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Exam 3
Equine Neuro Dz Part I
65
Veterinary Medicine
Professional
04/03/2017

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Term
What is the common name for Cervical Veterbral Stenotic Myelopathy?
Definition
-Wobblers
Term
What are the two general manifestations of cervical vertebral stenotic myelopathy?
Definition
-Cervical VErtebral Instability (CVI)
-Cervical Static Stenosis (CSS)
Term
Derscribe the cervical vertebral instability manifestation of wobblers.
Definition
-dynamic condition
-intermittent compression
-C3-4, C4-5
Term
Describe the cervical static stenosis of wobblers.
Definition
-static condition
-C5-6, C6-7
Term
What are the two broad classes of horses affected by wobblers?
Definition
-Young,male thoroughbreds
-old: any breed
Term
What are some predisposing factors of wobblers?
Definition
-young, rapidly growing
-males
-TB
-high carb diet
-zinc excess
-copper deficiency
Term
What are the CS of Wobblers?
Definition
-dysfunction of UMN & GP in all four limbs
-SYMMETRIC
-PL worse
Term
What CP deficits do we see w/ wobblers?
Definition
-stumbling
-toe dragging
-circumduction of hind limbs
-truncal sway
Term
What developmental orthopedic dz tend to occur w/ wobblers in young animals?
Definition
-OCD
-joint effusion
-physeal enlargement of long bones
-flexural limb deformities
Term
What do we see when wobblers animals are walked in a straight line?
Definition
-warying stride lengths
-hypometria: floating of hooves
-dragging of hooves
-outward or inward swaying of limbs in motion
-unsteady movement of trunk and pelvis
-may worsen w/ head elevation
Term
What do wobblers horses do when walking up and down a curb?
Definition
-hit curb or stumble
Term
What do wobblers horses do when walked in tight circles?
Definition
-pivot on hind lim
-circumduct outside limb
-scuff hooves
-step on themselves, strike inside of their own limbs
Term
What are is the most sensitive clinical test of UMN & GP function?
Definition
-walking tight circles
Term
What does a Wobblers horse do when backing up? On tail pull?
Definition
-backing: difficult, drag limbs, can fall backward
-easy to pull in motion
Term
What are some differentials for Wobblers (symmetrical spinal ataxia)?
Definition
-EHV-1
-WNV
-EDM
-trauma
-vertebral fracture, abscess
Term
What do we see on rads w/ wobblers?
Definition
-subluxation
-physeal enlargement & dorsal projection of the caudal epiphysis
-degen changes of articular processes
-osteochondrotic changes
Term
What direction is the compression w/ Wobblers?
Definition
-dorsoventral
Term
Which vertebrae are affected by vertebral malformation w/ vertebral subluxation that occurs during flexion? Extension?
Definition
-C2-5
-C5-T1
Term
How do we definitively diagnose wobblers?
Definition
-myelography
Term
What can we see on CSF w/ wobblers?
Definition
-typically normal
-can see slight inc in protein, xanthochromia, erythrophagocytosis
Term
How do we surgically fix Wobblers?
Definition
-basket: stabilize, decompress
-dorsal laminectomy
-rehab = 6-12m
Term
What is the prognosis of Wobblers?
Definition
-fair w/ some surgical techniques
-guarded to poor w/ dietary restriction
-poor w/ no tx
Term
How do we work to prevent Wobblers?
Definition
-most important is avoiding rapid growth
-avoid over-feeding
Term
Describe Equine Degenerative Myeloencephalopathy.
Definition
-noncompressive
-diffuse, symmetric
-degenerative dz
Term
Describe the clinical characteristics of Equine Degenerative Myeloencephalopathy.
Definition
-ataxia
-weakness
-spasticity
Term
Describe the signalment of Equine Degenerative Myeloencephalopathy.
