Cerebellar Abiotrophy in a 6-Year-Old Arabian Mare A
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130 EQUINE VETERINARY EDUCATION / AE / march 2011 Case Reporteve_166 130..134 Cerebellar abiotrophy in a 6-year-old Arabian mare A. Foley, J. Grady†, K. Almes‡, K. Patton§ and E. Davis¶* Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia; †Sapulpa Equine Hospital, Oklahoma; ‡Kansas State Veterinary Diagnostic Lab, Kansas; §Battelle Toxicology Northwest, Washington; and ¶Department of Clinical Sciences, Kansas, USA. Keywords: horse; cerebellar abiotrophy; neurolgical disease; Arabian horse; cerebellum; neurological examination Summary Thorough ante mortem neurological examination of suspect individuals will aid in excluding other causes of Cerebellar abiotrophy (CA) is an uncommon neurological equine cerebellar disease. Complete post mortem disease that most commonly affects Arabian horses. examination, including histopathology of affected tissues, Affected horses are typically identified within the first 6 is required to establish a definitive diagnosis of cerebellar months of life. Intention tremor, wide based stance and abiotrophy. Gross morphological changes are not a ataxia are common clinical signs observed in affected characteristic of equine cerebellar abiotrophy and individuals. No treatment is available for resolution therefore gross evaluation or advanced diagnostic of clinical signs. Definitive diagnosis is based on imaging with MRI will not provide definitive evidence of histopathological examination of cerebellar tissue, which is equine cerebellar abiotrophy. Although some individuals characterised by loss of Purkinje cell layer. This report may demonstrate static clinical signs with reported clinical describes a case of cerebellar abiotrophy that had a improvement, this condition is untreatable and typically delayed diagnosis until 6 years of age. follows a course of chronic progression following the onset of clinical signs. This report documents a 6-year-old Arabian Introduction mare that presented for veterinary evaluation of neurological disease that was ultimately diagnosed as Cerebellar abiotrophy (CA) has been reported to occur cerebellar abiotrophy. primarily in Arabian horses and is characterised by progressive, premature degeneration of Purkinje cells. History Clinical manifestations of disease in affected horses include an intention tremor, ataxia, wide-based stance A 6-year-old Arabian mare presented to the Veterinary (Videos S1 and 2), dysmetria, spasticity and hypermetria Medical Teaching Hospital with progressive neurological without evidence of weakness (Beatty et al. 1986; Summers disease of approximately 9 months duration. The main et al. 1995; Byre 2004) (Video S3). Onset of clinical disease complaints at the time of presentation included ataxia, typically occurs between 2 and 6 months of age (Beatty an intention tremor, difficulty prehending feed and et al. 1986). Previous reports have described the latest difficulty turning to the right both in hand and under recognition of Arabians with CA to be 9 and 24 months of saddle. age (De Lahunta 1983). The aetiology of CA in Arabian The mare was purchased one year prior to presentation horses remains elusive. Experimental breeding of affected by an experienced equine owner with the intent of using and related individuals has resulted in the determination the mare as a performance animal. Prior to purchase the that cerebellar abiotrophy is an autosomal recessive trait. mare had received minimal training and had not been Affected individuals suffer from a metabolic defect that ridden. Once purchased the horse was initially trained results in premature Purkinje cell apoptosis (Sponseller 1967; in-hand and in a round pen and after approximately 2 Blanco et al. 2006). In horses, cerebellar abiotrophy is months the mare was placed into a training programme confined to a small group of breeds: the Arabian, that included light riding under saddle. At approximately Oldenberg; Gotland and an Eriskay pony, the latter of this time it was noted that the mare had difficulty handling which are descendants of Arabian bloodlines (Palmer exercise, demonstrated by stumbling and reluctance to et al. 1973; Beatty et al. 1986). flex her head and neck to the right. The owner felt that the mare had worsened in clinical disease after the initiation of *Corresponding author email: [email protected] training, but this was somewhat difficult to completely © 2011 EVJ Ltd EQUINE VETERINARY EDUCATION / AE / March 2011 131 assess since this was the first time the mare had been used Diagnostic test results as a performance animal under saddle. It was noted that by the time of presentation her in-hand mannerisms had The primary region of interest for radiographic examination changed when compared