GRANULAMATOUS MENINGOENCEPHALITIS
INTRODUCTION
✏ an inflammatory disease of the central nervous system (CNS)
✏ happen to dogs and rarely to cats
✏ more common in female toy dogs of young and middle age
✏ an idiopathic inflammatory condition of the central nervous system (CNS)
✏ first reported by Braund and colleagues in 1978
CAUSES
1. Abnormal immune
💥response to an infectious
agent
2. Canine distemper virus
⚠ canines, distemper impacts several body systems, including the gastrointestinal and respiratory tracts and the spinal cord and brain, with common symptoms that include high fever, eye inflammation and eye/nose discharge, labored breathing and coughing, vomiting and diarrhea, loss of appetite and lethargy, and hardening of nose and footpads. The viral infection can be accompanied by secondary bacterial infections and can present eventual serious neurological symptoms.
3 TYPES OF GME
🚫 Focal which is limited to one location in the central nervous system
🚫 Disseminated or multifocal, involving multiple locations in the central nervous system
🚫 Ophthalmic, which involves the optic nerve and eye
SYMPTOMS
⚠ blindness
⚠ drowsiness
⚠ circling
⚠ seizure
⚠ behavior changes
⚠ weakness in the hind legs or all four limbs depending on where the lesion is located.
⚠head pressing
⚠ headache
DIAGNOSIS
❤ vet will perform a basic blood panel and urinalysis
❤ spinal tap
❤Additional testing is usually performed to rule out other conditions with similar symptoms, including viral encephalitis from distemper or rabies, parasitic encephalitis from toxoplasmosis, fungal encephalitis, breed-specific inflammatory diseases, and cancer.
❤ computerized axial tomography (CAT)
: ❤ Imaging (MRI)
TREATMENT
CHEMOTHERAPY
chemotheraphy agent called procarbazine has been combined with prednisone to improve the length of GME remission
CYCLOSPORINE
an immunomodulator used to inhibit organ transplant rejection, and cytosine arabinoside, another chemotherapy agent that can be combined with prednisone
LEFLUNOMIDE
One of the new drug to treat immune-mediated diseases of a type that includes GME
RADIOTHERAPY
If the GME is focal, radiotherapy will be helpful. Radiation of the head can lead to abnormal clotting, which can in turn lead to seizures for periods as long as 5 to 6 months after therapy.
CONCLUSION
Untreated GME is invariably fatal, and the disseminated form carries the worst prognosis. Radiation therapy combined with corticosteroids has been shown to significantly increase survival time in dogs with the focal form presenting with forebrain signs. Leflunomide therapy is promising; however, prospective evaluations of a larger treatment group with a longer follow-up to substantiate these initial findings is warranted. Cytarabine, procarbazine, and cyclosporine treatment for GME may result in better long-term outcomes than those previously reported with glucocorticosteroid treatment alone.
SURGERY
✅ Surgical intervention is not a typical treatment modality for infectious brain disorders. However, it is suggested that the mass removal and the decrease in intracranial pressure afforded by craniotomy may benefit the patient .
✅ Surgical removal enable histologic confirmation of GME, which then may be followed by the most appropriate medical treatment