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Equine Protozoal Myeloencephalitis (view source)

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→‎Differential Diagnoses

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| '''Tests to rule out'''

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|Cervical vertebral malformation (CVM, cervical compressive myelopathy, cervical vertebral instability, cervical spondylomyelopathy, Wobbler's syndrome)

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|Cervical vertebral malformation (CVM, cervical compressive myelopathy, cervical vertebral instability, cervical stenotic myelopathy, cervical spondylomyelopathy, Wobbler's syndrome).

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|Symmetrical gait deficits, worse in pelvic limbs<ref>Mayhew, I.G, deLahunta, A, Whitlock, R.H, Krook, L, Tasker, J.B (1978) Spinal cord disease in the horse, ''Cornell Vet'', 68(Suppl 8):110-120. In: Hahn, C.N (2010) ''Cervical Vertebral Malformation'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref> with spasticity and dysmetria, good retention of strength, no muscle wasting<ref name="Furr">Furr, M (2010) ''Equine protozoal myeloencephalitis'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref> '''NB:can be concurrent with EPM'''.<ref name="Hahn">Hahn, C.N (2010) ''Cervical Vertebral Malformation'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|Symmetrical gait deficits, worse in pelvic limbs<ref>Mayhew, I.G, deLahunta, A, Whitlock, R.H, Krook, L, Tasker, J.B (1978) Spinal cord disease in the horse, ''Cornell Vet'', 68(Suppl 8):110-120. In: Hahn, C.N (2010) ''Cervical Vertebral Malformation'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref> with spasticity and dysmetria, good retention of strength, no muscle wasting.<ref name="Furr">Furr, M (2010) ''Equine protozoal myeloencephalitis'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref> '''NB:can be concurrent with EPM'''.<ref name="Hahn">Hahn, C.N (2010) ''Cervical Vertebral Malformation'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

|Plain lateral radiography of C1 to T1<ref name="Hahn">Hahn, C.N (2010) ''Cervical Vertebral Malformation'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>, myelography. <ref name="Seino">Seino, K.K (2010) ''Spinal Ataxia'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 3.</ref>

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|West Nile encephalitis

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|Systemically ill, pyrexia. Difficult if horse afebrile and has no excessive muscle fasciculations<ref name="Long">Long, M.T (2010) ''Flavivirus Encephalitis'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|Systemically ill, pyrexia. Difficult to differentiate if horse is afebrile and has no excessive muscle fasciculations.<ref name="Long">Long, M.T (2010) ''Flavivirus Encephalitis'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

|Leukogram, CSF analysis, IgM capture ELISA, plaque reduction neutralization test (PRNT).<ref name="Seino">Seino, K.K (2010) ''Spinal Ataxia'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 3.</ref>

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|[[Equine Togaviral Encephalitis|WEE]]

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|Systemically ill, pyrexia, abnormal motor function<ref name="Long">Long, M.T (2010) ''Flavivirus Encephalitis'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|Systemically ill, pyrexia, abnormal motor function.<ref name="Long">Long, M.T (2010) ''Flavivirus Encephalitis'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|Leukogram, ELISA, titres, ~~viral~~ isolation.<ref name="Seino">Seino, K.K (2010) ''Spinal Ataxia'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 3.</ref>

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|Leukogram, ELISA, titres, virus isolation.<ref name="Seino">Seino, K.K (2010) ''Spinal Ataxia'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 3.</ref>

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|[[Equine Togaviral Encephalitis|EEE]]

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|Systemically ill, pyrexia, abnormal motor function<ref name="Long">Long, M.T (2010) ''Flavivirus Encephalitis'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref, rapidly progressive.<ref name="Seino">Seino, K.K (2010) ''Spinal Ataxia'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 3.</ref>

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|Systemically ill, pyrexia, abnormal motor function<ref name="Long">Long, M.T (2010) ''Flavivirus Encephalitis'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>, rapidly progressive.<ref name="Seino">Seino, K.K (2010) ''Spinal Ataxia'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 3.</ref>

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|Leukogram, CSF analysis, ELISA, titres, ~~viral~~ isolation

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|Leukogram, CSF analysis, ELISA, titres, virus isolation.<ref name="Seino">Seino, K.K (2010) ''Spinal Ataxia'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 3.</ref>

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|[[Equine Togaviral Encephalitis|VEE]]

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|Equine herpesvirus-1 myeloencephalopathy

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|Sudden onset and early stabilization of ~~neuro~~ signs, multiple horses affected, recent fever, abortion<ref>Wilson, W.D, Pusterla, N (2010) ''Equine Herpesvirus-1 Myeloencephalopathy'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>~~dysuria~~ not often seen in EPM.

