Podcast
Questions and Answers
Which of the following is NOT considered a multifocal and diffuse brain disorder?
Which of the following is NOT considered a multifocal and diffuse brain disorder?
- Vitamin deficiency (correct)
- Infectious and inflammatory conditions
- Traumatic brain injury
- Degenerative conditions
Which diagnostic method is NOT typically used in the initial approach to meningoencephalitis?
Which diagnostic method is NOT typically used in the initial approach to meningoencephalitis?
- Biopsy (correct)
- Multifocal clinical signs and localization
- Signalment and history
- MRI and CSF analysis
Which of these viruses belongs to the Rhabdoviridae family?
Which of these viruses belongs to the Rhabdoviridae family?
- Lyssa virus (correct)
- Feline infectious peritonitis virus
- West Nile virus
- Distemper virus
Which animal is LEAST likely to be susceptible to rabies?
Which animal is LEAST likely to be susceptible to rabies?
In the context of rabies, what does 'neurotrophic' mean?
In the context of rabies, what does 'neurotrophic' mean?
What is the typical incubation period for rabies in dogs?
What is the typical incubation period for rabies in dogs?
Which of the following is a characteristic of the prodromal phase of rabies?
Which of the following is a characteristic of the prodromal phase of rabies?
Which of the following is a typical clinical sign of the furious form of rabies?
Which of the following is a typical clinical sign of the furious form of rabies?
Which diagnostic test is considered the gold standard for confirming rabies infection postmortem?
Which diagnostic test is considered the gold standard for confirming rabies infection postmortem?
What are Negri bodies?
What are Negri bodies?
Which of the following is true regarding rabies vaccination in dogs?
Which of the following is true regarding rabies vaccination in dogs?
What type of virus is the canine distemper virus?
What type of virus is the canine distemper virus?
Which of the following is considered an 'extra-neural' sign of distemper in dogs?
Which of the following is considered an 'extra-neural' sign of distemper in dogs?
What is myoclonus, often seen in dogs with the CNS form of distemper?
What is myoclonus, often seen in dogs with the CNS form of distemper?
In cases of canine distemper, which diagnostic test is performed on epithelial cell swabs?
In cases of canine distemper, which diagnostic test is performed on epithelial cell swabs?
Which statement is most accurate regarding neurologic therapy for dogs with distemper?
Which statement is most accurate regarding neurologic therapy for dogs with distemper?
What is the recommended vaccination schedule for canine distemper?
What is the recommended vaccination schedule for canine distemper?
What percentage of cats with the nervous form of FIP (Feline Infectious Peritonitis) show CNS involvement?
What percentage of cats with the nervous form of FIP (Feline Infectious Peritonitis) show CNS involvement?
Which form of FIP (Feline Infectious Peritonitis) is characterized by a partial cellular response?
Which form of FIP (Feline Infectious Peritonitis) is characterized by a partial cellular response?
What diagnostic tool is considered most reliable for diagnosing the CNS form of FIP?
What diagnostic tool is considered most reliable for diagnosing the CNS form of FIP?
Which medication has shown promise in clinical trials for treating FIP, particularly in cases with CNS involvement?
Which medication has shown promise in clinical trials for treating FIP, particularly in cases with CNS involvement?
Which of the following is NOT a type of non-infectious meningoencephalitis of unknown origin (MUO)?
Which of the following is NOT a type of non-infectious meningoencephalitis of unknown origin (MUO)?
Which breed was necrotizing meningoencephalitis (NME) initially described in?
Which breed was necrotizing meningoencephalitis (NME) initially described in?
What is a key characteristic of the lesions associated with Necrotizing Leukoencephalitis (NLE)?
What is a key characteristic of the lesions associated with Necrotizing Leukoencephalitis (NLE)?
Which type of meningoencephalitis is characterized by granulomas often found in the brain stem?
Which type of meningoencephalitis is characterized by granulomas often found in the brain stem?
Which of the following is a typical signalment characteristic for dogs affected by Necrotizing Encephalitis (NE)?
Which of the following is a typical signalment characteristic for dogs affected by Necrotizing Encephalitis (NE)?
What is the primary characteristic of the lesions in dogs affected by Steroid Responsive Meningitis Arteritis (SRMA)?
What is the primary characteristic of the lesions in dogs affected by Steroid Responsive Meningitis Arteritis (SRMA)?
Which of the following breeds has a known predisposition for Steroid Responsive Meningitis Arteritis (SRMA)?
Which of the following breeds has a known predisposition for Steroid Responsive Meningitis Arteritis (SRMA)?
Which of the following is NOT a typical clinical sign associated with Steroid Responsive Meningitis Arteritis (SRMA)?
Which of the following is NOT a typical clinical sign associated with Steroid Responsive Meningitis Arteritis (SRMA)?
What is a common initial treatment for most immune-mediated CNS disorders?
What is a common initial treatment for most immune-mediated CNS disorders?
Besides prednisone, which of the following is used in the treatment protocols for immune-mediated CNS disorders?
Besides prednisone, which of the following is used in the treatment protocols for immune-mediated CNS disorders?
What percentage of disorders causing multifocal brain disorder presentations in small animals are immune mediated?
What percentage of disorders causing multifocal brain disorder presentations in small animals are immune mediated?
Which of the following is true regarding multifocal brain disorders?
Which of the following is true regarding multifocal brain disorders?
