐University Munich Germany
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Kristiansen KV, Schmökel H, Vermeire S. Hydrated Nucleus Pulposus Extrusion in Dogs: Thoracolumbar Compared to Cervical Cases. Vet Comp Orthop Traumatol 2022; 35:152-156. [PMID: 35008122 DOI: 10.1055/s-0041-1740608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to review and describe cases of thoracolumbar (TL) hydrated nucleus pulposus extrusion (HNPE) diagnosed with magnetic resonance imaging and surgery, and compare them to cases of cervical (C) HNPE. STUDY DESIGN Retrospective, single-center study. RESULTS Thirty-six dogs met the inclusion criteria. Fifteen cases were C and 21 TL. Thirteen dogs were chondrodystrophic breeds, mean body weight was 13 kg, median age was 7.5 years, and 30/36 were male. Fewer dogs were chondrodystrophic in the C group compared with the TL group (p = 0.022). More than 90% had an acute onset, and strong activity was more often reported in the TL group. TL HNPE was more often painful, and extruded disc material more often lateralized (p = 0.017). Median Modified Frankel Score at presentation was 3 and 72.2% were non-ambulatory. More TL HNPE (11/21) were treated surgically compared with C HNPE (4/15). Treatment choice was correlated with spinal cord compression (p = 0.0075). Median Modified Frankel Score improved during hospitalization (p = 0.002) and there was no difference in outcome between C and TL HNPE or conservative and surgical treatment. Mean follow-up time was 33 days. All patients were ambulatory at follow-up. CONCLUSION This study suggests that the HNPE is not limited to the C vertebral column of dogs and can occur in the TL vertebral column as well. Dogs with TL HNPE show spinal hyperesthesia more often and extruded nucleus material is more often lateralized. Outcome is similar to what has previously been described for C HNPE.
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Affiliation(s)
- K V Kristiansen
- Spine Center and Radiology Department, Specialistdjursjukhuset, Strömsholm, Sweden
| | - H Schmökel
- Spine Center and Radiology Department, Specialistdjursjukhuset, Strömsholm, Sweden
| | - S Vermeire
- Spine Center and Radiology Department, Specialistdjursjukhuset, Strömsholm, Sweden
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Santifort K, Mandigers P, Bergknut N, Van Soens I, Carrera I. Dysphonia in a dog with cervical spinal cord injury and suspected progressive myelomalacia caused by a C4‐C5 hydrated nucleus pulposus extrusion. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Koen Santifort
- Department of Neurology and Neurosurgery Evidensia Small Animal Hospital Arnhem The Netherlands
- Department of Neurology and Neurosurgery Evidensia Small Animal Hospital ‘Hart van Brabant’ Waalwijk The Netherlands
| | - Paul Mandigers
- Department of Neurology and Neurosurgery 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
- Department of Neurology and Neurosurgery Evidensia Small Animal Hospital ‘Hart van Brabant’ Waalwijk The Netherlands
| | - Iris Van Soens
- Department of Neurology and Neurosurgery Evidensia Small Animal Hospital ‘Hart van Brabant’ Waalwijk The Netherlands
| | - Ines Carrera
- Department of Diagnostic Imaging Willows Referral Centre Solihull UK
- Vet Oracle Teleneurology Diss UK
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Miranda DB, Neves Rocha Martins ÂP, Diniz R. Functional neurorehabilitation in a dog with acute non‐compressive nucleus pulposus extrusion. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Ângela Paula Neves Rocha Martins
- Functional Neurorehabilitation Department Universidade Lusófona de Humanidades e Tecnologias Campo Grande Lisboa Portugal
- Centro de Reabilitação Animal da Arrábida, Hospital Veterinário da Arrábida R. José Augusto Coelho Azeitão Portugal
| | - Renata Diniz
- RehabilitaCans Carrer de Juan Gris Palma de Mallorca Baleares‐España Spain
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Olby NJ, da Costa RC, Levine JM, Stein VM. Prognostic Factors in Canine Acute Intervertebral Disc Disease. Front Vet Sci 2020; 7:596059. [PMID: 33324703 PMCID: PMC7725764 DOI: 10.3389/fvets.2020.596059] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022] Open
Abstract
Knowledge of the prognosis of acute spinal cord injury is critical to provide appropriate information for clients and make the best treatment choices. Acute intervertebral disc extrusions (IVDE) are a common cause of pain and paralysis in dogs with several types of IVDE occurring. Important prognostic considerations are recovery of ambulation, return of urinary and fecal continence, resolution of pain and, on the negative side, development of progressive myelomalacia. Initial injury severity affects prognosis as does type of IVDE, particularly when considering recovery of continence. Overall, loss of deep pain perception signals a worse outcome. When considering Hansen type 1 IVDE, the prognosis is altered by the choice of surgical vs. medical therapy. Concentration of structural proteins in the plasma, as well as inflammatory mediators, creatine kinase, and myelin basic protein in the cerebrospinal fluid (CSF) can provide additional prognostic information. Finally, cross-sectional area and length of T2 hyperintensity and loss of HASTE signal on MRI have been associated with outcome. Future developments in plasma and imaging biomarkers will assist in accurate prognostication and optimization of patient management.
