Meningitis / Myelitis

Prospective randomized trial comparing relapse rates in dogs with steroid-responsive meningitis-arteritis treated with a 6-week or 6-month prednisolone protocol

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This study evaluated whether the resolution of clinical signs and rate of relapse of SRMA would be significantly different between a 6-month prednisolone protocol and a 6-week protocol.

 

All 44 included canine cases responded to their treatment protocol. Relapses occurred in 6/20 (30%) of the 6-month protocol and 9/24 (38%) of the 6-week protocol. There was no statistical difference in the incidence risk of at least 1 relapse between the 2 groups. Among the 15 dogs that relapsed, 10/15 (67%) relapsed once, 3/15 (20%) relapsed twice, and 2/15 (13%) relapsed 3 times. No statistical difference was detected in the incidence rate ratio of total relapse events between the 2 groups.

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The study concluded that a “short” 6-week prednisolone protocol could be used to treat SRMA, thereby presumably reducing the duration and severity of prednisolone's adverse effects.

Magnetic resonance imaging highlights the meningeal involvement in steroid responsive meningitis-arteritis and suggests the inflammation of the surrounding tissues (70 cases)

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This study looked at the MRI characteristics of  of the cervical spine in dogs diagnosed with SRMA. 70 dogs were selected with MRI abnormalities found in 69 of them. Enhancement of the meninges, nerve roots, synovium of the articular facets and paravertebral muscles was present in 61 (87.1%), 10 (14.3%), 34 (48.6%), and 34 (48.6%) cases suggesting that MRI can be a useful complementary tool to CSF analysis

Acquired cervical scoliosis in two dogs with inflammatory central nervous system disease

Scoliosis can be congenital, usually related to vertebral malformation or acquired. The latter has been reported in dogs as a sign secondary to syringomyelia. A different pathophysiology of scoliosis in those acquired cases has been suggested. The first one revolves around the damage to the LMN in the ventral horn of the spinal cord grey matter. As a result, there is asymmetrical paraspinal muscle denervation and atrophy secondary to ventral horn damage with a secondary imbalance in muscle tone with flexion of the neck away from the side of muscle atrophy. The second one results from interference with the proprioceptive innervation by interruption of the dorsally located general proprioceptve tracts receiving input from the neuromuscular spindles involved with stretch reflexes necessary to maintain muscle tone. In this scenario, unilateral denervation results in unopposed contraction of the contralateral paraspinal muscles and deviation of the neck to the contralateral side of the lesion. In this cases series, the authors describe two dogs with inflammatory CNS disease affecting the cranial cervical spinal cord gray matter with acute onset cervical scoliosis which resolved upon treatment with immuno-suppressive medications.

The image below is taken from this article and shows the curvature of the neck from above.

Magnetic resonance imaging findings in dogs with steroid-responsive meningitis-arteritis in the UK and their clinical significance: 53 cases (2013-2021)

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This is a multi-center retrospective case series of 53 dogs diagnosed with steroid-responsive meningitis-arteritis (SRMA) in the UK that underwent MRI. The presence or absence of specific MRI abnormalities were analysed for significant associations with presenting signs, results of investigations or case outcomes. 

 

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%). Hemorrhage was observed in five of 53 (9.4%) cases which was positively associated with the presence of parasis/paralysis as was T2W intramedullary hyperintensity. Approximately a third of dogs relapsed but there was no associated MRI finding.

Steroid-responsive meningitis-arteritis: What have we learned since 2010? a narrative review

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This article reviews a common neurologic disease and maybe the most frequent cause of neck pain with pyrexia in dogs. Although Boxers, Beagles, and Bernese mountain dogs are classically predisposed breeds, any breed could be affected and predispositions have also been described for multiple other breeds which include Border collies, Jack Russell terriers, Golden retrievers, German Shorthaired pointers, English Springer spaniels and Whippets. The most common clinical sign is neck pain - neurological signs can indicate progression of the disease and associated vascular compromises. The prognosis with early diagnosis and aggressive immunotherapy can be excellent but there are high recurrence rates noted in some studies. This review discusses the most recent studies which especially highlight new diagnostic and therapeutic considerations.

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