A dog presents with fever, lethargy, and cervical pain. CSF analysis reveals elevated protein and white blood cells. Which of the following is the MOST likely differential diagnosis, based solely on this information?
A dog presents with fever, lethargy, and cervical pain. CSF analysis reveals elevated protein and white blood cells. Which of the following is the MOST likely differential diagnosis, based solely on this information?
A veterinary neurologist is presented with multiple canine patients exhibiting neurological symptoms. Based on the information provided, which statement is MOST accurate?
A veterinary neurologist is presented with multiple canine patients exhibiting neurological symptoms. Based on the information provided, which statement is MOST accurate?
An unvaccinated stray dog is brought in displaying acute behavioral changes, including aggression and disorientation. Which of the following is the MOST appropriate next step?
An unvaccinated stray dog is brought in displaying acute behavioral changes, including aggression and disorientation. Which of the following is the MOST appropriate next step?
Lily arrives exhibiting lethargy, fever and pain. After some time, Lily begins presenting with a hunched back, and ultimately is transferred to neurology for assistance. Which of the following neurological conditions is the LEAST likely to contribute to these symptoms?
Lily arrives exhibiting lethargy, fever and pain. After some time, Lily begins presenting with a hunched back, and ultimately is transferred to neurology for assistance. Which of the following neurological conditions is the LEAST likely to contribute to these symptoms?
What is the typical course of CNS signs associated with canine distemper?
What is the typical course of CNS signs associated with canine distemper?
What is the primary mechanism by which rabies virus spreads within the host?
What is the primary mechanism by which rabies virus spreads within the host?
Why is serological testing not considered a reliable diagnostic tool for rabies in vaccinated animals?
Why is serological testing not considered a reliable diagnostic tool for rabies in vaccinated animals?
What is the most common initial treatment for most immune-mediated CNS disorders, as indicated in the material?
What is the most common initial treatment for most immune-mediated CNS disorders, as indicated in the material?
Which of the following components is unique to modified live rabies vaccines, such as PureVax Feline Rabies?
Which of the following components is unique to modified live rabies vaccines, such as PureVax Feline Rabies?
When considering a diagnosis of Granulomatous Meningoencephalitis (GME), which of the following factors is LEAST likely to influence the prognosis?
When considering a diagnosis of Granulomatous Meningoencephalitis (GME), which of the following factors is LEAST likely to influence the prognosis?
In the context of multifocal brain disorders, which category is LEAST likely to be a direct cause but can exacerbate underlying conditions?
In the context of multifocal brain disorders, which category is LEAST likely to be a direct cause but can exacerbate underlying conditions?
Which of the following statements best describes the role of viral load in the manifestation of neurological signs in canine distemper?
Which of the following statements best describes the role of viral load in the manifestation of neurological signs in canine distemper?
What is the reported success rate of GS-441524 (Obeldesivir) in treating cats with the nervous form of FIP?
What is the reported success rate of GS-441524 (Obeldesivir) in treating cats with the nervous form of FIP?
Besides supportive care, which of the following medications is typically administered to address myoclonus in dogs with distemper?
Besides supportive care, which of the following medications is typically administered to address myoclonus in dogs with distemper?
What is the MOST crucial aspect of a patient's history to consider when evaluating a potential case of meningoencephalitis?
What is the MOST crucial aspect of a patient's history to consider when evaluating a potential case of meningoencephalitis?
In a patient suspected of having a multifocal brain disorder, what is the MOST important initial diagnostic consideration?
In a patient suspected of having a multifocal brain disorder, what is the MOST important initial diagnostic consideration?
What is the primary reason dogs and cats are included in the wildlife rabies reservoir in certain countries?
What is the primary reason dogs and cats are included in the wildlife rabies reservoir in certain countries?
What is the MOST significant factor influencing the incubation period of the rabies virus?
What is the MOST significant factor influencing the incubation period of the rabies virus?
What is the mechanism by which the rabies virus gains entry into the nervous system?
What is the mechanism by which the rabies virus gains entry into the nervous system?
Why might an animal with rabies exhibit increased salivation?
Why might an animal with rabies exhibit increased salivation?
What is the primary reason cats are statistically the most common domestic animal diagnosed with rabies on the East Coast?
What is the primary reason cats are statistically the most common domestic animal diagnosed with rabies on the East Coast?
What is the MOST common neurological sign seen in young dogs affected by the gray matter form of canine distemper?
What is the MOST common neurological sign seen in young dogs affected by the gray matter form of canine distemper?
A dog presents with twitching which is characterized by abrupt, shock-like movements. What specific term describes these clinical signs?
A dog presents with twitching which is characterized by abrupt, shock-like movements. What specific term describes these clinical signs?
Why is it crucial to handle samples for canine distemper PCR testing with extreme care?
Why is it crucial to handle samples for canine distemper PCR testing with extreme care?
What is the known efficacy of specific antiviral medications in treating the CNS form of Feline Infectious Peritonitis (FIP)?
What is the known efficacy of specific antiviral medications in treating the CNS form of Feline Infectious Peritonitis (FIP)?
What distinguishes necrotizing meningoencephalitis (NME) from granulomatous meningoencephalitis (GME) in terms of lesion distribution?
What distinguishes necrotizing meningoencephalitis (NME) from granulomatous meningoencephalitis (GME) in terms of lesion distribution?
