Granulomatous meningoencephalitis

9 Granulomatous meningoencephalitis




INITIAL PRESENTATION


Staring into space while lying on the sofa.



INTRODUCTION


Looking in one direction for an extended period of time is often a sign of cerebral disease. Staring at walls, into corners, or ‘into space’ are common presenting signs and distracting the animal may or may not be successful at stopping it. Neck pain limits head movement and general activity but such animals move their eyes towards stimuli and are mentally responsive. Recently-blind animals move slowly, bump into objects and do not respond to visual clues; clinical diagnosis is straightforward.



SIGNALMENT


An 11-year-old male labrador.



CASE PRESENTING SIGNS


Episodes of staring.



CASE HISTORY


Hour-long episodes of being mentally unresponsive while lying on the sofa and staring at the wall commenced 6 months prior to referral. The events occurred at least once a week at any time of day and only when indoors. The dog was normal between the events. No other abnormalities were reported.



CLINICAL EXAMINATION


The dog was neurologically normal.



NEUROANATOMICAL LOCALIZATION


Cerebrum, due to the behaviour change, which may have been partial seizure activity.


It may not have been neurological: the dog may have had undiagnosed arthropathy causing a reluctance to move but this was not evident in the history or physical examination. An age-related hearing loss may not have been noticed previously and have contributed to the dog’s lack of response to being called. A trial of non-steroidal anti-inflammatory drugs (NSAIDs) had been used but this had had no effect on the frequency or duration of the events and had been discontinued.



DIFFERENTIAL DIAGNOSIS


Metabolic encephalopathy: intermittent loss of consciousness may be from hypoglycaemia which can be difficult to diagnose from one random blood sampling.


Liver failure, but there was no history or physical evidence of this and so was it discounted.


Seizure activity.


Increased intracranial pressure from neoplasia.


Cognitive dysfunction syndrome, a progressive, incurable loss of normal behaviour in the absence of any other known cause, was a consideration in this aged dog. Owners often describe their pet as ‘senile’. Systemic or primary neurological diseases must be ruled out first before diagnosing this condition.


Presenting signs mimic those of cerebral disease or ageing change (deafness, reduced mobility):


• Inattentive, becoming lost in familiar environments, failure to recognize familiar people/animals

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Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Granulomatous meningoencephalitis
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