What are Necrotizing Meningoencephalitis?
Though the cause of the disease is unknown, necrotizing meningoencephalitis (NME) was first recognized in the United States during the 1970’s. Initially, the disease was noticed only in pugs and was known as pug dog encephalitis. The disease has been recognized in other small breeds of dogs since 1989 and can occur in either sex.
Necrotizing meningoencephalitis has a typical anatomic distribution pattern as well as histological lesions that are different than those seen in other canine inflammatory conditions of the brain with known causes. In necrotizing meningoencephalitis, lesions are very inflammatory with meningitis. Typically, there are a minimal amount of inflammatory lesions located in the cerebellum, brainstem and spinal cord.
Necrotizing meningoencephalitis (NME) is an inflammatory disease of the central nervous system, typically with both a rapid onset and progression leading to death in dogs within a few months.
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Symptoms of Necrotizing Meningoencephalitis in Dogs
Dogs that are suffering from necrotizing meningoencephalitis will show variable symptoms that are dependent upon the part of their brain that is affected. In cases where your dog’s forebrain is impacted, symptoms may include seizures, blindness, circling, abnormal mentation and behavior changes. If the brainstem of your dog is affected, the following might be observed: changes in mentation, trouble walking and cranial nerve deficits. Other possible symptoms that may be noted in your dog include cervical pain, fever, head tilt, deafness, falling, paralysis in his face, trouble swallowing and weakness in his limbs.
- Seizures
- Blindness
- Circling
- Abnormal mentation
- Behavior changes
- Difficulty walking
- Back pain
- Fever
- Head tilt
- Falling
- Facial paralysis
- Difficulty swallowing
- Limb weakness
Types
The forebrain is the part of the brain that is most often affected in necrotizing meningoencephalitis. Lesions in this part of the brain are what are responsible for seizures, blindness and a change in your dog’s mental status.
Involvement in the inflammation in the meninges of the brain causes cervical rigidity, pain, and fever.
Should the lesions be in the brainstem, your dog may experience head tilt, falling, deafness, facial paralysis, weakness in the muscles that are used for swallowing and paralysis of his limbs.
Causes of Necrotizing Meningoencephalitis in Dogs
The cause of this disease is not known. The disease is known to develop in small dog breeds to include the following:
- Pug
- Maltese
- Chihuahua
- Pekingese
- Boston terrier
- Shih Tzu
- Coton du Tulear
- Papillon
Diagnosis of Necrotizing Meningoencephalitis in Dogs
Should you notice that something is not right with your dog, it is important to make an appointment to see your veterinarian, who will conduct a complete physical examination. Your veterinarian will also ask you for information regarding what symptoms you have noticed, when you first noticed them, and any changes in the symptoms that you have observed. In addition, if this is not your regular veterinarian, he will ask questions in order to get a complete history of your dog. The following tests may be conducted:
- A complete blood count
- Serum chemistry analysis
- Urinalysis
Depending on the results, your veterinarian may then recommend an MRI, which is the most reliable way to diagnose necrotizing meningoencephalitis in a living animal. Should your dog have this condition, typical findings on the imaging will include asymmetric, bilateral lesions in his forebrain. There may also be cystic areas in the parts of the brain that are necrotic. Your veterinarian may also recommend a cerebrospinal fluid (CSF) tap and/or an electroencephalogram (EEG). A bacterial and viral culture of CSF and serological testing will allow your veterinarian to rule out other causes of brain inflammation and notice if there is any increase in nucleated cells and protein which can also point to necrotizing meningoencephalitis.
Treatment of Necrotizing Meningoencephalitis in Dogs
Should your dog develop necrotizing meningoencephalitis, treatment goals are typically to provide supportive care and minimize his symptoms, as the prognosis is poor even with aggressive treatment. Treatment options include:
- Anticonvulsants (for example phenobarbital) to treat seizures
- Corticosteroids (for example dexamethasone or prednisone) to suppress your dog’s immune system and prevent additional destruction
- Anti-inflammatory medication
- Chemotherapy
- Rest
- Ensuring nutrition and necessary fluid intake to help your dog fight the inflammation
The prognosis for dogs with necrotizing meningoencephalitis is poor; the majority of dogs with the disease die or are euthanized within six months of their symptoms first becoming apparent.
