cat with odd neuro symptoms

Re: cat with odd neuro symptoms

Martin Atkinson — Sat, 02 Nov 2013 10:24:36 GMT

[quote user="Mark Lowrie"]Did you get a reason for the exclusion of FIP as a final diagnosis? [/quote] To quote the laboratory report (Axiom): "The meninges show perivascular cuffing, with lymphocytes predominating. There are fewer admixed plasma cells. The latter contain occasionally Russel bodies. Viral inclusion bodies are not evident. The clinically most significant finding is the chronic lymphocytic meningoencephalitis which readily explains the progressive neurological signs you report. Unfortunately, the tissue reaction isn't aetiologically diagnostic and possible causes include a viral and chronic bacterial infectious aetiology. However, do bear in mind that the cause of meningoencephalitis can not be established in a significant proportion of animals. The nature of the inflammation is not typical of feline infectious peritonitis and judging by your comments the feline coronavirus antibody titre (1:640) is low. The mesenteric lymphadenopathy is reactive only, simply indicating some form of antigenic stimulation".

I called the lab and discussed this with a pathologist who confirmed this interpretation. I am more inclined to accept your explanation Mark given the only other positive finding of any significance was the raised, albeit not dramatically, FCoV titre. Many thanks. Sadly there's no fresh sample left so PCR is probably not possible now.

Re: cat with odd neuro symptoms

Mark Lowrie — Fri, 01 Nov 2013 20:12:25 GMT

[quote user="Martin Atkinson"]

Out of interest, final chronic lymphocytic meningo-encephalitis of unknown origin.

[/quote] Did you get a reason for the exclusion of FIP as a final diagnosis? A lymphocytic meningoencephalitis is one of the hallmarks of FIP. I would say this PM supports FIP as a diagnosis. PCR would confirm.

Re: cat with odd neuro symptoms

Martin Atkinson — Fri, 01 Nov 2013 17:22:31 GMT

Out of interest, final update on this case. Six weeks following initial onset of symptoms the cat was euthanased due to progressive neurological disease, it was eventually recumbent with rigid forelimb hyper-extension and torticollis. PM examination of numerous tissues showed no evidence diagnostic of toxo, FIP or Rabies! However it had chronic lymphocytic meningo-encephalitis of unknown origin. Other changes included minimal renal urolithiasis, lymphocytic-plasmocytic cholaniohepatitis, and a reactive lymphadenopathy. Not sure what more we could have done, maybe a CSF sample may have given us a cause but the CP could not afford that and the cat had a therapeutic trial of anitbiotics and corticosteroids to which it failed to respond.

Re: cat with odd neuro symptoms

James Laidlaw — Wed, 23 Oct 2013 20:26:43 GMT

Had it been to Bulgaria or the Netherlands recently?

Re: cat with odd neuro symptoms

Martin Atkinson — Wed, 23 Oct 2013 10:38:47 GMT

[quote user="Mark Lowrie"]I’d give palliative anti-inflammatory prednisolone to alleviate symptoms short-term for the obstructive hydrocephalus but long-term there is no treatment that I feel will help this cat.[/quote] Thanks Mark. The cat has been on 5mg preds with antibiotic cover for a week with no change in symptoms so I'm now going to wean it off. While it remains happy, the CP are happy to foster it but it is obviously going to be difficult to re-home so long term is bleak any way. I'll try and follow it up long term an if circumstances permit try to remember to update progress on here.

Re: cat with odd neuro symptoms

Mark Lowrie — Wed, 23 Oct 2013 10:24:44 GMT

Hi Martin, apologies as I missed this post previously. In such a young cat with seemingly apparent CNS signs I would agree that the diagnosis is most likely FIP, FIP or FIP. There are other causes but this seems to fit well and your titre was also positive with high normal globulins. The other causes are so rare and also likely untreatable so given the difficulties in obtaining further diagnostics on this patient I feel you have done enough to give a good clinical suspicion of the disease. I can’t think of a single cheap test or treatment (other than pred) that would alter your approach to this case.

