Manual therapeutic plasma exchange for treatment of a dog with suspected acute canine polyradiculoneuritis.

BACKGROUND: Acute canine polyradiculoneuritis is one of the most common polyneuropathies occurring in dogs. The disease is very similar to the Guillain-Barré syndrome in humans. In veterinary medicine, there is no established treatment for this disease, while in human medicine, therapeutic plasma exchange and intravenous immunoglobulin administration are two main immunotherapy treatments of this syndrome. CASE PRESENTATION: A 12-year-old male Jack Russel Terrier was presented with a history of acute weakness of the pelvic limbs progressing to flaccid tetraplegia with respiratory compromise. Complete diagnostic workup was performed including blood work, diagnostic imaging (radiographs of the thorax as well as ultrasound of the abdomen) and echocardiography. Based on the clinical course, neurological localisation and the results of electrodiagnostic examination acute canine polyradiculoneuritis was suspected. During the hospitalization, the dog deteriorated and was admitted to the intensive care unit for respiratory support via tracheostomy tube. In addition to symptomatic treatment, immunotherapy via single treatment of manual therapeutic plasma exchange was administered. This procedure was safe, and the dog showed improvement of clinical signs 3 days after therapy was initiated, as well as improvement of neurological signs (from grade 4 tetraplegia to grade 3) within 5 days. However, the dog was euthanized 3 weeks later due to complications related to the tracheostomy. CONCLUSIONS: This is the first case report of a manual therapeutic plasma exchange in a dog with suspected acute canine polyradiculoneuritis suggesting that this method is safe and well tolerated in dogs with this disease. It may be a reasonable adjunctive treatment to supportive therapy in severe cases.

Multiple cranial nerve motor deficits, resembling polyneuritis cranialis, in a cat with hyperthyroidism.

A 14 plus-year-old (exact age unknown) neutered female domestic shorthair cat presented with a 6-day history of rapidly evolving difficulty in eating, dropped jaw, protrusion of the tongue, sialosis, change in voice (meow softer and higher pitched) and mild variable pelvic limb weakness. Salient clinical features were a left thyroid nodule, 2/6 systolic cardiac murmur, poor body condition, hypertension, bilateral retinal haemorrhages and an increased total thyroid hormone level consistent with a diagnosis of hyperthyroidism (HT). Neurological examination disclosed mild generalised weakness, bilateral visual deficits attributable to a hypertensive retinopathy and multiple cranial nerve (CN) motor deficits that included; mandibular paresis (CN V), bilateral external ophthalmoparesis (CNs III, IV, VI), bilateral facial paresis (CN VII), dysphagia (CNs IX, X), dysphonia (CN XI) and symmetrical paresis of the tongue (CN XII). Treatment with carbimazole, and subsequently, a modified extracapsular bilateral thyroidectomy resulted in a rapid improvement in neurological signs over 13 days and complete resolution by 100 days post thyroidectomy. To the best of the authors' knowledge, this is the first description of multiple CN motor deficits in a cat with HT and resembles polyneuritis crainialis that has recently been described in human patients with this disorder. It is suggested the underlying pathogenesis is a thyrotoxic polyneuropathy selectively affecting CN motor function, that HT needs to be considered in cats that might present with such signs and that resolution can occur with successful treatment of the HT.

Pyogenic meningitis and trigeminal neuritis secondary to periodontogenic paranasal sinusitis in a red deer (Cervus elaphus).

An adult female red deer died of a severe seizure and dysbasia. Postmortem computed tomography (CT) and magnetic resonance imaging (MRI) were performed. On CT, deciduous right maxillary second and third premolar teeth were observed, and the right infraorbital canal was disrupted. MRI showed that the right trigeminal nerve was enlarged and the right subarachnoid cavity was occupied by fluid and gas. On gross examination, the right paranasal sinus, swollen muscles of the orbit and tonsils, right trigeminal nerve, and right cerebrum surface contained a yellowish-white, cheese-like pus. Based on these findings, the deer was believed to have developed pyogenic meningitis caused by a neuropathic infection secondary to periodontogenic paranasal sinusitis.

Granulomatous interstitial polymyositis and intramuscular neuritis in a dog.

