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An update on steroid responsive meningitis-arteritis
1Department of Small Animal Medicine and Surgery, School of Veterinary Medicine Hannover, Bischofsholer Damm 15, Hannover, Germany.
The Journal of Small Animal Practice
|January 15, 2010
Summary
Steroid responsive meningitis-arteriitis (SRMA) in dogs presents acutely with pain and fever, or chronically with neurological deficits. Early treatment improves prognosis, but relapsing cases require aggressive immunosuppression.
Area of Science:
- Veterinary Neurology
- Immunology
- Canine Medicine
Background:
- Steroid responsive meningitis-arteriitis (SRMA) is a common immune-mediated disorder in dogs.
- SRMA presents in two forms: acute, characterized by fever and neck stiffness, and chronic, with neurological deficits.
- The exact cause of SRMA is unknown, but it involves an aberrant immune response targeting the central nervous system (CNS).
Purpose of the Study:
- To summarize the clinical presentation, diagnostic findings, and therapeutic considerations for SRMA in dogs.
- To elucidate the potential pathogenetic mechanisms underlying SRMA, including immune system dysregulation.
- To discuss the prognostic factors associated with different forms of SRMA.
Main Methods:
- Review of existing literature on canine SRMA.
- Analysis of clinical signs, cerebrospinal fluid (CSF) analysis, and treatment outcomes.
- Discussion of proposed pathogenetic pathways involving immune cells and molecular mediators.
Main Results:
- Acute SRMA typically shows neutrophilic pleocytosis in CSF, while chronic SRMA may exhibit mononuclear pleocytosis.
- Early anti-inflammatory therapy offers a good prognosis for acute SRMA.
- Protracted or relapsing SRMA cases have a guarded prognosis, necessitating aggressive, long-term immunosuppression.
Conclusions:
- SRMA pathogenesis likely involves an aberrant immune response against the CNS, with neutrophilic pleocytosis facilitated by chemotactic factors and blood-brain barrier disruption.
- Upregulation of IgA, driven by a Th2 immune response, is implicated in SRMA pathogenesis.
- Prognosis varies, with early intervention crucial for favorable outcomes in acute cases, while chronic or relapsing forms demand intensive management.
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