What cellular change is MOST commonly observed in the cerebrospinal fluid (CSF) of dogs with steroid-responsive meningitis-arteritis (SRMA)?
What cellular change is MOST commonly observed in the cerebrospinal fluid (CSF) of dogs with steroid-responsive meningitis-arteritis (SRMA)?
What is the typical age range for dogs affected by steroid-responsive meningitis-arteritis (SRMA)?
What is the typical age range for dogs affected by steroid-responsive meningitis-arteritis (SRMA)?
Why is additional immunosuppressive therapy typically added to the treatment plan for dogs with GME, NME, or SRMA?
Why is additional immunosuppressive therapy typically added to the treatment plan for dogs with GME, NME, or SRMA?
Considering the approach to multifocal brain disorders, which factor would LEAST influence the decision to initiate immediate empiric antimicrobial therapy?
Considering the approach to multifocal brain disorders, which factor would LEAST influence the decision to initiate immediate empiric antimicrobial therapy?
When evaluating a dog presenting with potential neurological signs of rabies, what historical detail would MOST increase suspicion for rabies, warranting extreme caution?
When evaluating a dog presenting with potential neurological signs of rabies, what historical detail would MOST increase suspicion for rabies, warranting extreme caution?
What is the MOST critical factor that determines the distribution and severity of central nervous system (CNS) lesions in canine distemper cases?
What is the MOST critical factor that determines the distribution and severity of central nervous system (CNS) lesions in canine distemper cases?
A cat presents with neurological signs suggestive of Feline Infectious Peritonitis (FIP), but the blood work is largely unremarkable. What action should the veterinarian perform?
A cat presents with neurological signs suggestive of Feline Infectious Peritonitis (FIP), but the blood work is largely unremarkable. What action should the veterinarian perform?
What is the MOST important consideration when choosing between different immunosuppressive drugs for long-term management of non-infectious meningoencephalitis?
What is the MOST important consideration when choosing between different immunosuppressive drugs for long-term management of non-infectious meningoencephalitis?
Which diagnostic finding is MOST consistent with steroid-responsive meningitis-arteritis (SRMA) in dogs?
Which diagnostic finding is MOST consistent with steroid-responsive meningitis-arteritis (SRMA) in dogs?
A dog presents with a one-week history of progressive neurological signs, including seizures and behavioral changes. Which of the following differentials would be the LEAST likely, assuming the dog is fully vaccinated and lives in a suburban environment?
A dog presents with a one-week history of progressive neurological signs, including seizures and behavioral changes. Which of the following differentials would be the LEAST likely, assuming the dog is fully vaccinated and lives in a suburban environment?
When diagnosing Feline Infectious Peritonitis (FIP), which sign(s) is MOST specific to nervous system involvement?
When diagnosing Feline Infectious Peritonitis (FIP), which sign(s) is MOST specific to nervous system involvement?
Which of the following findings would be MOST suggestive of a diagnosis of rabies in a dog presenting with acute neurological signs?
Which of the following findings would be MOST suggestive of a diagnosis of rabies in a dog presenting with acute neurological signs?
A 6-month-old Yorkshire Terrier presents with seizures, progressive ataxia, and vision deficits. What is the MOST likely differential diagnosis given the breed and age?
A 6-month-old Yorkshire Terrier presents with seizures, progressive ataxia, and vision deficits. What is the MOST likely differential diagnosis given the breed and age?
When considering the prognosis for dogs diagnosed with non-infectious meningoencephalitis, which statement is MOST accurate?
When considering the prognosis for dogs diagnosed with non-infectious meningoencephalitis, which statement is MOST accurate?
You are presented with a confusing neurological case. Which step would be LEAST helpful in narrowing down a diagnosis of multifocal brain disease?
You are presented with a confusing neurological case. Which step would be LEAST helpful in narrowing down a diagnosis of multifocal brain disease?
Which statement is MOST accurate regarding the typical treatment approach for dogs diagnosed with granulomatous meningoencephalitis (GME)?
Which statement is MOST accurate regarding the typical treatment approach for dogs diagnosed with granulomatous meningoencephalitis (GME)?
What diagnostic technique is considered the gold standard for confirming a clinical diagnosis of Feline Infectious Peritonitis (FIP) affecting the central nervous system ante-mortem (before death)?
What diagnostic technique is considered the gold standard for confirming a clinical diagnosis of Feline Infectious Peritonitis (FIP) affecting the central nervous system ante-mortem (before death)?
Considering the zoonotic importance of rabies, what is the MOST appropriate course of action immediately following a confirmed diagnosis of rabies in a dog?
Considering the zoonotic importance of rabies, what is the MOST appropriate course of action immediately following a confirmed diagnosis of rabies in a dog?
A veterinary neurologist diagnoses a patient with a multifocal brain disorder. The client asks if it could be genetic. How should the veterinarian respond?
A veterinary neurologist diagnoses a patient with a multifocal brain disorder. The client asks if it could be genetic. How should the veterinarian respond?
What is the BEST initial treatment of a patient with steroid-responsive meningitis-arteritis (SRMA)?
What is the BEST initial treatment of a patient with steroid-responsive meningitis-arteritis (SRMA)?
Which of these is NOT a common condition seen with multifocal disorders?
Which of these is NOT a common condition seen with multifocal disorders?
Which is the WORST option for a prognosis?