BACKGROUND: Granulomatous myositis is a rare condition in both humans and dogs. In humans it is most frequently related to sarcoidosis, where a concurrent granulomatous neuritis has been reported occasionally. Simultaneous granulomatous myositis and neuritis have been diagnosed previously in dogs (unpublished observations), but have not been studied further. Additional investigations are therefore warranted to characterize this disorder. Here we present a detailed description of concurrent idiopathic granulomatous myositis and granulomatous neuritis in a dog with suspected immune-mediated aetiology. CASE PRESENTATION: The dog presented with dysphonia and paresis in the pelvic limbs and tail. In addition to muscle biopsies being taken for histopathology, magnetic resonance imaging, computed tomography and electrodiagnostics were performed. Muscle biopsies displayed granuloma formation with giant cells and epithelioid macrophages in muscle fibres and nerve branches. Microorganisms were not detected. Long-term treatment with glucocorticoids was clinically successful. Two years after the clinical signs started, the dog presented with signs of sepsis and died. Histopathologically, no granulomatous inflammation could be demonstrated in either muscles or nerves at that time. CONCLUSIONS: This case illustrates a granulomatous interstitial polymyositis and intramuscular neuritis that improved clinically and resolved histologically with glucocorticoid treatment. Idiopathic granulomatous myositis and neuritis should be considered as a differential diagnosis in dogs with clinical signs of neuromuscular disorders.

Diagnostic Values of Clinical and Magnetic Resonance Findings in Presumptive Trigeminal Neuropathy: 49 Dogs.

The goal of this retrospective, cross-sectional study was to describe the different etiologies of trigeminal neuropathy based on clinical and MRI findings and to evaluate the significance of associated concomitant disorders. MRI studies of 49 dogs with trigeminal neuropathy were blindly reviewed and were classified into the following three groups: neoplasia, neuritis, or idiopathic trigeminal neuropathy (ITN). Thirty-one percent were suspected to have neoplasia (all unilateral), 16% to have neuritis (1 bilateral and 7 unilateral), and 53% to have ITN (4 unilateral and 22 bilateral). Dogs with clinical bilateral trigeminal dysfunction were most likely to have a diagnosis of ITN (predicted probability 95.7%). Unilateral clinical signs were significantly associated with neoplasia or neuritis compared with ITN (P < .001 and P = .002, respectively). Even with marked brainstem neoplastic involvement, central neurological deficits may be absent. Sensory impairment was significantly associated with either neoplasia or neuritis compared with ITN (P = .007 and P = .03, respectively). Ipsilateral noninfectious middle ear effusion was only seen in dogs with neoplasia (33%). Horner's syndrome was present in 12% of all dogs (2 dogs in each group). Dogs with neoplasia were significantly older than dogs with neuritis (P = .02) and ITN (P = .002). JAAHA-MS-6997.

Concurrent leukoencephalomyelitis and polyneuritis in a Maltese terrier: resembling combined central and peripheral demyelination in humans.

A one-year-old male Maltese terrier presented with mild ataxia and disorientation for 4 months. Over time, clinical signs progressed from paraparesis to non-ambulatory tetraparesis, voice change and dysphagia. Histological examination revealed concurrent leukoencephalomyelitis and polyneuritis. Infectious etiologies, including dengue, Japanese encephalitis, Zika, canine distemper, pseudorabies, rabies, toxoplasmosis, neosporosis, leishmaniasis, and encephalitozoonosis, were ruled out by PCR and/or immunohistochemical (IHC) staining. IHC tested on neurological tissues highlighted a heterogeneous population of infiltrating T and B lymphocytes admixed macrophages. Therefore, this case was diagnosed with current leukoencephalomyelitis and polyneuritis, resembling combined central and peripheral demyelination (CCPD), an autoimmune inflammatory demyelinating disease affecting both the CNS and PNS in humans.

Spontaneous peripheral neuritis in two electric eels (Electrophorus electricus).

This study represents cases with spontaneous neuritis of peripheral nerves in electric eels. Two electric eels were presented with abnormal swimming behavior and loss of appetite. Electric eels had extensive histopathologic lesions in the splenic and cardiac nerves. The lesions were characterized by swelling of neuronal cells, central chromatolysis and marked inflammatory cell infiltration consisting mainly of lymphocytes around the affected nerves. To the best of our knowledge, this is the first case report of spontaneous neuritis of peripheral nerves in electric eels.

Hypertrophic neuritis causing tetraparesis in a cat.

An 8-year-old castrated male cat presented with acute ataxia and paresis in all four limbs. The cat also exhibited signs of autonomic nervous system impairment. Magnetic resonance imaging revealed swelling of the brachial plexuses bilaterally. Despite treatment, the cat died after 10 days of treatment. A postmortem examination revealed swollen radial nerves and cervical nerve roots in which infiltration of inflammatory cells was histologically confirmed. Additionally, lymphocytic infiltration was found around the blood vessels of the sciatic nerve bundle and the vagus nerve. Histological features were comparable to previously reported brachial plexus hypertrophic neuritis in a cat. Our case was unique in that the autonomic nerves were also involved in addition to the somatic nerves in all four limbs.

