Top 15 Equine Neuro Disorders Part 2

Zuku's Top 15 Equine Neurologic Disorders To Know For NAVLE® Success:

6. Herpes myeloencephalopathy
Classic case:
Usually adult horses
Single horse or epizootic
Acute onset ataxia or recumbency
Urinary incontinence
Ascending paralysis
Stabilize after 24 h
+/- Stupor or cranial neuropathies
Other horses in herd:
Distal limb edema in pregnant mares
Scrotal edema in stallions
Abortions
Respiratory infections
Fever
Dx:
Etiology: Equine herpesvirus 1 (EHV-1): Xanthochromic (yellowish) CSF is
often seen with herpes
Typically the D752 strain causes neurologic disease myeloencephalopathy
and N752 strain causes non-neurologic disease
Strain-specific disease is not always clear cut and
crossover does occur
Diagnosis based on a combination of clinical suspicion
and clinical testing (below)
PCR (on nasopharyngeal swab, buffy coat)
CSF from lumbar puncture: Recumbent horses with EHV-1 have
Xanthochromia (yellow-tinged) worse outcomes than horses who can
Elevated protein stand
Usually no increase in cell count
Fourfold rise in EHV-1 serum titer over 2 wks (not practical
in acute cases)
Rx:
Glucocorticoids for up to 3 d
Nursing care:
Urinary bladder catheterization
Safe environment
Segregation and isolation of affected animals for 21-28 d after clinical signs and new cases
stop
Anti-virals (Valacyclovir) and heparin are used on a case-by-case basis
Prevention:
Vaccination may decrease respiratory symptoms and abortion but does NOT prevent
infection nor prevent neurologic disease
Isolate new arrivals for 2-3 wks
Pearls:
Prognosis:
Good for horses that can walk well
 Guarded to poor for recumbent horses

7. Neonatal encephalopathy "aka perinatal asphyxia syndrome (PAS) and hypoxic and
ischemic encephalomyelopathy (HIE)"
Classic case:
Signalment:
Newborn up to 1 wk of age
Thoroughbreds are over-represented
+/- History of premature placental separation or dystocia
Typical scenario:
First: Normal newborn for mins to hrs Foals with neonatal encephalopathy
Then: Loses interest in nursing, inability to suckle may have opisthotonus
(dysphagia)
Lethargic, stuporous, comatose
Aimlessly wandering
Central blindness
Opisthotonus
Seizures
Hypotonia
Abnormal vocalization (hence the nickname "barkers")
Typically afebrile in cases without concurrent sepsis or
meningitis
Dx:
Etiology: Thought to be due to unrecognized in utero or
peripartum hypoxia, neuronal hypoxia, oxidative stress, or
upregulation of the fetal inflammatory response
Diagnosis based on exclusion of sepsis, premature birth,
trauma, or meningitis Foals with neonatal encephalopathy
CSF may be xanthochromic require 24 h nursing care
Rx:
Anticonvulsants
24 h nursing care
Antibiotics due to risk of sepsis and/or hospitalization
Pearls:
Prognosis: Up to 80% survivial and good quality of life if not septic
Previously referred to as neonatal maladjustment syndrome
Madigan squeeze: New technique that shows great promise! Affected foals are squeezed to
mimic the birth canal transition. Check out this video, courtesy of Performance Equine Vets

