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Jones BA, Agthe P, Scarpante E, Crawford A, Black V, Espadas I, Formoso S, Fraser AR. Magnetic resonance imaging findings in dogs with steroid-responsive meningitis-arteritis in the UK and their clinical significance: 53 cases (2013-2021). J Small Anim Pract 2024. [PMID: 39228252 DOI: 10.1111/jsap.13775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/30/2024] [Accepted: 06/26/2024] [Indexed: 09/05/2024]
Abstract
OBJECTIVES To describe the MRI findings in a UK referral population of dogs with steroid-responsive meningitis-arteritis and to determine if they were associated with any specific clinical features or outcomes. MATERIALS AND METHODS We performed a multi-centre retrospective case series of dogs diagnosed with steroid-responsive meningitis-arteritis in the UK that underwent MRI. Blinded consensus review of the MRI studies was performed and the findings described. The presence or absence of specific MRI abnormalities were analysed for significant associations with presenting signs, results of investigations or case outcomes. RESULTS Fifty-three dogs were included. The most common MRI findings were paravertebral muscle changes (30/53; 56.6%), meningeal contrast enhancement (13/41; 31.7%) and spinal cord parenchymal T2-W hyperintensity (15/53; 28.3%). Haemorrhage was observed in five of 53 (9.4%) cases - three intradural-extramedullary, one intramedullary and one extradural. Following binary logistic regressions, T2-W spinal cord parenchymal hyperintensity had a significant positive association with paresis/paralysis (odds ratio 14.86, 95% confidence interval 1.42 to 154.99) as did haemorrhage (odds ratio 16.12, confidence interval 2.05 to 126.73). Fifty-two (98.1%) dogs survived to discharge. Relapse occurred in nine of 29 (31.0%) dogs with sufficient follow-up, and no MRI finding had a significant relationship with its occurrence. CLINICAL SIGNIFICANCE Magnetic resonance imaging findings for steroid-responsive meningitis-arteritis can be severe and extensive, as can the clinical presentation. The presence of paresis/paralysis should raise concern for haemorrhage, though most dogs still have a good prognosis.
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Affiliation(s)
- B A Jones
- Anderson Moores Veterinary Specialists, Winchester, UK
- Willows Veterinary Centre and Referral Service, Solihull, UK
| | - P Agthe
- Anderson Moores Veterinary Specialists, Winchester, UK
| | - E Scarpante
- Dick White Referrals, Six Mile Bottom, Cambridgeshire, UK
| | - A Crawford
- Clinical Science and Services, Royal Veterinary College, North Mymms, UK
| | - V Black
- Langford Vets, Bristol Veterinary School, Bristol, UK
| | - I Espadas
- Neurology/Neurosurgery Service, Pride Veterinary Centre, Derby, UK
- Servicio de Neurología y Neurocirugía, Hospital Veterios, Madrid, Spain
| | - S Formoso
- Queen's Veterinary School Hospital, The University of Cambridge, Cambridgeshire, UK
| | - A R Fraser
- Anderson Moores Veterinary Specialists, Winchester, UK
- Davies Veterinary Specialists, Higham Gobion, Hitchin, UK
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Wohlsein JC, Tipold A. Steroid-responsive meningitis-arteritis: What have we learned since 2010? A narrative review. Vet J 2023; 300-302:106030. [PMID: 37704169 DOI: 10.1016/j.tvjl.2023.106030] [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: 02/20/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/15/2023]
Abstract
Steroid-responsive meningitis-arteritis (SRMA) occurs as an immune-mediated, inflammatory, and non-infectious disorder of juvenile and young-adult dogs. In principle, SRMA is divided into two clinical courses: during the typical acute form, dogs are presented with fever, cervical hyperaesthesia, and reluctance to move. The more protracted form most probably emerges after insufficient immunosuppressive treatment or relapses, with additional neurologic deficits localized in the cervical and thoracolumbar spinal cord or multifocally. The trigger leading to SRMA still remains an unsolved riddle for immunologists and clinical neurologists. In the past, many attempts have been made to clarify the etiology of this disease without success. The purpose of writing this narrative review about SRMA is to summarize new insights on the pathogenesis of SRMA with a focus on immunologic dysregulation. Furthermore, unusual manifestations of the disease, new diagnostic approaches using possible laboratory biomarkers or diagnostic imaging tools, and potential innovative treatment strategies are discussed.
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Affiliation(s)
- Jan C Wohlsein
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, 30559 Hannover, Germany.