Which is the WORST option for a prognosis?
If a DVM is presented with an animal that they suspect has Rabies, which should they NOT do due to extremely high risk?
If a DVM is presented with an animal that they suspect has Rabies, which should they NOT do due to extremely high risk?
A dog has potential steroid-responsive meningitis arthritis (SRMA). Which is the LEAST beneficial lab test?
A dog has potential steroid-responsive meningitis arthritis (SRMA). Which is the LEAST beneficial lab test?
Which condition may be LESS treatable long-term?
Which condition may be LESS treatable long-term?
What is one of the MAIN organs involved in post-mortem rabies discovery?
What is one of the MAIN organs involved in post-mortem rabies discovery?
What is a possible side effect of Procarbazine?
What is a possible side effect of Procarbazine?
A veterinarian is treating a cat with FIP, but the owners mentioned that they did not want any type of experimental medicine. What should the DVM do?
A veterinarian is treating a cat with FIP, but the owners mentioned that they did not want any type of experimental medicine. What should the DVM do?
Which factor is LEAST important when initially evaluating a dog from Louisiana post-hurricane for potential meningoencephalitis?
Which factor is LEAST important when initially evaluating a dog from Louisiana post-hurricane for potential meningoencephalitis?
What is the MOST critical action to minimize false positives when performing PCR testing for canine distemper?
What is the MOST critical action to minimize false positives when performing PCR testing for canine distemper?
Which of these is NOT one of the main categories of disorders that can cause multifocal and diffuse brain disease?
Which of these is NOT one of the main categories of disorders that can cause multifocal and diffuse brain disease?
What does 'multifocal' mean in the context of neurological disorders?
What does 'multifocal' mean in the context of neurological disorders?
In a case of suspected rabies, what is the significance of the virus being 'neurotropic'?
In a case of suspected rabies, what is the significance of the virus being 'neurotropic'?
How does the rabies virus typically enter the nervous system?
How does the rabies virus typically enter the nervous system?
Why is travel history particularly important when assessing a patient for potential infectious meningoencephalitis?
Why is travel history particularly important when assessing a patient for potential infectious meningoencephalitis?
What is a key difference between necrotizing meningoencephalitis (NME) and granulomatous meningoencephalitis (GME) in lesion distribution?
What is a key difference between necrotizing meningoencephalitis (NME) and granulomatous meningoencephalitis (GME) in lesion distribution?
Which of the following MOST accurately describes the role of a veterinarian when rabies is suspected?
Which of the following MOST accurately describes the role of a veterinarian when rabies is suspected?
What neurological sign is MOST characteristic of the gray matter form of canine distemper in young dogs?
What neurological sign is MOST characteristic of the gray matter form of canine distemper in young dogs?
For which condition is periventricular contrast enhancement around the fourth and third ventricles on MRI MOST suggestive?
For which condition is periventricular contrast enhancement around the fourth and third ventricles on MRI MOST suggestive?
What is the MAIN goal of adding immunosuppressive medications (like cyclosporine or azathioprine) to the treatment plan for dogs with GME, NME, or SRMA?
What is the MAIN goal of adding immunosuppressive medications (like cyclosporine or azathioprine) to the treatment plan for dogs with GME, NME, or SRMA?
What is the initial step a veterinarian should take when they suspect a dog may have rabies?
What is the initial step a veterinarian should take when they suspect a dog may have rabies?
In a dog presenting with multifocal brain signs, which diagnostic result would MOST strongly suggest SRMA (steroid-responsive meningitis-arteritis)?
In a dog presenting with multifocal brain signs, which diagnostic result would MOST strongly suggest SRMA (steroid-responsive meningitis-arteritis)?
What is the MOST common way Feline Infectious Peritonitis (FIP) manifests in cats?
What is the MOST common way Feline Infectious Peritonitis (FIP) manifests in cats?
What is the MOST likely cause of a positive PCR test for distemper in a dog, if the test was not correctly performed by the lab technician?
What is the MOST likely cause of a positive PCR test for distemper in a dog, if the test was not correctly performed by the lab technician?
In the context of rabies transmission, what role do domestic animals like dogs and cats play in certain countries such as India?
In the context of rabies transmission, what role do domestic animals like dogs and cats play in certain countries such as India?
What is a common prodromal sign of rabies?
What is a common prodromal sign of rabies?
What is the typical signalment of a dog that's most likely to have steroid-responsive meningitis arteritis (SRMA)?
What is the typical signalment of a dog that's most likely to have steroid-responsive meningitis arteritis (SRMA)?
Why might the rabies incubation period be shorter if the animal is bitten on the face, as opposed to the leg?
Why might the rabies incubation period be shorter if the animal is bitten on the face, as opposed to the leg?
Which of the following best describes 'myoclonus' as it relates to canine distemper?
Which of the following best describes 'myoclonus' as it relates to canine distemper?
Which of the following would be the MOST appropriate initial treatment choice for a dog diagnosed with steroid-responsive meningitis-arteritis (SRMA)?
Which of the following would be the MOST appropriate initial treatment choice for a dog diagnosed with steroid-responsive meningitis-arteritis (SRMA)?
What is the MOST important historical detail to consider when evaluating a dog with new onset aggressive behavior?
What is the MOST important historical detail to consider when evaluating a dog with new onset aggressive behavior?
