Page 833 - Clinical Small Animal Internal Medicine

73 Meningoencephalitis and Meningomyelitis 801

clear benefit of these medications have not yet been pub- Prognosis
VetBooks.ir lished. The use of other immunomodulatory interventions, The prognosis for animals with inflammatory CNS
such as intravenous immunoglobulin and plasmaphere-
sis, is an intriguing possibility that has yet to be investi-
gated in small animal patients. Anticonvulsant therapy is disease is highly variable, and depends on both the
underlying etiology as well as an individual’s response
utilized in animals with seizures. Dogs with generalized to therapy. Some animals with viral disease may clear
tremor syndrome may also benefit from concurrent diaz- the virus, and the prognosis depends on the amount
epam therapy. Although the pain associated with menin- of damage that occurred to the CNS while infected
goencephalitis or meningomyelitis usually improves (e.g., canine distemper). These animals may survive,
dramatically with glucocorticoid therapy, additional anal- although often with residual deficits (e.g., distemper
gesics such as gabapentin or opioid medications may “myoclonus”). Conversely, some viral diseases such as
prove beneficial until the inflammation subsides. rabies, pseudorabies, and FIP are invariably fatal.
The primary means of monitoring response to therapy Fungal disease typically requires long‐term and often
in animals with inflammatory CNS disease is assessment life‐long therapy. Animals with bacterial or protozoal
of clinical signs based on examination and questioning of diseases can be treated successfully although they may
the owners. Although complete normalization is ideal and be left with residual deficits and the prognosis is typi-
achievable in many patients, some animals are left with cally guarded.
residual deficits. A significant challenge for the clini- Dogs with SRMA, generalized tremor syndrome, and
cian is to determine if such deficits are the result of active idiopathic eosinophilic meningoencephalitis, usually
inflammation or permanent damage (i.e., loss of cells or have a good prognosis, with full resolution of clinical
tissue) to the CNS. Periodic monitoring with a CBC and signs and long‐term remission after therapy, although
serum biochemistry is indicated in patients receiving glu- relapses are possible. The prognosis for dogs with
cocorticoids or other immunosuppressive drugs to detect GME, NME, and NLE is much more variable. Although
adverse effects associated with therapy (e.g., myelosup- some of these patients may respond fully to treatment,
pression, hepatic failure) as well as infections occurring life‐long therapy is typical, and many dogs will have an
secondary to immunosuppression. Monitoring of serum incomplete response. In addition, some dogs progress
drug concentrations is not routinely performed, although and die in spite of aggressive treatment. However, the
some clinicians will utilize this for ciclosporin A. Similarly, prognosis for cases cited in the literature is likely to be
repeat CNS imaging and/or CSF evaluation can be helpful overly pessimistic, as there is a bias towards dogs that
in some patients to assess the degree of ongoing inflam- have had disease confir mation via histopathology.
mation and other pathology, although this is not routinely Finally, the prognosis for animals with greyhound
performed by all clinicians and is obviously dependent on meningoencephalitis has been suggested to be poor,
the owner’s financial means. Serial monitoring of anti- although aggressive therapeutic intervention has not
body or antigen titers can be useful in the monitoring of yet been described in the literature.
some infectious diseases.

Further Reading

Barber RM, Porter BF, Li Q, et al. Broadly reactive polymerase in dogs: a systematic review of 457 published cases from
chain reaction for pathogen detection in canine 1962 to 2008. Vet J 2010; 184: 290–7.
granulomatous meningoencephalomyelitis and necrotizing Lowrie M, Penderis J, McLaughlin M, Eckersall PD,
meningoencephalitis. J Vet Intern Med 2012; 26: 962–8. Anderson TJ. Steroid responsive meningitis‐arteritis: a
Barber RM, Schatzberg SJ, Corneveaux JJ, et al. prospective study of potential disease markers,
Identification of risk loci for necrotizing prednisolone treatment, and long‐term outcome in 20
meningoencephalitis in pug dogs. J Heredity 2011; dogs (2006–2008). J Vet Intern Med 2009; 23: 862–70.
102(Suppl 1): S40–S46. Tipold A, Schatzberg SJ. An update on steroid responsive
Granger N, Smith PM, Jeffery ND. Clinical findings and meningitis‐arteritis. J Small Anim Pract 2010; 51:
treatment of non‐infectious meningoencephalomyelitis 150–4.