Bilateral tympanokeratomas (cholesteatomas) with bilateral otitis media, unilateral otitis interna and acoustic neuritis in a dog.

BACKGROUND: An aural cholesteatoma, more appropriately named tympanokeratoma, is an epidermoid cyst of the middle ear described in several species, including dogs, humans and Mongolian gerbils. The cyst lining consists of stratified, keratinizing squamous epithelium with central accumulation of a keratin debris. This case report describes vestibular ganglioneuritis and perineuritis in a dog with chronic otitis, bilateral tympanokeratomas and presumed extension of otic infection to the central nervous system. CASE PRESENTATION: An 11-year-old intact male Dalmatian dog with chronic bilateral otitis externa and sudden development of symptoms of vestibular disease was examined. Due to the dog's old age the owner opted for euthanasia without any further examination or treatment and the dog was submitted for necropsy. Transection of the ears revealed grey soft material in the external ear canals and pearly white, dry material consistent with keratin in the tympanic bullae bilaterally. The brain and meninges were grossly unremarkable. Microscopical findings included bilateral otitis externa and media, unilateral otitis interna, ganglioneuritis and perineuritis of the spiral ganglion of the vestibulocochlear nerve and multifocal to coalescing, purulent meningitis. A keratinizing squamous epithelial layer continuous with the external acoustic meatus lined the middle ear compartments, consistent with bilateral tympanokeratomas. Focal bony erosion of the petrous portion of the temporal bone and squamous epithelium and Gram-positive bacterial cocci were evident in the left cochlea. The findings suggest that meningitis developed secondary to erosion of the temporal bone and ganglioneuritis and/or perineuritis of the vestibulocochlear nerve. CONCLUSIONS: Middle ear tympanokeratoma is an important and potentially life-threatening otic condition in the dog. Once a tympanokeratoma has developed expansion of the cyst can lead to erosion of bone and extension of otic infection to the inner ear, vestibulocochlear ganglion and nerve potentially leading to bacterial infection of the central nervous system.

Avian Ganglioneuritis in Clinical Practice.

Avian ganglioneuritis (AG) comprises one of the most intricate pathologies in avian medicine and is researched worldwide. Avian bornavirus (ABV) has been shown to be a causative agent of proventricular dilatation disease in birds. The avian Bornaviridae represent a genetically diverse group of viruses that are widely distributed in captive and wild populations around the world. ABV and other infective agents are implicated as a cause of the autoimmune pathology that leads to AG, similar to human Guillain Barrè syndrome. Management of affected birds is beneficial and currently centered at reducing neurologic inflammation, managing secondary complications, and providing nutritional support.

Dutch Research on Beriberi: I. Christiaan Eijkman's Research and Evaluation of Kanehiro Takaki's Diet Reforms of the Japanese Navy.

Dutch researcher Christiaan Eijkman realized that a form of Polyneuritis closely resembling Beriberi occurred among chickens that were fed with cooked, instead of raw rice. He found that the cause of this illness lay in the nutritional differences between rice that still had its bran layer, and polished white rice. He also found that this bran layer had a therapeutic effect. He decided to investigate the incidence of Beriberi among humans by comparing a diet based on white rice with one based on unpolished, full-grain rice. In 1898, he published 'Beri-Beri en Voeding, Een Kritisch-Historische Studie' (Beri-beri and Feeding, An Important Historical Study), in which he discussed the diet reforms of Van Leent in the Dutch East Indian Navy, and of Kanehiro Takaki in the Japanese Navy. Notwithstanding the fact that Takaki's research was highly praised by the Lancet, Eijkman was very critical of his research methods. He was conscious, however, that a shift had occurred in the research of Beriberi from bacteria-based research to nutritional deficiencies, and discussed Takaki's findings insofar as he could.

IMAGING DIAGNOSIS - UNILATERAL TRIGEMINAL NEURITIS MIMICKING PERIPHERAL NERVE SHEATH TUMOR IN A HORSE.

A 16-year old Warmblood gelding presented with a nonhealing corneal ulcer and absent corneal sensation in the left eye. A lesion affecting the maxillary and ophthalmic branches of the left trigeminal nerve was suspected. Magnetic resonance (MR) imaging identified marked thickening of the ophthalmic and maxillary branches of the left trigeminal nerve. The nerve was iso- to hypointense on T1-weighted and T2-weighted images with heterogeneous enhancement. A peripheral nerve sheath tumor was suspected, however granulomatous neuritis was histopathologically confirmed. These inflammatory changes can result in severe nerve enlargement and should be considered with MR findings suggestive of peripheral nerve sheath tumor.

Acute idiopathic polyneuritis with spontaneous remission in an Abyssinian cat.