How has the approach to treating Feline Infectious Peritonitis (FIP) changed in recent years?
How has the approach to treating Feline Infectious Peritonitis (FIP) changed in recent years?
When collecting CSF for analysis while investigating a possible case of meningoencephalitis, what is considered a positive result that confirms that there is a meningoencephalitis?
When collecting CSF for analysis while investigating a possible case of meningoencephalitis, what is considered a positive result that confirms that there is a meningoencephalitis?
Why might a veterinarian consider empiric antimicrobial therapy in a patient presenting with a multifocal brain disorder?
Why might a veterinarian consider empiric antimicrobial therapy in a patient presenting with a multifocal brain disorder?
When might West Nile Virus and Triple E be differentials in the Northeast region of the United States?
When might West Nile Virus and Triple E be differentials in the Northeast region of the United States?
What does a dog in the wildlife reservoir look like?
What does a dog in the wildlife reservoir look like?
What does post-mortem examination for rabies typically involve?
What does post-mortem examination for rabies typically involve?
How has the geographic distribution of certain infectious diseases changed, and why?
How has the geographic distribution of certain infectious diseases changed, and why?
What is a classic sign that has high suspicion of the animal having a FIP infection?
What is a classic sign that has high suspicion of the animal having a FIP infection?
What is the most important thing to be concerned with if a dog is on Procarbazine long-term?
What is the most important thing to be concerned with if a dog is on Procarbazine long-term?
What can the clinic recommend to owners for cats diagnosed with FIP?
What can the clinic recommend to owners for cats diagnosed with FIP?
If the DVM wants to prevent Rabies, which is the MOST appropriate?
If the DVM wants to prevent Rabies, which is the MOST appropriate?
A dog presents with a hunched back and neck pain. Which of the following differentials would be the LEAST likely to contribute to these symptoms?
A dog presents with a hunched back and neck pain. Which of the following differentials would be the LEAST likely to contribute to these symptoms?
Upon necropsy of an animal that had rabies, what area will they evaluate?
Upon necropsy of an animal that had rabies, what area will they evaluate?
What is a potential treatment option of seizures associated with the FIP infection?
What is a potential treatment option of seizures associated with the FIP infection?
What is MOST important for sample collection for PCR collection in cases of canine distemper?
What is MOST important for sample collection for PCR collection in cases of canine distemper?
How would one describe a dog with rabies?
How would one describe a dog with rabies?
If a dog is found to have SRMA at five years of age, is it the MOST appropriate to treat?
If a dog is found to have SRMA at five years of age, is it the MOST appropriate to treat?
What is true of dogs with a multifocal brain disorder?
What is true of dogs with a multifocal brain disorder?
Which of the following is the MOST crucial piece of information to obtain when taking a history for a potential meningoencephalitis case?
Which of the following is the MOST crucial piece of information to obtain when taking a history for a potential meningoencephalitis case?
If a dog presents with neurological signs indicative of multifocal brain disease, what should be the PRIMARY rule-out?
If a dog presents with neurological signs indicative of multifocal brain disease, what should be the PRIMARY rule-out?
Which of the following is the MOST accurate description of how rabies is believed to spread throughout the body?
Which of the following is the MOST accurate description of how rabies is believed to spread throughout the body?
Upon suspicion of a rabies case characterized by both furious and paralytic signs, what is the MOST important reason for immediate euthanasia and testing?
Upon suspicion of a rabies case characterized by both furious and paralytic signs, what is the MOST important reason for immediate euthanasia and testing?
How does canine distemper typically manifest in older dogs, compared to younger dogs?
How does canine distemper typically manifest in older dogs, compared to younger dogs?
What is a critical consideration when collecting samples for canine distemper PCR testing to avoid false-positive results?
What is a critical consideration when collecting samples for canine distemper PCR testing to avoid false-positive results?
Which statement is MOST accurate regarding Feline Infectious Peritonitis (FIP) and its diagnosis?
Which statement is MOST accurate regarding Feline Infectious Peritonitis (FIP) and its diagnosis?
When interpreting MRI findings in a cat suspected of having FIP, what specific feature is MOST suggestive of CNS involvement?
When interpreting MRI findings in a cat suspected of having FIP, what specific feature is MOST suggestive of CNS involvement?
A 6-month-old Bernese Mountain Dog presents with fever, neck pain, and stiff gait. Which condition should be HIGH on your differential list?
A 6-month-old Bernese Mountain Dog presents with fever, neck pain, and stiff gait. Which condition should be HIGH on your differential list?
You are presented with a canine patient diagnosed with GME and are initiating immunosuppressive therapy. Which drug choice would be LEAST appropriate due to its propensity for cumulative, severe side effects?
You are presented with a canine patient diagnosed with GME and are initiating immunosuppressive therapy. Which drug choice would be LEAST appropriate due to its propensity for cumulative, severe side effects?
Flashcards
Multifocal/diffuse brain disorders
Multifocal/diffuse brain disorders
Disorders likely to affect the brain at multiple functional areas.
Rabies
Rabies
Viral disease affecting the central nervous system
What causes Rabies?
What causes Rabies?
Lyssa virus in the family Rhabdoviridae.
Rabies spread
Rabies spread
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How does Rabies spread?
How does Rabies spread?
