Neurologie

5. ročník

Equine neurology

MVDr. Eva Ludvíková

Neurological examination

• 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

• Behaviour, mental status

• Cranial nerves

• Fasciculation

• Neck stiffness, soreness (meningitis)

• Move

• CSF

Meningoencephalitis

Meningoencephalitis

Meningoencephalitis

Meningoencephalitis

• Corticosteroids

– dexamethason, prednisolon

• 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

Shivers Stringhalt

Dors. fixation of pately

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)

• 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

• TAT (CSF) – 5-10 tis. IU

• 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

• 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

• Head tilt

• Ventral strabismus

• Nystagmus

• Asymmetric ataxia

• X-ray

• Endo – guttural pouches

• NSAID, ATB, vitamin E

Neuritis caudae equinae

• Tail tone

• Anal reflex

• Anus and perineal anaesthesia

• Faeces retention

• Urine bladder paralysis

• EHV-1

• Sacral fractures (S2)

• Polyneuritis equi

• ?

One limb paresis

n. suprascapularis

One limb paresis

n. obturatorius

n. radialis

n. femoralis