to mannerisms at the time of included the basisphenoid and basioccipital bones, purchase, and now included head tremors and obvious occipital condyles and cranial cervical regions (C1–C2) to ataxia that limited her ability to handle work under saddle. determine if congenital skeletal abnormalities were It was strongly considered by the receiving veterinary present. For completeness of radiographic study, entire staff that this mare was not neurologically normal at the skull and cervical radiographs were obtained and found to time of purchase one year previously. However, the be within normal limits; therefore, there was no evidence description of neurological abnormalities over the past that congenital skeletal abnormalities were associated several months at rest while standing still, at the walk when with neurological deficits. not under saddle and while eating were concerning. In Specific findings of the cervical radiographic particular, the fact that these abnormalities were not evaluation did reveal mild degenerative changes of the present at the time of purchase, supported the concern articular processes between C6–C7 and C7–T1. Minimum although mild disease may have been present at the time sagittal ratios were within normal limits. Mild degenerative of purchase and went unnoticed, the current neurological joint disease of the caudal cervical spine may have played disease was apparently progressive and moderate in a contributing role in the mare’s reluctance to flex her nature. head to the right. Cerebral spinal fluid was analysis was consistent with a mildly traumatic tap. Three millilitres of CSF were submitted Clinical findings for analysis; leucocyte count was performed with a haemocytometer that revealed 0 WBC/ml, 165 At presentation, the mare’s vital parameters were within erythrocytes/ml and a trace of protein present. normal limits, she was mildly excited and exhibited a Cytocentrifugation was performed to concentrate cells for pronounced vertical head tremor (Video S4). The head analysis. This analysis revealed a low nucleated cellularity tremor was noted to worsen with intentional movement with 10% nondegenerate neutrophils, 55% lymphocytes, toward an object, such as when offered grain. The 35% monocytes; protein was 28 mg/dl and Western blot predominant abnormality that was noted on cranial nerve analysis was negative for immunoglobulins specific for examination included a bilaterally diminished menace Sarcocystis neurona. reflex established by the observation that minimal blinking occurred when a hand was moved toward the mare’s Diagnosis head. Vision was established by proper negotiation around obstacles. Moderate symmetric ataxia was present and Based on case details, clinical signs, slow progression of consistent with cerebellar disease. The mare demonstrated disease and elimination of other differential considerations a wide based stance, particularly in the hindlimbs a presumptive diagnosis of cerebellar abiotrophy was yet maintained appropriate strength. Thoracic limb made. Although the diagnosis of cerebellar abiotrophy hypermetria was present at the walk and was was made at this time it was speculated that this mare had exaggerated upon head elevation. When circling at the suffered from mild neurological deficits since an early age, walk circumduction of the pelvic limbs was observed. As a which would be consistent with previous reports of result of lesion localisation differential considerations were cerebellar abiotrophy developing in the first months of life. limited to primary cerebellar disease. We further speculated that although deficits were present at a young age they went unrecognised by those Differential diagnoses individuals associated with the mare. Based on the rather moderate severity of disease at the time of presentation to the VMTH it was considered likely that there had been Due to breed, age and long duration of clinical signs, progression of disease in the previous year. The mare cerebellar abiotrophy and equine protozoal probably had underlying neurological disease that was not myeloencephalitis (EPM) were the primary differential apparent to the lay observer, particularly since she had not diagnoses. Trauma was considered unlikely due to been used for performance prior to purchase. A veterinary chronicity and the progressive nature of disease. Initial examination had not performed at the time of purchase. diagnostic testing included haematology, skull and complete cervical radiography to rule out congenital malformation of the skull or cranial cervical spine. Based Outcome on negative findings, cerebral spinal fluid was collected by lumbosacral spinal fluid centesis and submitted for Due to progression of disease, severity of clinical signs and cytological analysis and EPM testing via Western