Page 1284 - Cote clinical veterinary advisor dogs and cats 4th

Meningoencephalitis of Unknown Origin 647

○ Misoprostol 3-5 mcg/kg PO q 8-12h depend on an acidic environment (e.g. • Capsule endoscopy may aid in identification
(dogs) for NSAID toxicity sucralfate, antacids). of GI bleeding when GI endoscopy is not
VetBooks.ir perforating GI ulcers, foreign bodies, or Possible Complications Prevention Diseases and Disorders
an option.
• Surgery may be necessary for patients with
• Gl perforation and septic peritonitis if GI
masses.
ulceration is present.
• If a definitive cause is not identified in a
stable patient, administer fenbendazole 50 • Anemia may require transfusion ± iron • Avoid the use of ulcerogenic drugs in animals
at risk for GI bleeding.
mg/kg q 24h PO for 5 days. supplementation. • Do not use corticosteroids and NSAIDS in
• If injury to GI epithelium is severe, bacterial combination. An exception to this rule is the
Chronic Treatment translocation may occur. coadministration of steroids and low-dose
• Iron dextran 5-10 mg/kg IM q 3-4 weeks for aspirin for patients at risk for thromboem-
patients with iron-deficiency anemia (e.g., Recommended Monitoring bolic disease.
microcytosis, nonregenerative anemia). Pre- Activity, respiratory rate, and packed cell • Misoprostol may decrease the risk of NSAID-
treatment with diphenhydramine is advised. volume/total solids (PCV/TS) are used to assess induced GI ulceration.
• Other therapies depend on the cause of for severity of bleeding.
melena. Technician Tips
PROGNOSIS & OUTCOME Advise clients to monitor for melena when
Nutrition/Diet administering ulcerogenic drugs, platelet
A canned, highly digestible, low-fat diet should Depends on ability to resolve cause, absence inhibitors, or anticoagulants.
be considered to promote gastric emptying and of GI perforation
avoid further GI mucosal trauma. SUGGESTED READING
PEARLS & CONSIDERATIONS Willard M: Hemorrhage (gastrointestinal). In
Drug Interactions Washabau R, et al, editors: Canine & feline
• Sucralfate requires an acidic environment and Comments gastroenterology, St. Louis, 2013, Elsevier Saunders,
interferes with the absorption of tetracyclines • In the absence of hemostatic disorders or 129-134.
and ciprofloxacin. Delay administration of ulcerogenic drugs, search for underlying AUTHOR: M. Katherine Tolbert, DVM, PhD, DACVIM
sucralfate by 2 hours when patient is receiv- neoplasia, especially in older animals with EDITOR: Leah A. Cohn, DVM, PhD DACVIM
ing antibiotics, acid suppressants, or antacids. melena.
• PPIs may have interactions with drugs • The absence of abdominal ultrasound
metabolized by cytochrome P450 (e.g., abnormalities does not rule out GI causes
itraconazole, cyclosporine) or those that of melena.

Meningoencephalitis of Unknown Origin Client Education
Sheet

Clinical Presentation
BASIC INFORMATION • Dogs with GME are generally older (4-8
years) than those with NE (<4 years). Pugs DISEASE FORMS/SUBTYPES
Definition with NE tend to be young (median age, 18 GME:
Meningoencephalitis of unknown origin months) • Focal: often forebrain signs
(MUO) is the clinical diagnosis given to • Slight female predisposition reported • Disseminated: multifocal central nervous
a group of noninfectious, inflammatory system (CNS) signs, including spinal cord
meningoencephal(omyel)itises of dogs. It can GENETICS, BREED PREDISPOSITION • Ocular: optic neuritis
be further classified based on histopathology • GME: poodles and terriers are predisposed, NE:
as granulomatous meningoencephalomyelitis but any breed and size can be affected. • NME: forebrain signs, especially seizures
(GME) or necrotizing encephalitis (NE). • NE: pug, Maltese, Yorkshire terrier, Chi- • NLE: forebrain and brainstem signs
huahua, French bulldog, papillion, shih
Synonyms tzu, Pekinese, West Highland white terrier, HISTORY, CHIEF COMPLAINT
Meningoencephalitis of unknown etiology Coton de Tuléar, Brussels griffon, miniature Subacute (days) to acute (weeks) focal or
(MUE; sometimes abbreviated MUA [atieol- poodle multifocal CNS signs; specific complaints
ogy]), granulomatous meningoencephalomy- • Pugs with a mutation of the dog lymphocyte vary based on region of nervous system
elitis (GME), necrotizing encephalitis (NE), antigen (DLA) region of chromosome 12 involved
necrotizing leukoencephalitis (NLE), Yorkshire have a 12.75 times greater likelihood of
terrier encephalopathy, necrotizing meningoen- developing NE. PHYSICAL EXAM FINDINGS
cephalitis (NME), pug (dog) encephalopathy, • Physical exam (other than neurologic exam):
Maltese encephalopathy RISK FACTORS often unremarkable
MUO is thought to be autoimmune but • Any neurologic deficit referable to disease
Epidemiology recent vaccination has not been found to be a in the brain (or spinal cord) can be
SPECIES, AGE, SEX trigger. present.
• Small to medium-sized breed (<10 kg), young • Common findings:
adult (3-7 years old) dogs most commonly GEOGRAPHY AND SEASONALITY ○ Forebrain signs: circling, seizures, blind-
affected Possible higher incidence in spring and summer ness, ataxia

www.ExpertConsult.com