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Affiliation(s)
- Natasha J. Olby
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States
| | - Ronaldo C. da Costa
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Jon M. Levine
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Veronika M. Stein
- Department for Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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da Costa RC, De Decker S, Lewis MJ, Volk H. Diagnostic Imaging in Intervertebral Disc Disease. Front Vet Sci 2020; 7:588338. [PMID: 33195623 PMCID: PMC7642913 DOI: 10.3389/fvets.2020.588338] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/09/2020] [Indexed: 12/27/2022] Open
Abstract
Imaging is integral in the diagnosis of canine intervertebral disc disease (IVDD) and in differentiating subtypes of intervertebral disc herniation (IVDH). These include intervertebral disc extrusion (IVDE), intervertebral disc protrusion (IVDP) and more recently recognized forms such as acute non-compressive nucleus pulposus extrusion (ANNPE), hydrated nucleus pulposus extrusion (HNPE), and intradural/intramedullary intervertebral disc extrusion (IIVDE). Many imaging techniques have been described in dogs with roles for survey radiographs, myelography, computed tomography (CT), and magnetic resonance imaging (MRI). Given how common IVDH is in dogs, a thorough understanding of the indications and limitations for each imaging modality to aid in diagnosis, treatment planning and prognosis is essential to successful case management. While radiographs can provide useful information, especially for identifying intervertebral disc degeneration or calcification, there are notable limitations. Myelography addresses some of the constraints of survey radiographs but has largely been supplanted by cross-sectional imaging. Computed tomography with or without myelography and MRI is currently utilized most widely and have become the focus of most contemporary studies on this subject. Novel advanced imaging applications are being explored in dogs but are not yet routinely performed in clinical patients. The following review will provide a comprehensive overview on common imaging modalities reported to aid in the diagnosis of IVDH including IVDE, IVDP, ANNPE, HNPE, and IIVDE. The review focuses primarily on canine IVDH due to its frequency and vast literature as opposed to feline IVDH.
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Affiliation(s)
- Ronaldo C da Costa
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, United States
| | - Steven De Decker
- Department of Clinical Sciences and Services, Royal Veterinary College, London, United Kingdom
| | - Melissa J Lewis
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, United States
| | - Holger Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hanover, Hanover, Germany
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Fenn J, Olby NJ. Classification of Intervertebral Disc Disease. Front Vet Sci 2020; 7:579025. [PMID: 33134360 PMCID: PMC7572860 DOI: 10.3389/fvets.2020.579025] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/24/2020] [Indexed: 12/24/2022] Open
Abstract
Intervertebral disc disease (IVDD) has been recognized in dogs since the 1800s, when the first descriptions of extruded disc material within the vertebral canal were published. In the intervening time our understanding of intervertebral disc pathology in dogs and cats has increased dramatically, with many variations of IVDD described. Whilst the volume of literature and collective understanding of IVDD has expanded, there has also been scope for confusion as the definition of intervertebral disc disease, with its myriad different manifestations, becomes more complicated. A large volume of literature has aimed to combine the use of histopathology, diagnostic imaging and clinical findings to better understand the various ways in which IVDD can be classified. Much of this research has focused on the classification of mechanisms of intervertebral disc degeneration, centering around the differences between, and overlaps in, IVDD in chondrodystrophic and non-chondrodystrophic dog breeds. However, with the increasing availability of advanced imaging modalities allowing more accurate antemortem diagnosis, the concept of IVDD has expanded to include other clinical presentations that may not fit into traditional models of classification of IVDD. This review aims to provide an up to date overview of both historical and current systems of IVDD classification, highlighting the important findings and controversies underpinning them.