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|Sudden onset and early stabilization of neurological signs, multiple horses affected, recent fever, abortion.<ref>Wilson, W.D, Pusterla, N (2010) ''Equine Herpesvirus-1 Myeloencephalopathy'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref> Dysuria not often seen in EPM.<ref name="Furr">Furr, M (2010) ''Equine protozoal myeloencephalitis'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

|CSF analysis, PCR<ref name="Furr">Furr, M (2010) ''Equine protozoal myeloencephalitis'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>, titres, virus isolation.<ref name="Seino">Seino, K.K (2010) ''Spinal Ataxia'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 3.</ref>

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|''Polyneuritis equi'' (previously ''cauda equina'' neuritis)

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|Cranial nerve deficits are peripheral with no change in attitude<ref>Scaratt, W.K, Jortner, B.S (1985) Neuritis of the cauda equina in a yearling filly. ''Compend Contin Educ Pract Vet'', 7:S197-S202. In: Saville, W.J (2010) ''Polyneuritis equi'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|Cranial nerve deficits are peripheral with no change in attitude.<ref>Scaratt, W.K, Jortner, B.S (1985) Neuritis of the cauda equina in a yearling filly. ''Compend Contin Educ Pract Vet'', 7:S197-S202. In: Saville, W.J (2010) ''Polyneuritis equi'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|Western blot analysis of CSF<ref>Granstrom, D.E, Dubey, J.P, Giles, R.C (1994) Equine protozoal myeloencephalitis: biology and epidemiology. In Nakajima, H, Plowright, W, editors: ''Refereed Proceedings'', Newmarket, England, R & W Publications. In: Saville, W.J (2010) ''Polyneuritis equi'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|Western blot analysis of CSF.<ref>Granstrom, D.E, Dubey, J.P, Giles, R.C (1994) Equine protozoal myeloencephalitis: biology and epidemiology. In Nakajima, H, Plowright, W, editors: ''Refereed Proceedings'', Newmarket, England, R & W Publications. In: Saville, W.J (2010) ''Polyneuritis equi'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|Equine degenerative myeloencephalopathy

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|Symmetrical signs<ref name="Nout">Nout, Y.S (2010) ''Equine Degenerative Myeloencephalopathy'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|Symmetrical signs.<ref name="Nout">Nout, Y.S (2010) ''Equine Degenerative Myeloencephalopathy'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|May get increased CSF CK<ref>Mayhew, I.G, deLahunta, A, Whitlock, R.H, Krook, L, Tasker, J.B (1978) Spinal cord disease in the horse, ''Cornell Vet'', 68(Suppl 8):1-207. In: Nout, Y.S (2010) ''Equine Degenerative Myeloencephalopathy'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref> and reduced serum Vitamin E concentrations but unreliable ante mortem diagnosis.<ref name="Nout">Nout, Y.S (2010) ''Equine Degenerative Myeloencephalopathy'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|May get increased CSF creatinine kinase (CK)<ref>Mayhew, I.G, deLahunta, A, Whitlock, R.H, Krook, L, Tasker, J.B (1978) Spinal cord disease in the horse, ''Cornell Vet'', 68(Suppl 8):1-207. In: Nout, Y.S (2010) ''Equine Degenerative Myeloencephalopathy'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref> and reduced serum Vitamin E concentrations but these are unreliable for ante mortem diagnosis.<ref name="Nout">Nout, Y.S (2010) ''Equine Degenerative Myeloencephalopathy'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|Verminous encephalomyelitis

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|Acute onset

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|Acute onset.