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Rabies incubation periods
Rabies incubation periods
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Prodromal phase
Prodromal phase
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Diagnosing Rabies
Diagnosing Rabies
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Rabies histopathology
Rabies histopathology
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Preventing Rabies
Preventing Rabies
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Distemper
Distemper
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Distemper pathogenesis
Distemper pathogenesis
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Extra neural signs of Distemper
Extra neural signs of Distemper
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CNS form signs
CNS form signs
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Treating Distemper
Treating Distemper
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Distemper prevention
Distemper prevention
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FIP
FIP
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FIP cause
FIP cause
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FIP forms
FIP forms
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FIP signs
FIP signs
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FIP diagnosis
FIP diagnosis
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FIP treatment
FIP treatment
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MUO
MUO
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MUO examples
MUO examples
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NME
NME
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GME
GME
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NE
NE
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SRMA
SRMA
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MUO treatments
MUO treatments
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Multifocal and Diffuse Brain Disorders
Multifocal and Diffuse Brain Disorders
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Causes of Multifocal/Diffuse Brain Disorders
Causes of Multifocal/Diffuse Brain Disorders
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Important History Questions
Important History Questions
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Diagnosing Multifocal Issues
Diagnosing Multifocal Issues
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Infectious Disorder Concerns
Infectious Disorder Concerns
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If Not Infectious...
If Not Infectious...
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Rabies Virus Type
Rabies Virus Type
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High Rabies Susceptibility (Wildlife)
High Rabies Susceptibility (Wildlife)
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Rabies Infection Spread
Rabies Infection Spread
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Rabies Prodromal Phase Signs
Rabies Prodromal Phase Signs
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Rabies Furious Form Symptoms
Rabies Furious Form Symptoms
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Rabies Paralytic Form Symptoms
Rabies Paralytic Form Symptoms
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Rabies Survival Time
Rabies Survival Time
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Canine Distemper Overview
Canine Distemper Overview
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Distemper History Clues
Distemper History Clues
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Distemper CNS Signs (Young Dogs)
Distemper CNS Signs (Young Dogs)
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Myoclonus Definition
Myoclonus Definition
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Diagnosing Distemper
Diagnosing Distemper
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Distemper Treatment
Distemper Treatment
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FIP (Feline Infectious Peritonitis)
FIP (Feline Infectious Peritonitis)
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FIP Brain MRI Signature
FIP Brain MRI Signature
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FIP Treatment Approach
FIP Treatment Approach
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Common MUO Forms
Common MUO Forms
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NME Characteristics
NME Characteristics
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GME Characteristics
GME Characteristics
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Necrotizing Encephalitis Signs
Necrotizing Encephalitis Signs
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SRMA Characteristics
SRMA Characteristics
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Treating Immune-Mediated Issues
Treating Immune-Mediated Issues
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Study Notes
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Approaching Multifocal and Diffuse Brain Disorders
- Multifocal disorders involve several brain areas; diffuse disorders are continuous throughout the brain.
- The result of both presentations is approximately the same.
- Key categories of these disorders include infectious and inflammatory, degenerative conditions, poly-trauma, and metabolic/toxic issues.
- Infectious and inflammatory conditions are often the main cause for multifocal localization
- When assessing, signalment and history are crucial, along with age, breed, vaccination status, and travel history.
- Travel history is very crucial for infections that are regionally distinct (e.g., different infections in Louisiana vs. California).
- The presence of multifocal clinical signs should raise suspicion for infection/inflammation.
- MRI is helpful for visualizing lesion distribution throughout the brain.
- CSF analysis is helpful to confirm inflammation (pleocytosis, increased protein levels).
- Bacterial infections should be ruled out initially; a CSF with 90% neutrophils suggests a chance of bacterial involvement.
- If the CSF has more mononuclear pleocytosis other investigations should be performed.
- Titer tests screen for rickettsial, protozoal, fungal and parasitic disorders.
- Distemper is still seen with Triple E/West Nile Fever on the uprise
Rabies
- First reported 5000 years ago, 1768 in Boston.
- It is caused by Lyssa virus in the family Rhabdoviridae.
- The virus is characterized by a single-stranded RNA with a glycoprotein envelope.
- Rabies is neurotrophic, replicating primarily in the central nervous system (CNS).
- Animals with high susceptibility include foxes, coyotes, wolves, jackals, skunks, raccoons, bats, and rabbits.
- Animals with moderate susceptibility include dogs, cattle, sheep, goats, horses, and cats.
- Low susceptibility animals: birds and opossums.
- The Enzootic reservoir for rabies includes wildlife such as foxes, coyotes, skunks, raccoons, jackals, mongooses, bats, dogs, and cats.
- Domestic animals affected: dogs, cats, horses, and ruminants.
- 25,000 humans died worldwide in 2015.
- Raccoon rabies is a major concern on the East Coast of the U.S.
- The virus spreads to the CNS through retrograde intra-axonal flow.
- Nutrient transport occurs from the alpha motor neuron to the nerve periphery and waste is transported back to the neuron.
- The virus hitches a "free ride" and has free entry to the nerves.
- Viral replication occurs in the spinal cord and brain.
- The virus spreads centrifugally through peripheral nerves, reaching the salivary glands.
- The incubation period depends on the length of the nerve and travel time via retrograde axonoplasmatic flow.
- The average incubation for dogs is 3-8 weeks and for cats 4-6 weeks.
