Question of the Day

Signs of central nervous system disease in a young, small breed dog are consistent with a diagnosis of granulomatous meningoencephalomyelitis (GME). The lesion in this case localizes to the left cerebellum causing the left hypermetria and right paradoxical head tilt.

GME is an idiopathic, presumed immune-mediated, inflammatory condition of the brain +/- spinal cord. Poodles and terriers are predisposed. Necrotizing encephalitis (NE) is a similar condition seen most commonly in pugs and other small breeds e.g., Maltese, Yorkshire terrier. 

GME is typically a diagnosis of exclusion; rule out infectious (e.g., fungal, protozoal, vector-borne agents) etiologies. MRI and CSF tap are useful for definitive diagnosis.

Tx: Glucocorticoids +/- additional immunosuppression (e.g., cyclosporine, cytarabine, procarbazine). 

Px: Fair to guarded. Up to 33% dogs die within the first three months of diagnosis. Those that respond to Tx and survive the first three months can do well. Median survival is 1 – 2 years.