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|CSF analysis<ref>Jose-Cunilleras, E (2010) ''Verminous Encephalomyelitis'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|CSF analysis.<ref>Jose-Cunilleras, E (2010) ''Verminous Encephalomyelitis'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|Bacterial meningoencephalitis

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|Stiff neck<ref name="Pasq">Pasquini, C, Pasquini, S, Woods, P (2005) '''Guide to Equine Clinics Volume 1: Equine Medicine''' (Third edition), ''SUDZ Publishing'', 245-250.</ref>

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|Stiff neck.<ref name="Pasq">Pasquini, C, Pasquini, S, Woods, P (2005) '''Guide to Equine Clinics Volume 1: Equine Medicine''' (Third edition), ''SUDZ Publishing'', 245-250.</ref>

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|CNS abscessation<ref name="Furr">Furr, M (2010) ''Equine protozoal myeloencephalitis'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|CNS abscessation due to 'bastard strangles'<ref name="Furr">Furr, M (2010) ''Equine protozoal myeloencephalitis'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|History of ''Streptococcus equi subsp. equi'' infection.<ref name="Byrne">Byrne, B. A (2010) ''Diseases of the Cerebellum'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|CSF analysis (severe, suppurative inflammation), culture of CSF.<ref name="Byrne">Byrne, B. A (2010) ''Diseases of the Cerebellum'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|Spinal trauma<ref name="Pasq">Pasquini, C, Pasquini, S, Woods, P (2005) '''Guide to Equine Clinics Volume 1: Equine Medicine''' (Third edition), ''SUDZ Publishing'', 245-250.</ref>

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|Hx (usually acute onset ~~neurologica~~ signs), usually solitary lesion localised by neurological exam<ref>Smith, P.M, Jeffery, N.D (2005) Spinal shock - comparative aspects and clinical relevance. ''J Vet Intern Med'', 19:788-793. In: Nout, Y.S (2010) ''Central Nervous System Trauma'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|History (usually acute onset neurological signs), usually solitary lesion localised by neurological exam.<ref>Smith, P.M, Jeffery, N.D (2005) Spinal shock - comparative aspects and clinical relevance. ''J Vet Intern Med'', 19:788-793. In: Nout, Y.S (2010) ''Central Nervous System Trauma'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

|Radiography, myelography, CT, MRI, nuclear scintigraphy, ultrasound, CSF analysis, nerve conduction velocities, EMG, transcranial magnetic stimulation.<ref>Nout, Y.S (2010) ''Central Nervous System Trauma'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|Occipito-atlanto-axial malformation (OAAM)

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|Deficits develop before 6mths in Arabian horse<ref>Watson, A.G, Mayhew, I.G (1986) Familial congenital occipitoatlantoaxial malformation (OAAM) in the Arabian horse. ''Spine'', 11:334-339. In: Seino, K.K (2010) ''Spinal Ataxia'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 3.</ref>

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|Deficits develop before 6mths in Arabian horse.<ref>Watson, A.G, Mayhew, I.G (1986) Familial congenital occipitoatlantoaxial malformation (OAAM) in the Arabian horse. ''Spine'', 11:334-339. In: Seino, K.K (2010) ''Spinal Ataxia'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 3.</ref>

|Radiography.<ref name="Seino">Seino, K.K (2010) ''Spinal Ataxia'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 3.</ref>

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|Spinal ~~tumors~~

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|Spinal tumor

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|Signs can usually be localized to one region of the CNS

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|Signs can usually be localized to one region of the CNS.

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|CT, MRI~~, definitive dx~~ requires cytology, biopsy, histopathology, CSF analysis<ref>Sellon, D.C (2010) ''Miscellaneous Neurologic Disorders'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|CT, MRI. Definitive diagnosis requires cytology, biopsy, histopathology or CSF analysis.<ref>Sellon, D.C (2010) ''Miscellaneous Neurologic Disorders'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 12.</ref>

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|Sorghum cystitis/ataxia<ref name="Pasq">Pasquini, C, Pasquini, S, Woods, P (2005) '''Guide to Equine Clinics Volume 1: Equine Medicine''' (Third edition), ''SUDZ Publishing'', 245-250.</ref>

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|''Sorghum'' cystitis/ataxia<ref name="Pasq">Pasquini, C, Pasquini, S, Woods, P (2005) '''Guide to Equine Clinics Volume 1: Equine Medicine''' (Third edition), ''SUDZ Publishing'', 245-250.</ref>

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|Posterior ataxia or paresis, cystitis, hx of grazing Sorghum species<ref>Talcott, P (2010) ''Toxicoses causing signs relating to the urinary system'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 22.</ref>

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|Posterior ataxia or paresis, cystitis, history of grazing ''Sorghum'' species<ref>Talcott, P (2010) ''Toxicoses causing signs relating to the urinary system'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 22.</ref>

|Demonstration of cystitis or pyelonephritis by laboratory methods, but not specific.<ref>Talcott, P (2010) ''Toxicoses causing signs relating to the urinary system'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 22.</ref>

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