Can MUE be spinal only?

Clinical presentation, diagnostic findings and outcome in dogs diagnosed with presumptive spinal-only meningoencephalomyelitis of unknown origin

I. Cornelis, H. A. Volk, L. Van Ham, S. De Decker

Background
Meningomyelitis of unknown origin (MUO) in dogs refers to non-infectious inflammation of the spinal cord and meninges, with no identifiable infectious or specific non-infectious causes. MUO is a rare but significant disorder, often associated with a guarded prognosis. This study aimed to characterize the clinical presentation, diagnostic findings, and long-term outcomes of dogs with presumptive spinal MUO.

Methods
A retrospective analysis of medical records from 21 dogs diagnosed with presumptive spinal MUO between 2006 and 2015 was conducted. Inclusion criteria involved comprehensive medical and imaging records, inflammatory cerebrospinal fluid (CSF) analysis, and MRI findings. Dogs with signs of intracranial involvement, positive infectious disease tests, or histopathologically confirmed alternative diagnoses were excluded. Treatment and follow-up data were also analyzed.

Results
-Clinical Presentation: Dogs presented with acute (43%) or chronic (52%) neurological signs. Ambulatory paraparesis was the most common symptom (67%), and spinal hyperesthesia was noted in 71%.

-Diagnostics: CSF analysis showed pleocytosis (median total nucleated cell count: 209 cells/mm³). MRI revealed lesions in 90% of cases, characterized as extensive, ill-defined, hyperintense on T2-weighted images, and contrast-enhancing in 86%.

-Treatment and Outcomes: All dogs received immunosuppressive glucocorticoids, often combined with cytosine arabinoside. Median survival time (MST) was 669 days. Despite treatment, 48% of dogs either died or were euthanized due to disease progression. Successful outcomes were achieved in 45% of cases, with neurological normalization or significant improvement.

Limitations
The study's retrospective nature limited standardization of diagnostic and treatment protocols.
Small sample size reduced generalizability.
Lack of consistent imaging protocols, particularly for advanced techniques like STIR imaging.
Some cases had incomplete long-term follow-up or post-mortem confirmation.

Conclusions
Spinal MUO presents as acute or chronic myelopathy, with typical MRI and CSF findings aiding diagnosis. While immunosuppressive therapy can result in improvement, long-term prognosis remains guarded, with nearly half of the affected dogs succumbing to the disease. Further prospective studies are warranted to optimize diagnostic and therapeutic strategies.

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