Page 826 - Clinical Small Animal Internal Medicine

794 Section 8 Neurologic Disease

Ideally, patient thiamine levels +/− diet thiamine levels latory patients (sometimes more severe in the PL), kypho­
VetBooks.ir would be pursued. Often, supplementation with thia­ sis, and proprioceptive deficits without loss of strength.
Discontinuation of the medication will result in resolution
mine and resolution of signs may be the only option. The
signs are completely reversible if treated in a timely
manner and fatal if untreated. of signs over days to weeks, but treating with IV or oral diaz­
epam (0.5 mg/kg TID 3–5 days) can expedite recovery.
Ronidazole is most commonly used for the treatment
Metronidazole and Ronidazole Toxicity of tritrichomonas foetus in cats and toxicity results in
Toxicity associated with metronidazole is most often similar signs as above.
found with high doses (15–30 mg/kg BID) or prolonged The mechanism of toxicity is not known. In people,
therapy even at more conservative doses. Signs vary in changes on MRI show bilaterally symmetric alterations
severity and often appear more cerebellar than vestibular, in the cerebellar dentate nuclei signal intensity and often
but may include vertical nystagmus or ocular tremors, the vestibular nuclei as well. There is speculation that it
intact vision with absent menace, mild to severe general­ may be mediated by thiamine deficiency due to similar
ized ataxia, possibly progressing to a nonambulatory MRI changes in patients diagnosed with Wernicke
state with decerebellate posturing, hypermetria in ambu­ encephalopathy.

Further Reading

Bentley RT, March PA. Recurrent vestibular paroxysms effusion in Cavalier King Charles spaniels. Vet Rec. Jul;
associated with systemichypertension in a dog. J Am Vet 167(2): 55–8.
Med Assoc. 2011 Sep 1; 239(5): 652–5. Hermanson JW, deLahunta A, Evans HE (2020). Miller
Cornelis I, Van Ham L, Gielen I, De Decker S, Bhatti SFM. and Evan’s Anatomy of the Dog, 5th edition. St. Louis,
Clinical presentation, diagnosticfindings, prognostic Missouri, Saunders Elsevier.
factors, treatment and outcome in dogs with Kim E, Na DG, Kim EY, Kim JH, et al. (2007) MR Imaging
meningoencephalomyelitis of unknown origin: of Metronidazole­Induced Encephalopathy: Lesion
A review. VetJ. 2019 Feb; 244: 37–44. Distribution andDiffusion­Weighted Imaging Findings.
de Lahunta A, Glass EN, Kent M (2015). Veterinary American Journal of Neuroradiology 28(9) 1652–1658
Neuroanatomy and Clinical Neurology, 4thedition. Marks SL, Lipsitz D, Vernau KM, Dickinson PJ, Draper W,
St. Louis, Missouri. Saunders Elsevier. Larsen JA, Fascetti AJ. (2011) Reversible encephalopathy
Guevar J, Olby NJ, Meurs KM, Yost O, Friedenberg SG. secondary to thiamine deficiency in 3 cats ingesting
(2018) Deafness and vestibular dysfunction in a commercial diets. J Vet Intern Med. Jul­Aug; 25(4):
Doberman Pinscher puppy associated with a mutation 949–53.
in the PTPRQ gene. J Vet Intern Med. Mar; 32(2): Tauro A, Beltran E, Cherubini GB, Coelho AT, Wessmann
665–669. A, Driver CJ, Rusbridge CJ. (2018) Metronidazole­
Hayes GM, Friend EJ, Jeffery ND. (2010) Relationship induced neurotoxicity in 26 dogs. Aust Vet J. Dec;
between pharyngeal conformation and otitis media with 96(12): 495–501.