Definition
-YOUNG, both sexes <6m
-Arabians, TB, Paso Finos, Appaloosas, Standardbreds
-MORE COMMON IN NE USA
-Vit E deficiency plays a role
Term
What are the clinical signs of Equine Degenerative Myeloencephalopathy?
Definition
-dysmetric gait, stab around w/ limbs
-hind limb interference, drag toes
-resist backing, can fall and dog sit
-abnormal postural placement
-circumduct & pivot when circled
-NO CN INVOLVEMENT, M ATROPHY, SKIN SENSATION CHANGES, TAIL TONE ABNORMALITY
-potential hyporeflexia of neck & trunk
Term
What are some risk factors that lead to Equine Degenerative Myeloencephalopathy?
Definition
-use of insecticides
-exposure to wood preservatives
-FREQUENT TIME IN A DIRT LOT
-dam w/ previous foal diagnosed w/ EDM
Term
What is a protective factor that lead to Equine Degenerative Myeloencephalopathy?
Definition
-time spent on green pastures
Term
How do we definitively diagnose Equine Degenerative Myeloencephalopathy?
Definition
-post-mortem histopath
Term
What are some major differentials of Equine Degenerative Myeloencephalopathy?
Definition
-CVSM
-EPM
Term
How do we treat/prevent Equine Degenerative Myeloencephalopathy?
Definition
-oral vit E supplementation
-IM vit E tx
-monitor serum vitamin E concentrations
-exposure to fresh, green forage
-prophylactic vit E supplementation
Term
What is the prognosis of Equine Degenerative Myeloencephalopathy?
Definition
-poor
Term
What is the typical history of Equine Protozoal Myeloencephalitis?
Definition
-only one horse is affected
Term
What is the typical signalment of Equine Protozoal Myeloencephalitis?
Definition
-horses 2-4y
Term
What is the major concern w/ diagnosis EPM?
Definition
-way, way over-diagnosed dz
Term
What are the CS seen w/ EPM?
Definition
-highly variable b/c organism can affect many different areas of CNS
-may observe muscle atrophy: most common in quadriceps & gluteals
-CS: asymmteric ataxia, gait can mimic Sweeney, brainstem involvement
Term
What do we find on neuro exam w/ EPM?
Definition
-frequent complaint of obscure lmeness that progresses to ataxia, spasticity, incoordination
-worse when head is elevated or when waking on incline
-findings can be focal or extensive: seizures, blindness, head shaking, severe vestibular signs
Term
How do we diagnose EPM?
Definition
-SAG 2/3/4 w/ CSF index or IFAT
-CSF & blood
Term
What are the major differentials for EOM?
Definition
-CVSM
-SNV
-EHV
-trauma
-EEE,WEE
-EDM
-verminous myeloencephalitis
-rabies
Term
How do we treat EPM?
Definition
-TMS + pyrimethamine: blocks foalte met in protozoan
-Diclazuril
-Ponazuril
-Decoquinate/Levamisole
-Anti-inflamm meds: Flunixin meglumine
-supportive care: padded helmets, slings, deeply bedded, supportive fluids & nutrition if needed
Term
What is our caution w/ using TMS + Pyrimethamine to treat EPM?
Definition
-block folate metabolism for sperm & in pregnant mares
Term
What is the prognosis of TMS + Pyrimethamine?
Definition
-60-75% improve 1 grade
-<25% return to normal activity
Term
How do we work to prevent EPM?
Definition
-vx
-prevent wildlife access to feed
-keep premises clear of dead cats, armadillos, skunks, racoons
-dec exposure of horses to opossums
Term
Describe Equine Herpes Myeloencephlopathy.
Definition
-diffuse, multifocal CNS lesions
-vasculitis, hemorrhage, thrombosis, ischemic neuronal injury
Term
What virus is most commonly associated w/ Equine Herpes Myeloencephalopathy?
Definition
-EHV-1
Term
What are the typical clinical features of Equine Herpes Myeloencephalopathy?