8. Vestibulopathy
Classic case:
Head tilt (ipsilateral) exacerbated when
blindfolded
Nystagmus (fast phase opposite lesion)
Ipsilateral ventral strabismus when head is raised
Ataxia:
Staggering
Truncal swaying
Leaning or falling toward side of lesion
Drifting sideways during ambulation
Examiner unable to predict where feet will land during
ambulation
Lifts only one foot at a time
Hypometria
Violent thrashing
Rolling Right facial nerve paralysis (note right
lip and ear droop). Facial nerve
 Wide base stance and gait paralysis may be concurrent in
Circling (toward affected side) vestibular disease due to otitis
If central disease (brainstem): media/interna
Nystagmus may be in any direction, but vertical
nystagmus is only seen with central disease
Somnolence
Weakness
Hemiparesis (ipsilateral)
If peripheral disease (anywhere the vestibular nerve
passes from the skull to the inner ear):
Typically horizontal nystagmus with fast phase away
from lesion; may be rotary or angular, but never
vertical
Facial nerve paralysis may be concurrent in some
cases of peripheral disease (otitis, guttural pouch
disease, temporohyoid osteoarthropathy, trauma) due
to close anatomic proximity of facial and vestibular
nerves
Bilateral disease will cause wide swaying movements of
the head Left head tilt. In vestibular disease, the
Dx: head tilt is toward the side of the
Multiple etiologies: lesions
Central:
Head trauma
EPM
Migrating parasites
Neoplasia
Peripheral:
Temporohyoid osteoarthropathy
Suppurative otitis media/interna
Guttural pouch disorders
Idiopathic
Skull radiography, CT, MRI
Upper airway, guttural pouch endoscopy
CSF analysis if central
Culture and sensitivity of CSF or exudates
+/- Brainstem auditory evoked response
Rx:
Treat infections aggressively with antibiotics or antifungals (at least 2-4 wks)
Treat for head trauma if indicated (see Equine Neuro Part 1)
Ceratohyoidectomy for temporohyoid osteoarthropathy
Pearls:
Prognosis:
Depends on underlying cause
Fair to good with otitis interna/media
Chronic cases don't do as well
May have residual head tilt
Head trauma is guarded, depending on extent of injury
The most common causes are temporohyoid osteoarthropathy and head trauma
Paradoxical vestibular syndrome occurs in central lesions that involve specific areas of the
cerebellum, resulting in a head tilt and circling away from side of lesion

9. Polyneuritis equi
Classic case: (aka cauda equina neuritis)
Any breed or age (except young foals or aged horses)
Urinary incontinence and fecal impaction
 Urine scald
Tail head rubbing (see broken tail head hairs)
Analgesia and areflexia of tail, anus, perineum,
rectum, and penis (but not prepuce)
Cranial neuropathies (head tilt, facial nerve paralysis,
tongue paralysis)
Impotence in stallions
+/- Recent history of vaccination or respiratory illness
Dx:
Etiology: Likely autoimmune
Can measure circulating antibodies to P2-myelin protein
via ELISA (many false positives) In polyneuritis equi, may see broken
Highly based on clinical suspicion - presence of cauda tail head hairs due to excessive
equina +/- cranial nerve involvement rubbing
CSF:
Xanthochromia
Mononuclear pleocytosis
Elevated protein
May be normal in some cases
Electromyography (EMG)
Rx:
Nursing care
Frequent bowel and bladder evacuation
Pearls:
Prognosis: Poor for functional recovery
EMG is an ancillary diagnostic tool for
polyneuritis equi
10. Meningitis
Classic case:
Usually neonatal or weanling foals; sometimes
adults
Hyperesthesia (tactile and auditory)
Stiff, extended neck
Muscle tremors
Somnolence
Concurrent omphalitis, ophthalmitis in neonates
Lack of suckling reflex in neonates
+/- Fever
If brain involvement (meningoencephalitis):
Seizures
Central blindness
Wandering
Head pressing
Star gazing
Abnormal vocalization
Dx: Head pressing may occur with
Bacteria: Most commonly ... meningoencephalitis
Actinobacillus equuli
Rhodococcus equi
Streptococcus equi equi
CSF:
Neutrophilic pleocytosis (acute): May not occur in
neonates or foals if neutropenic from sepsis
Monocytic pleocytosis (chronic)
Increased protein
Negative glucose (can use urine strip to test)
Blood and CSF culture
 Rx: CSF with neutrophilic pleocytosis can
Antimicrobial therapy: occur in acute cases of meningitis
Based on culture and sensitivity
Treat for 2-6 wks
Notes on the blood brain barrier (BBB):
Meningitis compromises the BBB which allows penetration of most antibiotics early
on
However, should always try to start with antibiotics that penetrate the BBB as it will
heal before treatment is complete
NSAIDs
+/- Plasma for neonates
Pearls:
Prognosis: Guarded to poor (25% survival in foals)
Failure of passive transfer is a huge risk factor in neonates

Images courtesy of bianditz (horses in field), Dschafar (xanthochromic CSF), Andrew Gray (horse in lateral recumbency), PLOS Genetics
(recumbent foal), Dr Stephanie Brault (foal on IV fluids), Dr Nora Grenager (facial nerve paralysis, head pressing), Appaloosas (head tilt),
Ealdgyth (tail head), Jensflorian (neutrophilic pleocytosis), " target="_blank"> (), " target="_blank"> (), and D. Gordon E. Robertson (EMG).

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