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, 30559 Hannover, Germany
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Santifort KM, den Toom M, Garosi L, Carrera I. Case report: Intracranial and spinal subarachnoid hemorrhage in a dog with Angiostrongylosis. Front Vet Sci 2023; 10:1190792. [PMID: 37292430 PMCID: PMC10244777 DOI: 10.3389/fvets.2023.1190792] [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: 03/21/2023] [Accepted: 04/25/2023] [Indexed: 06/10/2023] Open
Abstract
A 1-year-old male intact Staffordshire terrier, born and raised in the Netherlands, was presented with a 3-week history of progressive lethargy and spinal, predominantly cervical, hyperesthesia. Other than hyperthermia and cervical hyperesthesia, general and neurological examination did not reveal any abnormalities. Comprehensive hematological and biochemical tests were considered normal. Magnetic resonance imaging of the craniocervical region revealed heterogeneity of the subarachnoid space, characterized by pre-contrast T1W hyperintensity, corresponding to a T2* signal void. Extending from the caudal cranial fossa to the level of the third thoracic vertebra, there were uneven patchy extra-parenchymal lesions that caused mild spinal cord compression, most marked at the level of C2. At this level, the spinal cord showed an ill-defined hyperintense T2W intramedullary lesion. Mild intracranial and spinal meningeal contrast enhancement was evident on post-contrast T1W images. Subarachnoid hemorrhage was suspected, and further diagnostic tests including Baermann coprology resulted in a diagnosis of hemorrhagic diathesis caused by an Angiostrongylus vasorum infection. The dog rapidly responded to treatment with corticosteroids, analgesic medication, and antiparasitic treatment. Follow-up over 6 months yielded complete clinical remission and repeatedly negative Baermann tests. This case report details clinical and magnetic resonance imaging findings in a dog with subarachnoid hemorrhage associated with an Angiostrongylus vasorum infection.
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Affiliation(s)
- Koen M. Santifort
- IVC Evidensia Small Animal Referral Hospital Arnhem, Neurology, Arnhem, Netherlands
- IVC Evidensia Small Animal Referral Hospital Hart van Brabant, Neurology, Waalwijk, Netherlands
| | - Marjolein den Toom
- IVC Evidensia Small Animal Referral Hospital Nieuwegein, Cardiology, Nieuwegein, Netherlands
| | | | - Ines Carrera
- Vet Oracle Teleradiology, Norfolk, United Kingdom
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West N, Butterfield S, Rusbridge C, Fernandez A, Tabanez J, Rudolf NJ, Archer S, Whittaker D. Non-traumatic hemorrhagic myelopathy in dogs. J Vet Intern Med 2023; 37:1129-1138. [PMID: 37095733 DOI: 10.1111/jvim.16694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/17/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Non-traumatic spinal cord hemorrhage (NTSH) is an uncommon cause of myelopathy in dogs. OBJECTIVES Describe the clinical characteristics, concurrent medical conditions and underlying causes, magnetic resonance imaging (MRI) findings and outcome in dogs with NTSH. ANIMALS Dogs diagnosed with NTSH using gradient echo T2-weighted (GRE) sequences with or without histopathological confirmation of hemorrhage were included. Dogs with a traumatic cause were excluded, including those with compressive intervertebral disc extrusion. METHODS Retrospective descriptive study; the databases of 2 referral hospitals were searched between 2013 and 2021. RESULTS Twenty-three dogs met inclusion criteria. The onset of signs was acute and progressive in 70% of cases; spinal hyperesthesia was variable (48%). Hemorrhage was identified in the thoracolumbar spinal segments in 65% of dogs. An underlying cause was identified in 65% of cases. Angiostrongylus vasorum represented 18% of the total cohort, followed by steroid-responsive meningitis arteritis (SRMA; 13%). Overall, 64% of dogs had a good or excellent outcome, regardless of cause; which was increased to 100% for SRMA, 75% for A. vasorum and 75% for idiopathic NTSH. Outcome was not associated with neurological severity. Recovery rate was 67% and 50% for nociception-intact and nociception-negative dogs, respectively. CONCLUSIONS Larger prospective studies would be required to define prognostic factors for dogs with NTSH, but outcome appeared to be most influenced by the underlying cause, as opposed to neurological severity at presentation.
