Successful surgical and medical treatment of a severe, acute epidural bleed in a young dog due to steroid responsive meningitis-arteritis

Abstract

Background Steroid responsive meningitis-arteritis (SRMA) is an immune-mediated disease of the leptomeninges and its associated blood vessels, typically responsive to corticosteroids. Clinically relevant haemorrhage is a rare finding in such patients and for this reason surgical decompression of the spinal cord is normally not considered. The diagnosis of SRMA is supported by serum C-reactive protein (CRP) increase, cerebrospinal fluid (CSF) examination, including cytology (polymorphonuclear pleocytosis in the acute form), nucleated cell-, red blood cell- and protein count, as well as by evaluating CSF and serum IgA concentrations. D-dimer concentrations in serum and CSF should be elevated as well and therefore can be also evaluated as a further diagnostic tool. Case presentation A 1.5-year-old mixed breed dog was presented with pyrexia, cervical pain and acute tetraparesis. Magnetic resonance imaging revealed an extradural mass lesion at the level of the sixth cervical vertebra, consistent with a subacute epidural haemorrhage, causing severe compression of the spinal cord. Based on the dog’s signalment, clinical history and results of the blood and CSF analyses (incl. D-dimer determination), SRMA with secondary epidural haemorrhage was suspected. Decompressive surgery was performed through a right sided partial dorsal laminectomy. Post-surgical immunosuppressive treatment was started with cytarabine and then continued with prednisolone after completion of wound healing. Conclusions This is the first report in which medical and surgical treatment were combined in a patient with SRMA and it highlights the possibility of performing a successful surgical intervention despite the need for immunosuppressive therapy. Moreover, while SRMA diagnosis is normally based on CSF analysis and CSF and serum IgA concentrations, D-dimer concentrations in serum and CSF were also useful in this patient.

Clinical, Diagnostic, and Imaging Findings in Three Juvenile Dogs With Paraspinal Hyperesthesia or Myelopathy as a Consequence of Hemophilia A: A Case Report

“…Two of the cases presented also had evidence of extradural compressive material on MRI. Dogs with SRMA can experience secondary extradural or intramedullary vertebral canal hemorrhage (9,23,24). This can be difficult to differentiate from hemorrhage secondary to an inherited coagulopathy.…”

C-Reactive Protein as a Diagnostic Marker in Dogs: A Review

“…Testing 48 h before the workout began and within 20 min of completing it, over a 10-time fold increase was observed (rising from a mean of 22.4 ± 16.3 µg/mL to 263.3 ± 103.8 µg/mL). CRP concentration was also measured in sled dogs completing a 1650-km race and significant changes were observed: CRP (median [range]) start: 18 μg/mL [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ]; midpoint: 119 76 μg/mL [ 12 , 13 , 14 , 15 , 16 ,…”

“…CRP increases in Steroid Responsive Meningitis-Arteritis (SRMA) but not in meningoencephalitides of unknown origin, although the magnitude of increase in SRMA is similar to that of other inflammatory diseases. In a group of autoimmune diseases of the brain, meningoencephalitides of unknown origin, CRP often stays within reference values as systemic inflammation does not take place [ 89 ] in opposite to steroid-responsive meningitis arthritis (SRMA), where CRP rise is observed [ 21 , 90 , 91 ]. It is a valuable finding since the differential diagnosis between these two often requires a costly MRI scan, but SRMA-caused blood CRP shift is indistinguishable from one caused by systemic inflammatory disease [ 22 ].…”

Non‐traumatic hemorrhagic myelopathy in dogs

“…1 Non-traumatic spinal hemorrhage (NTSH) is rare in both veterinary and human medicine. 1,2 Sporadic reports of NTSH exist in veterinary medicine, but these are largely confined to case reports, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] with a single study describing 6 cases of spontaneous extradural spinal cord hemorrhage. 3 In comparison, ischemic myelopathies are commonly described in dogs, [20][21][22] representing 10% of dogs presented to a single referral center over a 1-year period for investigation of a spinal cord disorder.…”

“…Non-traumatic spinal hemorrhage can be idiopathic or secondary to an underlying disease process or medical condition. Several medical conditions previously have been associated with NTSH in dogs, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] which can be broadly divided by the stage of hemostasis affected. Primary hemostatic disorders have been associated with hemorrhagic myelopathies secondary to Angiostrongylus vasorum (A. vasorum), 4,5 acute lymphoid leukemia 6 and hemophilia.…”