View Question

Meningoencephalitis In A Dog

by johnnalsmith - June 6, 2023 View Case Report

Frankie is an approx 4 year old, MN, pittie mix. He was found as a stray in the fall of 2020 so no prior history. After the owners had him for about six months he began having neurologic episodes of weakness, ataxia, and semi-loss of consciousness. In the video they showed me his front and back legs would buckle under him and he would collapse to the ground momentarily, but could pick himself up. However, his gait was abnormal. These episodes would last about 4-5 minutes, then Frankie would be exhausted and sleep for several hours. MRI and CSF tap were originally perceived to be inconclusive so Frankie was started on Phenobarbitol and Keppra. However within a few days his episodes went from one a week to having four within a 24 hour period. After a second opinion the MRI showed mild inflammation in the spinal cord near the head/neck. Frankie was taken off of the anti-seizure medications and started on a moderate dose of prednisone (10mg BID). Within 48 hours of starting the prednisone, Frankie was back to himself. He was tapered off the prednisone over a course of 3 months and after 30 days of being off the prednisone had another very mild episode. He was started on pred immediately and is now managed on 1.25mg BID for the past 4 months. On high doses of pred he was PU/PD, however, now that has decreased. He is still extremely hungry and will overeat if given the opportunity. Prior to the prednisone his hair coat was full and shiny. Now it is thin, dull, coarse and dry. He seems more lethargic and a bit depressed now too. The tip of his tail breaks open very easily due to lack of hair and thin skin.

T: pink to lavender and thin,
P: Toned and superficial. Feels stronger with needling GB 34

His owners and primary vet want to get him off or at least to a lower dose of prednisone to get rid of his side effects.

I just saw him for the first time last week and started him on Settle the Yang due to the pulse responding to GB34. However, I am confused by the worsening on anti-seizure medications. I also feel like he's very dry now, despite the PU/PD at the beginning of prednisone. He loves to sun bathe and still will even on hot days.

I was hoping to get some insight on how to interpret worsening symptoms on seizure medications. And make sure Settle the Yang is the right option moving forward.

Thank you
Johnna

by naturevet

June 6, 2023

Hi Johnna

That is an interesting case you have there. For sure the dryness indicates Blood and Yin deficiency. That can serve as an aggravating factor in both Shao Yang disharmony, which you're treating for now, and a Tai Yang excess (i.e., Wind invasion). Both conditions can present with a superficial pulse, too. Pulses from Shao Yang disharmony should moderate after treating important GB points like GB 34. The pulse from Tai Yang excess moderates when BL 40 is sedated. You mention the pulse getting stronger with needling of GB 34, but I was not clear if that meant more forceful (which we don't really want) or more supple yet full feeling. If it's stronger and more forceful (i.e., finger lifting) then that may not be a good thing, although deliberately sedating and tonifying GB points can produce opposite pulse effects.

Is there any chance that the cord inflammation could have been caused by instability of the vertebral column? If so, and if BL 40 improves the pulse, this is likely a Du Huo Ji Sheng Tang case. Bu Gan Tang should probably also be used to tonify Blood and Yin. It is a deficiency of the latter that creates the vacuity in the Tai Yang channels that leaves the animal prone to Wind invasion.

If GB 34 definitely leaves the pulse more moderate and healthy feeling, then it is a Shao Yang case. The spring onset (assumed, given the timeline you mentioned) is more consistent with a Shao Yang issue.

Yin deficiency can underlie Shao Yang disharmony. The latter is really just uncontrolled movement of Yang. Since Yin serves as both an anchor and an attractant to Yang, and since it moves first in the body, a Yin deficiency can result in Yang moving both too slowly, or too rapidly. Seizure medications can make Yin deficient animals worse from being too drying; or can be injurious if they are sinking Yang energy inwards, causing pathology to aggravate. That can be seen in Qi collapse, but also potentially in the Wind invasion (Tai Yang excess) that we talked about.

For meningoencephalitis, my preference is to use Chai Ge Jie Ji Tang (Bupleurum and Kudzu Combination). If you were to pair a Yin and Blood tonic with it, Yi Guan Jian might be the best one, especially with the polyphagia seen on pred. If there has been no problem with CHJLGMLT, then use it instead, but add in Yi Guan Jian

Hopefully this helps you out! Let us know how this case goes!

Steve

by johnnalsmith

November 28, 2023

Hi Steve,

I wanted to update this case and get an updated opinion on where to go next. Frankie had been doing fairly well, but his owners got super busy and haven't been in August of this year. On the CHJLGMLT he was able to get down to a lower dose of prednisone and his hair coat even seemed to be growing back some. I tried adding YGJ, but his stomach could not tolerate it. So we pushed forward.

The owners ran out of CHJLGMLT in early October and he actually seemed to improve much more after stopping it. No GI upset, thicker and less dry hair coat, plenty of energy overall. Then in early November he had a full clonic-tonic seizure with a second follow up seizure a few days later. In the past, the neurologic episodes only progressed to ataxia and weakness; not full seizures. He is now back on a higher dose of prednisone and levetiracetam again. No seizures or episodes since then. He isn't nearly as polyphagic on the prednisone this time and he's having a lot of belching and reflux type GI distress at the higher dose.

I saw him today and his tongue was pale pink/lavender and his pulse was hard to find and easily pushed through. It wasn't overly thin, but I was concerned with just how feeble it was for a dog his size and age. It became stronger and improved with SP 10 stimulation. It was hard to check the other points as he was more resistant of handling and his needles today. Typically he would fall asleep after the first or second placement. Today he was agitated and restless. He also belched several times and seemed quite nauseous.

Could this be a fall thing and blood flow issue? I didn't start anything until consulting with you first.

Thanks so much!

by naturevet

November 29, 2023

It could be. Given the response to SP 10, the weak pulse and the pale tongue, try Tian Ma Gou Teng Yin. It treats Blood and Yin deficiency as a cause of seizures. Both Blood/Yin deficiency and Shao Yang disharmony tend to get worse in the fall. TMGTY should not be drying, at least. If he seems to settle on his next visit, then they can look at drug withdrawals again. If it helps, then I have my doubts this particular episode is due to meningoencephalitis

Steve

You must be logged in to reply

CuredCases.com