An Abyssinian kitten was presented after a sudden onset of neurological disorders consistent with a polyneuropathy. Electrophysiological and histological investigations revealed an inflammatory polyneuropathy. No infectious agents were detected. Spontaneous recovery occurred rapidly without relapse (2 years follow-up). This is the first description of a histologically confirmed self-limiting feline polyneuritis.

Polyneurite idiopathique aiguë avec rémission spontanée chez un chat Abyssinien. Un chaton Abyssinien a été présenté suite à l'apparition soudaine de troubles neurologiques conformes à une polyneuropathie. Les enquêtes électrophysiologiques et histologiques ont révélé une polyneuropathie inflammatoire. Aucun agent infectieux n'a été détecté. Le rétablissement spontané s'est produit rapidement sans rechute (suivi de 2 ans). Il s'agit de la première description d'une polyneurite féline auto-limitée confirmée par histologie.(Traduit par Isabelle Vallières).

Lymphocytic ganglioneuritis secondary to intervertebral disc extrusion in a dog.

This study presents a case of lymphocytic ganglioneuritis in a dog secondary to intervertebral disc extrusion that mimicked a peripheral nerve sheath tumour on magnetic resonance imaging. A four-year-old spayed female dachshund with lumbar pain was imaged via magnetic resonance. A tubular, space-occupying, contrast-enhancing lesion was noted in the right intervertebral foramen at L6 to L7. This was presumed to represent focal enlargement of the right sixth lumbar spinal nerve. A right-sided haemilaminectomy was performed at L6 to L7 and material that grossly resembled extruded nucleus pulposus was removed. The right L6 dorsal root ganglion, dorsal nerve root and proximal spinal nerve were severely enlarged and a partial thickness biopsy was collected from the dorsal root ganglion. Results of histopathological examination of the submitted tissue samples were consistent with extruded disc material and lymphocytic ganglioneuritis. To the author's knowledge, this is the first published report of lymphocytic ganglioneuritis secondary to intervertebral disc disease in a dog.

Headshaking in 5 horses after paranasal sinus surgery.

OBJECTIVE: To report headshaking and presumptive trigeminal neuritis as a potential complication after paranasal sinus surgery in horses. STUDY DESIGN: Retrospective case series. ANIMALS: Horses (n = 5) that developed headshaking within 45 days of paranasal sinus surgery. METHODS: Medical records (2007-2010) of horses that had been evaluated for headshaking after paranasal sinus surgery were reviewed. RESULTS: Of 5 horses that developed headshaking within 45 days of paranasal sinus surgery, resolution occurred after treatment in 2 horses. One horse was euthanatized because clinical signs associated with headshaking could not be controlled. Headshaking persisted in the other 2 horses but was either adequately controlled with analgesics or was considered infrequent and transient enough to not warrant therapeutic intervention. Only 2 of 5 horses returned to full work after development of headshaking. CONCLUSIONS: Headshaking because of presumptive trigeminal neuritis is a possible career-ending or fatal complication of paranasal sinus surgery in horses.

Chronic hypertrophic ganglioneuritis mimicking spinal nerve neoplasia: clinical, imaging, pathologic findings, and outcome after surgical treatment.

OBJECTIVE: To report the clinical, imaging, pathologic findings, surgical planning, and long-term outcome after surgery in a dog with neurologic deficits because of a hypertrophic ganglioneuritis that compressed the spinal cord. STUDY DESIGN: Clinical report. ANIMAL: An 8-year-old male intact Yorkshire terrier. METHODS: The dog had ambulatory tetraparesis and neurologic examination was consistent with a C1-C5 myelopathy. Magnetic resonance imaging (MRI) revealed enlargement of the left C2 spinal nerve causing compression of the spinal cord. The main differential diagnosis was spinal nerve neoplasia with compression and possibly spinal cord invasion. On ultrasonography, there was enlargement of the spinal nerve and fine needle aspiration did not show evidence of neoplasia. Fascicular biopsy of the spinal nerve was consistent with enlargement because of chronic inflammation (hypertrophic neuritis). RESULTS: Hemilaminectomy followed by durotomy and rhizotomy allowed resection of an intradural-extramedullary mass that was the enlarged left C2 spinal nerve. Histopathology was consistent with a hypertrophic ganglioneuritis. Thirteen months later the dog remained free of clinical signs. CONCLUSION: Hypertrophic neuritis affecting the spinal nerves may be misdiagnosed as spinal nerve neoplasia that in dogs is usually malignant with a poor prognosis. Focal spinal nerve lesions with compression of the spinal cord evident on MRI may be inflammatory and are not necessarily a neoplastic condition.