Meningoencefalomielites de origem desconhecida no cão: análise de 8 casos clínicos
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2020-03-11
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As meningoencefalomielites de origem desconhecida (MOD) abrangem um grupo de doenças inflamatórias, idiopáticas e presumivelmente imunomediadas, do sistema nervoso central (SNC). Incluem a meningoencefalomielite granulomatosa (MEG) e as encefalites necrosantes (EN), que por sua vez, se subdividem em meningoencefalite necrosante (MEN) e em leucoencefalite necrosante (LEN). Estas doenças podem afetar todas as idades e raças, mas os cães jovens ou de meia-idade de raças pequenas aparentam estar predispostos. Os sinais clínicos de disfunção neurológica refletem a distribuição e localização das lesões no SNC. O diagnóstico presuntivo consiste na realização de provas de imagiologia avançada, nomeadamente a ressonância magnética (RM), na análise do líquido cefalorraquidiano (LCR) e em testes de despiste de agentes infeciosos. Contudo, uma avaliação histopatológica do tecido afetado, através de biópsia antemortem ou necrópsia, é fulcral para o diagnóstico definitivo. A abordagem terapêutica consiste na administração de medicação imunossupressora com o intuito de controlar os sinais clínicos, ou ainda, de alcançar a remissão dos mesmos. A literatura atual descreve que o prognóstico é variável.
Esta dissertação foi elaborada com a intenção de caracterizar a amostra relativamente ao género, idade, raça e peso, descrever os sinais clínicos observados, analisar os exames complementares e tratamento instituído e, por fim, comparar os resultados obtidos com a bibliografia existente. Para efeitos do estudo, foram selecionados 8 casos clínicos de cães com diagnóstico presuntivo de MOD no Hospital Ars Veterinária, em Barcelona.
A população em estudo é constituída por 6 fêmeas (75%) e 2 machos (25%) com uma faixa etária bastante variável, com idades compreendidas entre os 2 e os 8 anos, peso vivo corporal entre os 1,6 e os 11,2 kg e duração da sintomatologia até ao diagnóstico clínico de 10,5 dias. Atendendo à distribuição de raças, o Yorkshire Terrier foi a raça mais representada e o sinal clínico mais frequentemente observado foi a tetraparesia. Todos os animais efetuaram uma RM e provas de despiste de doenças infeciosas, mas apenas 5 recolheram LCR. No que diz respeito aos seus resultados, 87,5% dos animais revelaram lesões hiperintensas em imagens ponderadas em T2 e FLAIR e iso a hipointensas em T1 e a pleocitose mononuclear foi a alteração do LCR mais comum. A totalidade da amostra recebeu fármacos imunossupressores.
Meningoencephalomyelitis of unknown origin (MUO) encompasses a group of idiopathic and presumably immune-mediated inflammatory diseases of the central nervous system (CNS). It includes granulomatous meningoencephalomyelitis (GME) and as necrotizing encephalitis (NE), which in turn subdivides into necrotizing meningoencephalitis (NME) and necrotizing leukoencephalitis (NLE). These diseases can affect all ages and breeds, but young or middle-aged small breeds dogs appear to be predisposed. Clinical signs of neurological dysfunction reflect the distribution and location of CNS lesions. The presumptive diagnosis consists of performing advanced imaging tests, including magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis and infectious agent screening tests. However, a histopathological evaluation of the affected tissue by antemortem biopsy or necropsy is essential to the definitive diagnosis. A therapeutic approach is the administration of immunosuppressive drugs in order to control the clinical signs, or to achieve their remission. Current literature describes that the prognosis is variable. This dissertation was designed with the intention of characterizing the sample regarding gender, age, race and weight, describing the clinical signs observed, analyzing the complementary exams and treatment instituted and, finally, comparing the results obtained with the existing bibliography. For the purpose of the study, 8 clinical cases of dogs with presumptive diagnosis of MOD were selected at Ars Veterinary Hospital in Barcelona. The study population consists of 6 females (75%) and 2 males (25%) with a very variable age range, aged between 2 and 8 years, body weight between 1.6 and 11.2 kg and duration of symptoms until clinical diagnosis of 10.5 days. Given the breed distribution, the Yorkshire Terrier was the most represented breed and the most frequently observed clinical sign was tetraparesis. All animals had MRI and screening for infectious diseases, but only 5 collected CSF. Regarding their results, 87.5% of the animals showed hyperintense lesions on T2-W and FLAIR images and iso-to-hipointense T1-W images and mononuclear pleocytosis was the most common CSF alteration. The entire sample received immunosuppressive agents.
Meningoencephalomyelitis of unknown origin (MUO) encompasses a group of idiopathic and presumably immune-mediated inflammatory diseases of the central nervous system (CNS). It includes granulomatous meningoencephalomyelitis (GME) and as necrotizing encephalitis (NE), which in turn subdivides into necrotizing meningoencephalitis (NME) and necrotizing leukoencephalitis (NLE). These diseases can affect all ages and breeds, but young or middle-aged small breeds dogs appear to be predisposed. Clinical signs of neurological dysfunction reflect the distribution and location of CNS lesions. The presumptive diagnosis consists of performing advanced imaging tests, including magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis and infectious agent screening tests. However, a histopathological evaluation of the affected tissue by antemortem biopsy or necropsy is essential to the definitive diagnosis. A therapeutic approach is the administration of immunosuppressive drugs in order to control the clinical signs, or to achieve their remission. Current literature describes that the prognosis is variable. This dissertation was designed with the intention of characterizing the sample regarding gender, age, race and weight, describing the clinical signs observed, analyzing the complementary exams and treatment instituted and, finally, comparing the results obtained with the existing bibliography. For the purpose of the study, 8 clinical cases of dogs with presumptive diagnosis of MOD were selected at Ars Veterinary Hospital in Barcelona. The study population consists of 6 females (75%) and 2 males (25%) with a very variable age range, aged between 2 and 8 years, body weight between 1.6 and 11.2 kg and duration of symptoms until clinical diagnosis of 10.5 days. Given the breed distribution, the Yorkshire Terrier was the most represented breed and the most frequently observed clinical sign was tetraparesis. All animals had MRI and screening for infectious diseases, but only 5 collected CSF. Regarding their results, 87.5% of the animals showed hyperintense lesions on T2-W and FLAIR images and iso-to-hipointense T1-W images and mononuclear pleocytosis was the most common CSF alteration. The entire sample received immunosuppressive agents.
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Dissertação de Mestrado Integrado em Medicina Veterinária
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meningoencefalomielites de origem desconhecida , meningoencefalomielite granulomatosa