Equine internal medicine -. Lecture 5. year Neurology
Transcript of Equine internal medicine -. Lecture 5. year Neurology
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