- Initial (prodromal) signs: typically last 2-3 days; can include variable fever, licking site of inoculation due to sensory dysfunction, nervousness, agitation, searching for solitude, and dilated pupils.
- "Lily" had a recent trip on a ferry to Martha's Vineyard.
- "Lily" showed lethargy, fever and seemed painful three days prior to admission.
- "Lily" developed a hunched back, cried, and bit two days prior.
- "Lily" was reluctant to eat, remained painful, and showed proprioceptive deficits, with pain medication ineffective one day before.
- "Lily" spent 2.5 days in the ICU before being transferred to neurology.
- Furious rabies symptoms: salivation, irritability, viciousness, photophobia, disorientation, changes in mental status, ataxia potentially leading to tetraplegia, and grand mal seizures.
- Dumb or paralytic rabies symptoms: LMN paralysis, CN affected first, dropped jaw, swallowing dysfunction, and coma.
- Survival time after clinical signs is 3-8 days, with a median of 4 days.
- Diagnostic methods include direct fluorescent antibody (DFA) tests on skin biopsies and brain tissue, RT-PCR on saliva or CSF and rapid fluorescent focus inhibition test (RFFIT) of serum or CSF.
- Serological tests are not possible after vaccination.
- Histopathology will show Mononuclear infiltration, Perivascular cuffing of lymphocytes or polymorphonuclear cells, Lymphocytic foci. Nodules consisting of glial cells, Negri bodies = filamentous ribonucleoproteins
- The vaccination for dogs: killed virus (Imrab 3 TF) with initial vaccination at 3 months, a booster at 1 year, and revaccination every 1-3 years.
- The vaccination for cats is with killed virus (Imrab 3 TF) or modified live virus, with Canarypox virus expressing rabies glycoprotein (PureVax Feline Rabies) and the same schedule as for dogs. Vaccination brings exponential drop in the likelihood of contracting rabies, but is not 100%.
Distemper
- For the viral replication cycle, it starts with inoculation of the respiratory tract and viral replication in local B cells, T cells, and macrophages.
- This is followed by lymphatic spread to tonsils and bronchial/retropharyngeal lymph nodes and then viral replication and lymphoid organ colonization.
- The immune response determines if there will be widespread invasion of epithelial cells and the CNS, leading to symptomatic or asymptomatic outcomes depending on the individual.
- Extraneural: fever, conjunctivitis, pneumonia, diarrhea, hyperkeratosis, retinitis, and cachexia are indicators in addition to neurological signs.
- History of diarrhea, ocular discharge, hyperkeratosis and retinal/teeth abnormalities are supportive of a diagnosis of distemper.
- Forms of encephalomyelitis in young dogs: onset with myoclonus; gray > white matter disease.
- In mature dogs: white matter disease, myoclonus is rare.
- Chronic old dog encephalitis occurs with forebrain changes.
- Post-vaccinal distemper encephalitis: often in young dogs, unclear pathogenesis (very rare).
- In the CNS form, rapid progression with, seizures, abnormal behavior, ataxia, paresis, myoclonus, cerebellar or vestibular signs, and epaxial pain can be observed.
- Rapidly progressive CORS (cerebral, ocular, respiratory signs), but slower than rabies.
- It may take weeks as opposed to the very rapid progression of rabies.
- In young dogs with gray matter involvement, seizures and myoclonus are often seen.
- Myoclonus can be the only sign.
- Diagnostic tests for distemper include IF on epithelial cell swabs, IgM/IgG antibody titers in blood or CSF, and PCR on blood, urine, CSF, or conjunctival swabs.
- Samples should be handled carefully when performing PCR (false positives can occur due to measles virus shedding from humans).
- A positive PCR has an 80-90% likelihood of indicating distemper infection.
- In post-infection, IF is 3 weeks, antibody titers 8 days to 3 weeks, and PCR has a sample dependent result
- In post-vaccination IF is unavailable, antibody titer several months and PCR has MLV weeks result
- Treatment is primarily supportive, aiming to aid the immune system.
- High doses of glucocorticoids followed by maintenance doses, alongside immunomodulators help therapy.
- Seizures can be managed with prophylactic therapy at the onset of systemic signs.
- There is irreversible myoclonus without proven therapy, but procainamide, lidocaine, and levetiracetam can be used; levothyretacem/Keppra is often the first treatment of choice for myoclonus.
- Vaccination is key for prevention: every 3-4 weeks between 6-16 weeks of life, then every 3 years.
- Over 50% of dogs with neurological distemper have been vaccinated, and encephalitis has been reported after vaccination.
- Infected dogs should be isolated as they can shed the virus for 1-2 weeks after systemic infection or longer.
FIP (Feline Infectious Peritonitis)
- It is caused by a corona virus and is characterized by immune complex disorder and vasculitis. The virus undergoes a spontaneous mutation and generates the FIP variant.
- Effusive (wet) form with no cellular immunity or dry with partial cellular response, or a combined form are possible presentations.
- About 30% of cats with FIP show CNS involvement. Some cases show nearly no systemic signs.
- the brain stem is often affected:.
- Varying signs of feline infectious peritonitis (FIP) may include fever, lethargy, loss of appetite, weight loss, effusions in the abdomen or thorax, CNS signs like central vestibular issues, and anterior uveitis.
- There is no single reliable test for FIP diagnosis, it requires a combination of multiple tests include blood work (CBC), chemistry profile, X-rays / ultrasound, FIP titers.