Definition
-ataxia
-paresis
-urinary incontinence
-recent hx of fever, resp dz, or abortion on farm
Term
Which vx is best for Equine Herpes Myeloencephalopathy?
Definition
-monovalent is best
Term
Describe the epidemiology of Equine Herpes Myeloencephalopathy.
Definition
-majority of horses have been exposed
-most horses infected via resp route in first yr of life
-majority of horses remain latently infected for life
Term
What is the incubation period of Equine Herpes Myeloencephalopathy?
Definition
-2-10d
Term
Describe natural infection w/ Equine Herpes Myeloencephalopathy.
Definition
-inhalation or ingestion of aerosolized virus
-direct contact w/ abortion fluids/tissues, nasal or ocular discharge or salive of infected horses
-EHV1 can remain infective in the environemnet for up to 14d and on horse hair for 35-42d
Term
Describe the seasonality of Equine Herpes Myeloencephalopathy.
Definition
-late winter, spring, early summer
Term
When during pregnancy must a mare be infected w/ Equine Herpes Myeloencephalopathy for the neuro form to occur? Abortive form?
Definition
-neuro form: infected during first two trimesters
-abortive form: infected during last trimester
Term
When do neuro signs develop in relation to Equine Herpes Myeloencephalopathy?
Definition
-6-10d after infection
Term
Neuro signs may be preceded (2w) or accompanied by what other signs w/ EHM?
Definition
-upper resp signs
-fever
-inappetance
-hind limb edema
Term
What neuro signs occur w/ Equine Herpes Myeloencephalopathy?
Definition
+/- fever
-acute onset of neuro signs
-predominant spinal white matter: ataxia, paresis of limbs, hypotonia of tail & anus, urinary incontinence
-typically symmetric but can be asymmetric
-hind limbs affected earlier and more severely
Term
What CP deficits occur w/ mild Equine Herpes Myeloencephalopathy cases?
Definition
-reluctance to move
-clunsiness
-toe dragging
-knuckling
-stumbling
-pivoting
-circumduction on circling
Term
What deficits occur w/ severe cases of Equine Herpes Myeloencephalopathy?
Definition
-profound limb weakness
-swaying of hind quarters
-paralysis of affected limbs
-dog sitting
-complete recumbency
-tetraplegia: urinary incontinence
Term
Why are Equine Herpes Myeloencephalopathy cases difficult for euthanasia?
Definition
-horses typically remain alert and appetant
Term
What are your differentials for Equine Herpes Myeloencephalopathy?
Definition
-WNV, EEE, WEE
-CVSM
-EPM
-trauma
-rabies
-verminous myeloencephalitis
-botulism
Term
How do we diagnose Equine Herpes Myeloencephalopathy?
Definition
-CSF: xanthochromia, inc protein, WBC=WNL
-virus isolation: may be negative
-PCR
-serologic titers
Term
How do we treat Equine Herpes Myeloencephalopathy?
Definition
-prompt isolation
-supportive nursing and nutritional care
-reduce CNS inflammation
Term
What kind of supportive care do we use for Equine Herpes Myeloencephalopathy?
Definition
-protection from self-inflicted trauma
-make food and water easly accessible
-recumbent patients
-maintain hydration
-laxative diet to avoid impactions
-appropriate caloric intake
-urinary bladder catheterization
-anti-inflamms
-ANTI-VIRAL MEDS: Valacyclovir, Gancyclovir
Term
What is the prognosis of Equine Herpes Myeloencephalopathy?
Definition
-good if they remain standing
-poor if they become recumbent
Term
What control measures do we use for Equine Herpes Myeloencephalopathy?
Definition
-minimize contact: aerosol, direct contact, fomites
-minimize stress
-isolate suspect animals immediately
-isolate exposed animals for 30d, pregnant mares until they foal
-fetuses and membranes bagged and disposed of for necropsy
-clean infected stalls
-clean fomites
-vx of unexposed animals
-new farm arrivals isolated
-minimize stress
-broodmare separate from rest of farm population
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