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Also know as: '''''Neuritis of the Cauda Equina — Cauda Equina Syndrome — Cauda Equina Neuritis — PNE'''''
==Introduction==
Polyneuritis equi is uncommon and caused by a '''progressive immune-mediated lymphocytic infiltration and demyelination''' of the sacrococcygeal and lumbosacral nerve roots of the '''cauda equina'''. Nerves outside the cauda equina, such as the '''cranial nerves''', may also be affected.
The aetiology of the disease is unknown, but evidence suggests that it is an allergic-mediated polyneuropathy similar to '''Guillain-Barré syndrome in humans''' and experimental allergic neuritis (EAN) of laboratory rodents. Infection with [[Equine Herpesvirus 1|Equine Herpesvirus-1]] and ''[[Campylobacter species - Overview|Campylobacter]]'' have been proposed, but there has been no confirmation.
It is seen in '''adult horses of all breeds in North America and Europe'''.
==Clinical Signs==
Typically, there is a '''slow progressive paralysis''' of the tail, rectum, anus and bladder and hindlimb weakness and ataxia.
There will be '''urine scalding''' of the hindlimbs, hyperaesthesia and muscle fasciculations over the hindquarters.
'''Muscle atrophy''' is variably present.
'''[[Cranial Nerves - Anatomy & Physiology|Cranial nerve]] involvement''', particularly CN V, VII and VIII, may also be present and is usually asymmetric. This will present as paralysis of the facial muscles, head tilt, nystagmus, tongue paralysis and difficulty swallowing.
==Diagnosis==
Currently there are no specific antemortem tests to detect the disease in horses.
The diagnosis is one of '''exclusion''', supported by the clinical signs and history.
An [[ELISA testing|ELISA]] can be performed to detect '''antibodies against P2-myelin protein''', but the test is not available commercially and is not specific for the disease.
On routine '''haematology''': evidence of chronic inflammation is usually detected.
Analysis of the [[Cerebral Spinal Fluid - Anatomy & Physiology|'''CSF''']] reveals: xanthochromia and a mildly increased protein and cell count.
'''Differential diagnoses''' that should be ruled out before a diagnosis of PNE is considered include:
:[[Equine Herpesvirus 1|Equine herpesvirus-1]] myeloencephalopathy
:Sacral/coccygeal trauma
:[[Equine Motor Neuron Disease|Equine motor neuron disease]]
:Abberant parasite migration (e.g. [[:Category:Strongyloidea|''Strongylus spp.'']])
:In endemic areas, such as the USA ''[[Sarcocystis|Sarcocystis neurona]]'' myelitis ([[Equine Protozoal Myeloencephalitis|equine protozoal myelitis]])
:[[Rabies]] and ''[[Rhodococcus equi]]'' myeloencephalitis should also be considered.
The definitive diagnosis is made on '''post-mortem examination'''. Extradural and intradural nerve roots of the cauda equina are grossly thickened and are infiltrated with inflammatory cells. Demyelination and axonal degeneration are present. Similar changes in the cranial nerves may be observed.
==Treatment==
Treatment is '''palliative''', including managmenent of urinary and faecal incontinence, managing cystitis and minimising urine scalding.
Horses with dysphagia may need tube feeding.
Treatment with '''corticosteroids''' has provided some palliative benefits but the effect is short-lived.
The condition is '''slowly progressive, but the prognosis is generally poor'''.
{{Learning
|flashcards = [[Equine Orthopaedics and Rheumatology Q&A 06]]
}}
==References==
DeLahunta, A. (2008) '''Veterinary neuroanatomy''' ''Elsevier Health Sciences''
Merck and Co (2008) '''Merck Veterinary Manual''' ''Merial''
Taylor, F. (2009) '''Diagnostic techniques in equine medicine''' ''Saunders''
Furr, M. (2008) '''Equine Neurology''' ''John Wiley and Sons''
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[[Category:Neurological Diseases - Horse]]
[[Category:Expert Review - Horse]]
[[Category:Central Nervous System - Idiopathic Pathology]]
[[Category:Central Nervous System - Idiopathic Pathology]]
[[Category:Peripheral Nervous System - Pathology]]