Epistaxis and Intradural-Extramedullary Haemorrhage in a Dog With Steroid Responsive Meningitis-Arteritis

A 2-year-old female entire Golden Retriever with a history of being subdued was seen. Her physical and neurological examinations were initially unremarkable, but she acutely progressed to non-ambulatory paraparesis, with absent cervical or thoracolumbar hyperaesthesia. Magnetic resonance imaging of the vertebral column was performed, showing a well-defined, intradural-extramedullary mass at the level of the caudal aspect of L2 causing right-sided ventrolateral marked cord compression. The lesion was T2W hyperintense and mildly hyperintense on T1W images. The signal intensity pattern of this lesion suggested the presence of an early stage hyperacute hemorrhagic process. Cerebrospinal fluid (CSF) was collected from the cisterna magna. CSF analysis exhibited a marked mixed pleocytosis with a slight neutrophilic predominance and elevated protein content. Due to the dog going from being ambulatory to non-ambulatory paraparetic with absent postural reactions in her pelvic limbs, surgery was performed to allow decompression of the spinal cord. A hemilaminectomy with durotomy was performed. Over the course of the dog's hospitalisation, she had two episodes of left-sided epistaxis which resolved with local application of adrenaline. Seven days post-operatively, the dog was discharged being non-ambulatory paraparetic with voluntary movement in both pelvic limbs. Three months after discharge, the dog was ambulatory with no ataxia noted in the pelvic limbs. As there is no current definitive diagnostic test for steroid responsive meningitis-arteritis (SRMA) available, the diagnosis of it in this case is supported by the dog's signalment, bloodwork, CSF analysis and response to corticosteroid therapy. This report details a rare clinical presentation, including epistaxis, intradural-extramedullary haemorrhage and absence of cervical or thoracolumbar hyperaesthesia, in a dog diagnosed with suspected SRMA.