- For diagnosing CNS form, MRI, CSF analysis, immunofluorescence antibody tests, and immunohistochemistry of tissue samples are most reliable.
- Periventricular enhancement around the fourth and third ventricles on MRI is nearly classical for FIP.
- FIP therapy includes prednisone for disease control, antiviral medications (GS-441524) in clinical trials, and anticonvulsants.
- GS-441524, at 10 mg/kg SID to BID subcutaneously for 3 months, showed positive responses in 75% of cats with CNS involvement; relapses after treatment completion are possible.
- The medication interferes with viral RNA transcription, with potential liver and kidney toxicity. The cost can be around $2000 for a 3 month treatment at 10mg/kg BID.
- Some cats relapse after stopping antiviral treatment.
- One cat developed an accumulation of viral substance in the bladder that caused obstruction.
- Remdesivir showed less success than GS-441524.
- Combining prednisolone with antivirals may prolong life in some cats.
Non-Infectious Meningoencephalitis
- Meningoencephalitis of unknown origin (MUO) and meningitis of unknown origin are both important.
- MUO includes necrotizing meningoencephalitis (NME, including Pug dog encephalitis), necrotizing encephalitis (NE, including Yorkshire encephalitis and necrotizing leuko-encephalitis), and granulomatous meningoencephalitis (GME).
- Meningitis of unknown origin includes steroid-responsive meningitis-arteritis (SRMA) and idiopathic pachymeningitis of greyhounds.
- Necrotizing Meningoencephalitis (NME): cause is unknown (immune-mediated suspected).
- First identified in 1982 in CA and MA.
- NME occurs in intact and neutered males and females.
- NME has acute and chronic clinical forms. Acute forms are difficult to treat due to risk of increased ICP.
- Recent studies show antibodies against GFAP of astrocytes in CSF along with elevated GFAP CSF levels; significance not clear, but supports the possible immune mediated condition.
- NME is largely a gray matter disease, typically affecting the cortex with severe meningitis. The brainstem is typically spared.
- The cortex collapses and fades away in chronic cases.
- Inflammation of the gray matter with necrosis of the white matter below.
- Granulomatous Meningoencephalitis (GME) has an unknown cause that is most likely immune mediated.
- GME is more likely in middle-aged dogs, small breeds and has females.
- GME can manifest as ocular, focal (brainstem), or disseminated (spinal cord, brainstem, forebrain) forms.
- GME is more common in the white matter of the brainstem and sometimes includes the spinal cord.
- Necrotizing Encephalitis (NE) and Necrotizing Leukoencephalitis (NLE) are idiopathic.
- NLE is described in Yorkshire terriers and diagnosed in other breeds like French bulldogs or Boston terriers.
- Symptoms appear around ~4.5 years (range 1-10 yrs) with no gender predilection.
- NLE has Large, focal, asymmetric necrosis, cyst formation, severe inflammation around necrotic, mostly white matter disease, Meninges is mostly spared, and located in the mid brain, brainstem, cerebellum.
- Steroid Responsive Meningitis Arteritis (SRMA) is most likely immune mediated.
- SRMA is not fully understood, it includes upregulation of CD4, CD8 & CDIIT-cells, downregulation of interleukins IL2, IL4 and interferon, high level of IL8 and IgA, severe meningitis and damage to small arteries of meninges.
- JSRMA can appear with joint, heart and thyroids' disease.
- Younger dogs (5-19 months old) are more susceptible, it would be very unlikely in dogs older than the age of 2.
- Those Breeds are beagles, Bernese mountain dogs, boxers, border collies, English Springer Spaniels, Jack Russells, Labrador retrievers, Nova Scotia Duck Toll retrievers, Weimaraners, whippets, and Wirehaired Pointing Griffons.
- SRMA clinical signs: are fever, lethargy, stiff gait, neck and thoracolumbar pain, and joint pain.
- In some cases, there's reduced heart function and pericardial fluid.
- Diagnostic features: signalment, clinical signs, CSF analysis (granulcytic pleocytosis), tests for C-reactive protein. Values can go up as high as 1500 Y-pod cells in the CSF (upper limit 8).
- Due to damaged arteries, protein can be elevated in the range of 100-300 (normal range up to 25)
- Rule out infectious disorders, a joint tap (if indicated), and MRI.
- Prednisone, dexamethasone IV, methylprednisolone IV, and prednisone PO can be used.
- Use it to slowly taper off and continue at the lowest possible level.
- Immunomodulating therapy: lomustine (CCNU), procarbazine, cytosine arabinoside, cyclosporine, leflunomide, and azathioprine.
- Steroids help to slow down the immune system, but dogs respond poorly to long-term treatment.
- Procarbazine may be very helpful to replace steroids; Cytosine can only be administered via IV so it has to be given recurring every 4 weeks; Low-Mustine CCNU has cumulative side effects so there is also a time limit.
Summary
- Multifocal brain disorders are common in small animal neurology.
- Inflammatory and infectious disorders are most common.
- Of the disorders, about 80% are immune mediated, which are often treatable.
- Toxic and metabolic conditions are another important group.
- Trauma and poly-trauma cases are often presented to ER.
- Degenerative conditions are rare and challenging to diagnose.
- Expertise in infectious and non-infectious brain disorders is crucial for small animal medicine, internships/residencies, and private practice.
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