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dwerten · 05-25-2010, 08:13 PM

These signs can progress at various rates, but surprisingly they are often acute (1-2 days) to peracute (8-12 hours) in duration on initial presentation. In the peracute form these autoimmune brain and spinal cord diseases can be one of the most serious neurological emergencies. It is possible for a dog with GME involving the brain stem to progress from mild vestibular ataxia to severe violent rolling to opisthotonos, coma and death within 12-24 hours from the first onset of clinical signs. A dog with GME involving the cervical spinal cord may progress from signs of mild ataxia to full tetraplegia in 1-2 days mimicking a cervical disc herniation. Pugs, Maltese terriers and Yorkshire terriers with necrotizing encephalitis commonly present with only 1-2 days or even a few hours of pacing, demented behavior followed by near constant seizure activity and death within 12 to 24 hours.

Although in most cases a neurological patient should be stabilized and diagnostic tests evaluated before treatment is started, a dog with rapidly progressive GME or necrotizing encephalitis may be dead, or permanently neurologically damaged, if treatment is withheld for 8-12 hours so a cerebrospinal fluid (CSF) analysis and advanced imaging can be evaluated before treatment is begun. It is therefore imperative that a high index of suspicion be maintained for autoimmune CNS disease when dogs are presented with unusually rapidly developing seizures, vestibular signs, tetraparesis, violent generalized tremors or blindness. Frequent, accurate neurological examinations will indicate if rapidly progressive or static to improving disease is present. For this reason do not admit a dog that appears to have acute onset geriatric vestibular disease with plans to re-evaluate the dog the next morning. If the dog has GME death may occur by then. If rapid neurologic deterioration is noted on repeat examination then immediate referral to a 24-hour emergency center or aggressive immune suppressive therapy should be started until a CSF analysis and advanced CNS imaging can be done to confirm the diagnosis. Increased cellularity of a CSF analysis is not likely to be altered by corticosteroid or other immunosuppressive therapy for 12 to perhaps 24 hours; so an accurate diagnosis can still be made after glucocorticoid therapy has begun. However, if CSF is collected after 12-24 hours of glucocorticoid therapy false negative results are often obtained. Therefore you must begin, or refer the dog for, diagnostic testing as soon as possible after initiating therapy in such an emergency situation.

05-25-2010, 08:13 PM	#78
dwerten BANNED! Join Date: May 2007 Location: USA Posts: 11,073	These signs can progress at various rates, but surprisingly they are often acute (1-2 days) to peracute (8-12 hours) in duration on initial presentation. In the peracute form these autoimmune brain and spinal cord diseases can be one of the most serious neurological emergencies. It is possible for a dog with GME involving the brain stem to progress from mild vestibular ataxia to severe violent rolling to opisthotonos, coma and death within 12-24 hours from the first onset of clinical signs. A dog with GME involving the cervical spinal cord may progress from signs of mild ataxia to full tetraplegia in 1-2 days mimicking a cervical disc herniation. Pugs, Maltese terriers and Yorkshire terriers with necrotizing encephalitis commonly present with only 1-2 days or even a few hours of pacing, demented behavior followed by near constant seizure activity and death within 12 to 24 hours. Although in most cases a neurological patient should be stabilized and diagnostic tests evaluated before treatment is started, a dog with rapidly progressive GME or necrotizing encephalitis may be dead, or permanently neurologically damaged, if treatment is withheld for 8-12 hours so a cerebrospinal fluid (CSF) analysis and advanced imaging can be evaluated before treatment is begun. It is therefore imperative that a high index of suspicion be maintained for autoimmune CNS disease when dogs are presented with unusually rapidly developing seizures, vestibular signs, tetraparesis, violent generalized tremors or blindness. Frequent, accurate neurological examinations will indicate if rapidly progressive or static to improving disease is present. For this reason do not admit a dog that appears to have acute onset geriatric vestibular disease with plans to re-evaluate the dog the next morning. If the dog has GME death may occur by then. If rapid neurologic deterioration is noted on repeat examination then immediate referral to a 24-hour emergency center or aggressive immune suppressive therapy should be started until a CSF analysis and advanced CNS imaging can be done to confirm the diagnosis. Increased cellularity of a CSF analysis is not likely to be altered by corticosteroid or other immunosuppressive therapy for 12 to perhaps 24 hours; so an accurate diagnosis can still be made after glucocorticoid therapy has begun. However, if CSF is collected after 12-24 hours of glucocorticoid therapy false negative results are often obtained. Therefore you must begin, or refer the dog for, diagnostic testing as soon as possible after initiating therapy in such an emergency situation.