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Exam 3
Equine Neuro II
34
Veterinary Medicine
Professional
04/05/2017

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Cards

Term
Is EPM a herd problem or an individual problem?
Definition
-individual problem
Term
What is the typical age of horses affected by EPM?
Definition
-2-4y
Term
What are the clinical signs of EPM?
Definition
-VARIABLE: can look like anything
-muscle atrophy of quads & gluteals
-asymmetric ataxia
-gait + muscle atrophy can look like Sweeney or radial n paralysis
-brainstem involvement: dec tongue tone, head tilt, facial n paralysis, chewing m atrophy
-worse when head is elevated or when on incline
Term
How do we diagnose EPM?
Definition
-SAG 2/3/4 w/ CSF Index or IFAT
-CSF & blood
Term
What are some major differentials for EPM?
Definition
-CVSM
-WNV
-EHV
-trauma
-EEE, WEE
-EDM
-verminous myeloencephalitis
-rabies
Term
Why does TMS + pyrimethamine work to tx EPM? OUtline the protocol.
Definition
-blocks folate metabolism in protozoan
-tx for 5m w/ bi-monthly monitoring of PCV
Term
Why do we caution using TMS + pyrimethamine to treat EPM in stallions?
Definition
-can block sperm folate metabolism
Term
In addition to TMS + pyrimethamine, what else can we use to treat EPM?
Definition
-Diclazuril
-Ponazuril
-Decoquinate/Levamisole (trial phase)
-anti-inflamms: Flunixin meglumine
Term
Why is the use of glucocorticoids controversial to treat EPM?
Definition
-there might be an immunosuppression component & good evidence to support worsening of signs
Term
What supportive care is needed for EPM horses?
Definition
-padded helmets
-slings
-deeply bedded/padded stall
-supportive fluids & nutrition if needed
Term
What is the prognosis of EPM?
Definition
-60-75% improve 1 grade
<25% return to normal activity
Term
What is the rate of recurrence w/ EPM?
Definition
-TMS-Pyrimethamine: 10-28%
-Diclazuril <5%
Term
How do we prevent EPM?
Definition
-vx is crap
-prevent wildlife access to feed
-keep premises clear of dead cats, armadillos, skunks, and raccoons
-dex exposure of horses to opossums
Term
In general, describe Equine Herpes Myeloencephalopathy.
Definition
-diffuse, multifocal CNS lesions
-vasculitis, hemorrhage, thrombosis, ischemic neuronal injury
Term
Which virus is EHM most commonly associated?
Definition
-EHV-1
Term
EHM vx may not be protective against neuro manifestations. Which form of the vx is the best?
Definition
-monovalent
Term
What is the typical history of EHM?
Definition
-multiple horses on premises affected
-recent hx of fever, resp dz, or abortion on farm
Term
True or False: The majority of horses have not been exposed to EHM.
Definition
-FALSE, the majority of horses have been exposed
Term
Describe the timeline of EHM.
Definition
-incubation period is 2-10d
-CS resolve in 1-2w
Term
How long does immunity last for EHM after infection?
Definition
-3-4m
Term
How do horses get naturally infected w/ EHM?
Definition
-inhalation or ingestion of aerosolized birus
-direct contact w/ abortion fluids/tissues, nasal or ocular discharge or saliva of infected horses
Term
What is the typical seasonality of EHM?
Definition
-late winter, spring, early summer
Term
When during pregnancy must a mare be infected w/ EHM for the neuro form to occur? Abortive form?
Definition
-neuro form: first two trimesters
-abortive form: last trimester
Term
Neuro signs due to EHM typically develop 6-10d after infection however they can be preceded or accompanied by other signs. What are those other CS?
Definition
-upper resp signs
-fever
-inappetance
-hind limb edema
Term
What are the neuro signs of EHM?
Definition
-ataxia, paresis of limbs
-hypotonia of tail and anus
-urinary incontinence
-symmetric > asymmetric
-PL affected earlier & more severely
Term
What CP deficits do we see w/ milder EHM?
Definition
-reluctance to move
-clumsiness
-toe dragging
-knuckling
-stumbling
-pivoting
-circumduction on circling
Term
What CS do we see w/ severe EHM?
Definition
-profound limb weakenss
-swaying of hind quarters
-paralysis of affected limbs
-dog sitting
-complete recumbency
-tetraplegia
-urinary incontinence
Term
Why are EHM euthanasias particularly emotionally taxing?
Definition
-horses typically remain alert & appetent
Term
What are the major differentials for EHM?
Definition
-WNV
-EEE, WEE
-CVSM
-EPM
-trauma
-rabies
-verminous myeloencephalitis
-botulism
-EDM: depending on age
Term
How do we diagnose EHM?
Definition
-CSF: xanthochromia, inc protein
-virus isolation: may be negative
-PCR
-serologic titers: 4x inc
Term
How do we treat EHM?
Definition
-prompt isolation
-supportive nursing & nutritional care
-reduce CNS inflammation: anti-inflamm or immunosuppressives
-anti-virals
Term
What kind of supportive care is needed for EHM cases?
Definition
-protection from self-inflicted trauma
-make food & water easily accessible
-maintain in sternal, sling if possible
-maintain hydration
-laxative diet to avoid impaction
-appropriate caloric intake
-urinary bladder catheterization
-anti-inflamm or immunosuppressives
-ANTI-VIRAL MEDS
Term
What is the prognosis of EHM?
Definition
-god if they remain standing: variable healing rates (few days to 1y)
-poor if they become recumbent
Term
What are some control measures for EHM?
Definition
-minimize contact: aerosol, direct contact, fomites
-minimize stress
-isolate suspect animals immediately
-isolate exposed animals for 30d, pregnant mares until they foal
-fetuses & membranes bagged & disposed of for necropsy
-vx unexposed animals
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