| Signalment |
Three year-old male castrated poodle |
| Chief Complaint |
Behavior change |
| Onset |
Three weeks ago |
| Course |
Initially dog began to be withdrawn from the
owner. Next the dog would not respond when called. Owner would
find dog "lost" in the house. The dog would be found in rooms
it never went in or staring at walls. Signs were progressively
worse over the three weeks. Finally the dog was circling to
the right and bumping into things on the left side. The owner
had to hand feed the dog. |
| Past Pertinent History |
None |
| Physical Exam |
A moderately large bladder was found on abdominal
palpation. The remaining physical exam was normal. |
| Neurologic Exam |
The dog was dull and inappropriate characterized
by wide circles to the right, bumping into things on the left
side, getting stuck in corners, and staring off into space.
Cranial nerve exam revealed a decreased menace L>R, decreased
palpebral on the left, decreased nasal sensation on the left,
with other cranial nerves being normal including papillary
light reactions. Gait revealed no ataxia, but incessant circling.
Conscious proprioception was decreased in the left fore limb
greater than the left rear limb. A positive crossed extensor
was found right to left in the fore limbs. There was no asymmetry
on thoracic sensory examination (pinching the left and right
side of the thorax was perceived similarly). |
| Neuroanatomic Diagnosis |
Right greater than left cerebral |
| Differential Diagnosis |
Encephalitis (granulomatous meningoencephalitis
- GME, infectious - Toxoplasmosis, Neospora, tick borne, fungal)
vs. hydrocephalus vs neoplasia vs degenerative/storage disease. |
| Diagnostics |
CBC, chemistry panel, U/A were NSF. Titers for tick borne disease, Toxoplasma and Neospora were all negative. |
| MRI |
Multifocal intra-axial hyperintense signal
lesions throughout the cerebral and thalamus on the sagittal
and axial T2WI. CSF tap. CSF analysis revealed an increased
number of leukocytes 25, with a mixed pleocytosis (lymphocytes,
macrophages, and an occasional neutrophil); and an increased
protein content (67 mg/dl). |
| CSF tap |
CSF analysis revealed an increased number of leukocytes 25, with a mixed pleocytosis (lymphocytes, macrophages, and an occasional neutrophil); and an increased protein content (67 mg/dl).
|
| Diagnosis |
Granulomatous meningoencephalitis (GME). |
| Treatment |
Dexamethasone 0.25mg TID x 7 days, BID x 21
days, SID x 42 days, EOD x 42 days. |
| Outcome |
The dog improved markedly over the first week
and then at a slower rate over the remaining treatment protocol.
The dog was weaned off steroids and remains with a subtle
decreased menace response in the left eye three years after
diagnosis. |
|
 |
Granulomatous meningoencephalitis (GME).
T2 axial images reveal multifocal hyperintense lesions throughout
the cerebrum and thalamus.
|
