Equine internal medicine -. Lecture 5. year Neurology

Equine internal medicine -. Lecture 5. year Neurology

Equine neurology
MVDr. Eva Ludvíková
Neurologie
5. ročník
Neurological examination
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Clinical and laboratory examination
Behaviour, posture
Cranial nerves + body (in rest)
In motion
X-ray, (CT, USG) – head, neck
CSF – cytology, protein,….
EMG – LMN, peripheral nerve, muscle
Ophthalmologic examination (lipofuscin)
Ataxia
• CVSM
• Vestibular syndrome
– Peripheral – otitis media/interna
– Central
• Cerebelar abiotrophy + other cerebellum
lesions
Abnormal behaviour
• Encephalitis
• Meningitis
• Metabolic problem;absces,tumor,bleeding, ……
• EHV-1
• Bacterial inf.: Staphylococcus, Streptococcus,
Rhodococcus,….
• Borna disease
• Rabies
• West Nile virus
Meningoencephalitis
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Behaviour, mental status
Cranial nerves
Fasciculation
Neck stiffness, soreness (meningitis)
Move
CSF
Meningoencephalitis
Meningoencephalitis
Meningoencephalitis
Meningoencephalitis
• Corticosteroids
– dexamethason, prednisolon
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NSAID – flunixin meglumin, phenylbutason
ATB
DMSO?
Vitamin E 2 000 mg pro toto PO
Vitamin B
Meningoencephalitis
• ATB penetrating across hematoencephalic
barrier
– Ceftazidim, cefotaxim, cefepim, ceftriaxon
– Chloramphenikol – 25-50 mg/kg PO
– Trim. sulphonamide – 15-30 mg/kg PO, IV BID
– Enrophloxacin – 5,5 mg/kg SID, 7,5 mg/kg PO
SID
– Rifampin – 10 mg/kg IV BID
– Metronidazol – 12-25 mg/kg PO QID
Abnormal behaviour
• Epilepsy
• Diazepam 0,1 mg/kg/h; midazolam (0,05-0,1 mg/kg)
• Phenobarbital 4-10 mg/kg PO
– Idiopathic epilepsy of Arabian foals
• Narcolepsy a cataplexy
– Dif. dg. syncope, seizures, sleeping deprivation,
– Foals (more often Shetland, Am. miniature horse,
Suffolk, Lipizzaner)
–  hypocretin
– Fysostigmin test
Narcolepsy
Epilepsy
Epilepsy
Abnormal movement
Fibrotic myopathy
Dors. fixation of pately
Stringhalt
Shivers
Stringhalt
Equine reflex hypertonia
• Excessive flexion of hind limb/s
• Hypertony/hyperreflexie m. extensor digiti
lateralis
• Two forms:
– Plants intake related form (more affected
horses)
– Sporadic form (isolated cases)
Stringhalt
Plants intake related form
• Hypochoeris radicata, Taraxacum
officinalis, Malva parviflora
• Progressive, amyotrophy, front limb
• More severe than sporadic form
• More horses in the same herd
• Hemiplegia laryngis sinistra
• Distal axonopathy
• Recovery in 6-12 months
Stringhalt
Sporadic form
• More often unilateral
• After trauma (dors. metatarsus/tarsus)
• Also idiopathic
• Without pathohistologic findings
• EMG – pathologic spontaneous activity
• Myotenectomy m. extensor digiti lateralis –
sometimes improvement
Stringhalt
Fibrotic myopathy
• Repeated injury m. semitendinosus, m.
gracilis (and other muscles)
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Scar tissue, non-painful, chronic
Sliding-stop, barrel-racing, trauma
In walk; in trot less obvious
USG
Tenotomy – improvement in some cases
Prognosis - guarded
Fibrotic myopathy
Fibrotic myopathy
Fibrotic myopathy
Spinal cord trauma
Tetanus
• Cl. tetani (tetanospasmin)
• Wounds, injections, placenta retention, sole
absces, umbilicus
• Toxin cleaves synaptobrevin (protein required
for exocytosis inhibitory neurotransmiters GABA, glycin)
• Diffuse, symmetrical hypertonicity (tetanic
spasm)
• Ears, thirds eyelids, nostrils, tail, stiffness,
dysphagia, hyperesthesia, recumbency
• Mortality 75 %
Tetanus
Tail, ears, neck
Third eyelids protrusin
Tetanus
• Metronidazol x PNC iv
• Diazepam, ACP, + xylazin
• TAT (iv, im) – 2,5 mil. IU
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TAT (CSF) – 5-10 tis. IU
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Therapeutic vaccination
• Rest, calm surroundings, dark, silence
• Nutrition – indwelling feeding tube, infusion
• Faeces and urine evacuation
• Sling
dysphagia
Tetanus
• Vaccination 1x per year
• In a case of injury revaccination
• Injured of non-vaccinated horse – 1500 IU
TAT + vaccination
• Pregnant mare – vaccination 10-11 m. of
pregnancy
• Foals from 3 months (3, 4, 6 m., next year)
Weakness
• Equine motor neuron disease
• Botulismus
EMND
Botulism
EMND
Botulism
• Cl. botulinum – A, B, C1, C2, D, E, F
• Toxin blocks acetylcholin release
 Toxin in forage (haylage, round bale hay,
packed hay)
 Wound or umbilicus contamination by Cl.
botulinum
 Toxin production in GIT
• Flaccid paralysis (x LMN) – weakness,
dysphagia, incontinence, mydriasis, ptosis,
muscle tremor and fasciculation, ↓ tongue
retraction
• Without ataxia!, clinical signs are symmetric!
Botulismus
• Dg.: clinical signs
• Toxin confirmation in serum, GIT content,
feedstuff (by bio-mousse-assay)
• Spores in feedstuffs or GIT content
• Antibodies confirmation (in non-vaccinated Eq)
• Therapy: antitoxin (mono/polyvalent)
• Rest, infusion, nutrition, sling
• CI: aminoglycosides, tetracycline, procainPNC
Horner`s syndrom
• Sympathetic lesions
– Miosis
– Eyelids ptosis
– Enophtalmus
– Third eyelids protrusion
– Sweating (head, neck to C2)
• Paravenious injection, neck trauma,
guttural pouch mycosis,…
Cranial nerves lesions
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N. facialis – often with CN VIII
N. trigeminus
N. opticus – head trauma
N. vagus, n. glosospharyngeus – guttural
pouch
• N. vestibularis – otitis interna/media
(temporohyoid osteoartropathy)
• NSAID (sys. + loc.), DMSO, corticoids,
rehabilitations
n. facialis
n. glossopharyngeus, n. vagus
dysphagia
n. vagus (n. laryngeus recurrens)
degenerative distal axonopathy
n. vestibularis
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Head tilt
Ventral strabismus
Nystagmus
Asymmetric ataxia
X-ray
Endo – guttural pouches
NSAID, ATB, vitamin E
Neuritis caudae equinae
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Tail tone
Anal reflex
Anus and perineal anaesthesia
Faeces retention
Urine bladder paralysis
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EHV-1
Sacral fractures (S2)
Polyneuritis equi
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One limb paresis
n. suprascapularis
One limb paresis
n. femoralis
n. obturatorius
n. radialis