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Affiliation(s)
- Joe Fenn
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
| | - Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
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Nessler J, Flieshardt C, Tünsmeyer J, Dening R, Tipold A. Comparison of surgical and conservative treatment of hydrated nucleus pulposus extrusion in dogs. J Vet Intern Med 2018; 32:1989-1995. [PMID: 30267615 PMCID: PMC6271322 DOI: 10.1111/jvim.15304] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/23/2018] [Accepted: 07/24/2018] [Indexed: 11/30/2022] Open
Abstract
Background Whether compressive cervical myelopathy caused by hydrated nucleus pulposus extrusion (HNPE) in dogs should be treated surgically or conservatively has been debated. Only 1 recent study has contradicted the former predominant reports of surgical treatment for HNPE. Hypothesis and method Single center retrospective study to compare the outcome of client‐owned dogs with HNPE after decompressive surgery or conservative treatment. Animals Thirty‐six dogs diagnosed with HNPE confirmed by magnetic resonance imaging (MRI). Results Eighteen of 36 dogs underwent surgery whereas 18 dogs were managed conservatively including cage rest and physiotherapy. The most common affected intervertebral disc space was C4‐5. In 3 dogs, HNPE was diagnosed at the level of T13‐L1. Median time to regain ambulation was 6.6 days (range, 0‐28 days) after surgery and 5.9 days (range, 0‐15 days) with conservative management (P = .37). Only the length of a potential intramedullary lesion in cervical HNPE detected by MRI had an influence on the prognosis to gain ambulatory status in a time period of ≤9 days (P = .0035) and on short‐term survival (P = .0011). Conclusions and clinical importance Conservative management of HNPE in the cervical as well as in the thoracolumbar region represents a reasonable alternative to surgery, showing similar favorable outcome.
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Affiliation(s)
- Jasmin Nessler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | | | - Julia Tünsmeyer
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Ricarda Dening
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
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Annette W, Posporis C. Compressive hydrated nucleus pulposus extrusion: is surgery necessary? Vet Rec 2017; 181:622-624. [PMID: 29222149 DOI: 10.1136/vr.j5683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Wessmann Annette
- Neurology and Neurosurgery Service, Pride Veterinary Centre, Derby, UK
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De Decker S, Fenn J. Acute Herniation of Nondegenerate Nucleus Pulposus: Acute Noncompressive Nucleus Pulposus Extrusion and Compressive Hydrated Nucleus Pulposus Extrusion. Vet Clin North Am Small Anim Pract 2017; 48:95-109. [PMID: 28964544 DOI: 10.1016/j.cvsm.2017.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Acute herniation of nondegenerate nucleus pulposus material is an important and relative common cause of acute spinal cord dysfunction in dogs. Two types of herniation of nondegenerate or hydrated nucleus pulposus have been recognized: acute noncompressive nucleus pulposus extrusion (ANNPE) and acute compressive hydrated nucleus pulposus extrusion (HNPE). Spinal cord contusion plays an important role in the pathophysiology of both conditions. Sustained spinal cord compression is not present in ANNPE, whereas varying degrees of compression are present in HNPE. Although affected animals often present with severe neurologic signs, good outcomes can be achieved with appropriate treatment.
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Affiliation(s)
- Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK.
| | - Joe Fenn
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
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