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Affiliation(s)
- Natalie West
- Fitzpatrick Referrals Ltd, Halfway ln, Godalming, UK
- North Downs Specialist Referrals, part of Linnaeus Veterinary Limited, Bletchingley, UK
| | - Sarah Butterfield
- The Queen Mother Hospital for Small Animals, Royal Veterinary College
| | - Clare Rusbridge
- Fitzpatrick Referrals Ltd, Halfway ln, Godalming, UK
- The University of Surrey, Surrey, UK
- Wear Referrals, County Durham, UK
| | - Ana Fernandez
- Fitzpatrick Referrals Ltd, Halfway ln, Godalming, UK
| | - Joana Tabanez
- Fitzpatrick Referrals Ltd, Halfway ln, Godalming, UK
| | | | | | - Danielle Whittaker
- Fitzpatrick Referrals Ltd, Halfway ln, Godalming, UK
- The Queen Mother Hospital for Small Animals, Royal Veterinary College
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Hemophilia A Resulting in Severe Hyperesthesia Due to Extraparenchymal Spinal Cord Hemorrhage in a Young Golden Retriever Puppy. Vet Sci 2022; 9:vetsci9110638. [DOI: 10.3390/vetsci9110638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/07/2022] [Accepted: 11/12/2022] [Indexed: 11/19/2022] Open
Abstract
A ten-week-old male Golden retriever puppy was presented with severe hyperesthesia, mild neurological deficits and episcleral bleeding. Clotting times showed a normal prothrombin time (PT) and prolonged activated partial thromboplastin time (aPPT). Computed tomography (CT) of the vertebral column showed intradural, extraparenchymal hyperattenuating changes on precontrast CT images and epidural mass lesions, suggestive of hematorrhachis. Hemophilia A was confirmed by a low-factor VIII activity (FVIII:C). Although the dog improved clinically with intravenous analgesia and cage rest, it was euthanized by the owners’ choice because of the risk of developing future episodes of spontaneous hemorrhage. In young male puppies with severe hyperesthesia and mild neurological deficits, hemophilia A should be considered as a possible differential diagnosis.
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Fowler KM, Bolton TA, Rossmeisl JH, Arendse AU, Vernau KM, Li RHL, Parker RL. Clinical, Diagnostic, and Imaging Findings in Three Juvenile Dogs With Paraspinal Hyperesthesia or Myelopathy as a Consequence of Hemophilia A: A Case Report. Front Vet Sci 2022; 9:871029. [PMID: 35498741 PMCID: PMC9051508 DOI: 10.3389/fvets.2022.871029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/15/2022] [Indexed: 12/02/2022] Open
Abstract
Three juvenile dogs presented with an acute onset of paraspinal hyperesthesia and/or neurologic deficits. These dogs underwent anesthesia for MRI and additional diagnostics. The thoracolumbar MRI in Dog 1 revealed an accumulation of T2-weighted (T2W) hyperintense, T1-weighted (T1W) iso- to hyperintense, contrast enhancing extradural material. The differential diagnoses were meningitis with secondary hemorrhage or empyema or late subacute hemorrhage. The initial cervical MRI in Dog 2 revealed T1W meningeal contrast enhancement suspected to be secondary to meningitis. A repeat MRI following neurologic decline after CSF sampling revealed a large area of T2W and T1W hyperintensity between fascial planes of the cervical musculature as well as T2W iso- to hyperintense and T1W iso- to hypointense extradural material at the level of C1 consistent with hemorrhage. The cervical MRI in Dog 3 revealed T2W hyperintense and T1W iso- to hypointense extradural compressive material consistent with hemorrhage. Dogs 1 and 2 underwent CSF sampling and developed complications, including subcutaneous hematoma and vertebral canal hemorrhage. Dog 3 underwent surgical decompression, which revealed a compressive extradural hematoma. In each case, a hemophilia panel including factor VIII concentration confirmed the diagnosis of hemophilia A. Dog 1 had a resolution of clinical signs for ~5 months before being euthanized from gastrointestinal hemorrhage. Dog 2 was euthanized due to neurologic decompensation following CSF sampling. Dog 3 did well for 2 weeks after surgery but was then lost to follow-up. This case series provides information on clinical signs, MRI findings, and outcome in 3 juvenile dogs with hemophilia A that developed neurologic deficits or paraspinal hyperesthesia secondary to spontaneous or iatrogenic vertebral canal hemorrhage. Hemophilia A should be considered as a differential in any young dog presenting with an acute onset of hyperesthesia with or without neurologic deficits. This diagnosis should be prioritized in young male dogs that have other evidence of hemorrhage on physical exam.
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Affiliation(s)
- Kayla M. Fowler
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
| | - Timothy A. Bolton
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
| | - John H. Rossmeisl
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
- Comprehensive Cancer Center and Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Avril U. Arendse
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
| | - Karen M. Vernau
- Department of Surgical and Radiological Sciences, University of California, Davis, Davis, CA, United States
| | - Ronald H. L. Li
- Department of Surgical and Radiological Sciences, University of California, Davis, Davis, CA, United States
| | - Rell L. Parker
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
- *Correspondence: Rell L. Parker
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