An easy thing you could do – it would be nice to know if this cat has central vestibular signs, I would try turning the cat on its back and looking for nystagmus. If vertical nystagmus is present then you definitely have central vestibular signs but if any other nystagmus is present then you certainly have vestibular signs which would most likely be central given the other clinical signs. Cats with FIP get an obstructive hydrocephalus causing multifocal CNS signs – sometimes vestibular symptoms are all that is seen though it sounds like this cat may also have forebrain disease from your description given the behavioral changes.

I’d give palliative anti-inflammatory prednisolone to alleviate symptoms short-term for the obstructive hydrocephalus but long-term there is no treatment that I feel will help this cat.

Re: cat with odd neuro symptoms

Glenn Hodgson — Tue, 22 Oct 2013 21:22:38 GMT

I was also thinking trial clind. poss false - ve toxo titre? but more likely congenital and cant be helped.

Then if all else fails and quality of life intoleRable, more an immunosuppressive course of 'roids?

Re: cat with odd neuro symptoms

Kate Richardson — Tue, 22 Oct 2013 19:11:49 GMT

Martin I have a similar case at the moment which started with respiratory signs and now has twitching and mild tremors and is ataxic. BAL showed eosinophilic response. Suggestions- lungworm migrating or toxoplasma. Trial treatment with fenbendazole and or clindamycin given no funds to investigate further?

Re: cat with odd neuro symptoms

Martin Atkinson — Tue, 22 Oct 2013 16:43:52 GMT

Well this is where we have come to, I think there is a limit to what progress could be made even if money was no object.

Re: cat with odd neuro symptoms

Anthony Dennison — Tue, 22 Oct 2013 13:53:51 GMT

Or possibly a problem with the myelination of nerves? Similar to lambs with swayback (but not sure whether copper would be involved)

Re: cat with odd neuro symptoms

Anthony Dennison — Tue, 22 Oct 2013 13:52:44 GMT

This could be multifactorial, possibly some cerebellar hypoplasia from infection in utero?

Re: cat with odd neuro symptoms

Martin Atkinson — Tue, 22 Oct 2013 13:25:11 GMT

Well this kitten/cat is still alive and showing the same symptoms - no progression or improvement except not as wary of the other cats and people (although it has been confined in a pen), still wobbly but bright, playful and eating. Based on the fact that the only thing that has come out of investigation is a moderate FCoV titre, that there is no money to do any further investigations and that that nothing should be allowed to die without the benefit of a course of steroids and antibiotics that's just what its had. One week on and still no change. Any other ideas (other than rabies)!?

Re: cat with odd neuro symptoms

mariette asselbergs — Sun, 13 Oct 2013 00:47:05 GMT

I am completely with Mark and my very first reaction on reading Martin's signs was: RABIES. This is exactly how cats manifest. So yes, I would think rabies from a bat until proven otherwise which is 10 days later if improved or still alive. The problem with rabies is, if you are not paranoid enough you 'll have a death at some point.....

Mariette

Re: cat with odd neuro symptoms

Mark Hedberg — Thu, 10 Oct 2013 11:55:29 GMT

Hi Martin! Sorry, wasn't meant to be tongue in cheek - I just know that there are folks who prefer to think that lyssavirus doesn't exist in the UK. It's no longer as unlikely as it was before; as long as the looser border controls are not matched by a corresponding increase in rabies vaccination, there is a risk that rabies will find a nice, immunologically naive population to have fun with. If cat is stable, then great :) if it gets worse, well, funny neuro signs are dangerous neuro signs.

Re: cat with odd neuro symptoms

Martin Atkinson — Thu, 10 Oct 2013 11:25:29 GMT

[quote user="Mark Hedberg"]

The incoordination and behavior changes, then progressing to ataxia...yes, yes, Britain has no rabies and all that but you could do far worse than isolate the cat and send the blood for rabies titre testing. Certainly it's unlikely but I've been blindsided once before by a disease that hadn't been reported before (not rabies, but dead embarrassing) and I'm not doing that again.

[/quote] Thanks for the input but not sure if this was tongue in cheek Mark! Not impossible indeed but so unlikely its not worth wasting the CP's resources, Anyway the kitten has stabilised - it is no worse in a week and seems far too well.

Re: cat with odd neuro symptoms

Mark Hedberg — Thu, 10 Oct 2013 11:16:16 GMT