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Recovery of Necrotizing Meningoencephalitis in Dogs
It will be important to follow the treatment recommendations of your veterinarian to best help your dog should he be diagnosed with necrotizing meningoencephalitis. Ensuring that your dog receives proper nutrition, gets plenty of rest, remains well hydrated and has minimal stress are the best ways to help him. While the prognosis for this condition is poor, working with your veterinarian will help you to make sure your dog has the best quality of life for as long as possible despite the condition.
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Necrotizing Meningoencephalitis Questions and Advice from Veterinary Professionals
Shih Tzu
Molly
13 Years
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My pet has the following symptoms:
Disoriented, Clumsy, Inactive
My 13 year old shih tzu has become very clumsy and disoriented. She stopped using her doggy door. After I hold her then put her down, she’ll stand frozen and not move, like she doesn’t know where she is. She acts like she can’t get comfortable. Instead of laying down in her bed, she’ll stand and rest her head on the side of her bed. Since I first got her at 8 weeks, she has always been a little uncoordinated. But it’s gotten 10 times worse in the last 6-7 months. I took her to my vet yesterday. He ruled out arthritis (she has arthritis, but not severe enough to cause mobility problems), no vision problems and her blood work was unremarkable. When the vet moved her head side to side, it seems to hurt her. Other than that, she doesn’t act like she’s in any pain, ever. He did the test where he takes each leg, bends it backwards, then let’s it go. Each leg, when released, did not go back to normal. Instead, her feet stayed bent backwards and she’d be standing on the front of her legs with her pads upward. He is limited to what he can do, since he is a small town vet. He told me that he feels that it’s neurological. He mentioned possibly tumor, autoimmune disease or a type degenerative neurological disease as possibilities.
I can’t afford an MRI. I love my Molly, but I don’t have that kind of money. Is there any other way she can be diagnosed, that isn’t as expensive? I’m concerned it sounds like she has a type of brain or brain stem disorder like Necrotising leucoencephalitis. I’ve been googling, and I’ve found just enough information to scar me crazy. Does this sound like Necrotising leucoencephalitis and what can I do to help Molly without spending thousands of dollars for an MRI?
May 16, 2018
Answered by Dr. Michele K. DVM
0 Recommendations
The signs that you describe and the medication that your veterinarian has put Molly on sound like she has some neck pain, and the medications may help her become more comfortable so that she can rest on her bed normally. She may be having some normal aging changes with her brain, and some dogs respond well to a medication called Anipryl, which you can discuss with your veterinarian, once you see if her current medications help her, to see if that would be appropriate. I hope that all goes well for her.
May 16, 2018
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Pug
Doris
3 years 6 months
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3 found this helpful
My 3 1/2 year old pug has had NME for 7 months & is doing great. Except, recently she has started to retain her urine (24 - 36 hours). I've had her to the vet, no UTI (yet). No dehydration. She has plenty of opportunity to potty outside & she will not potty in her pee pad fortified indoor pen. My regular vet could not address my neurological questions: Could it be that her brain just isn't sending her the signals to void regularly? Is this a sign of deterioration?
Meds: 50mg seizure med (1x daily) & 10 mg prednisone every other day.
She eats/drinks well.Thank you
Oct. 23, 2017
3 Recommendations
Commonly Necrotizing Meningoencephalitis may lead to urinary (and faecal) incontinence not urinary retention; there are a few medical options for urinary retention depending on the pathway involved which are discussed on the article linked below. Regards Dr Callum Turner DVM
www.msdvetmanual.com/pharmacology/systemic-pharmacotherapeutics-of-the-urinary-system/urine-retention
Oct. 23, 2017
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Boston Terrier
Ace
7 Years
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My pet has the following symptoms:
Seizures
Panting
Blindness
Rapid Breathing
Falling Over
Disoriented
Lameness In Legs
Our 7-year-old Boston Terrier showed no symptoms until the day before he passed. He seemed like he wasn't feeling well in the morning but went out like normal and then went on a walk with us. He did cry out when we tried to pick him up but we didn't think too much of it. Later in the afternoon, he seemed cold so I put his favorite blanket in his bed. After he got up he seemed disoriented and clumsy. His balance was off and his legs kept crossing and he was falling over. We put him on the couch with us and I looked into his ears and that's when his first seizure started. It was a short one so we called some vets to get advise. They told us to keep an eye on him so we did. He didn't seem to be recovering and then his breathing became rapid and he seemed to have partial blindness, was restless, and could not stand up so we drove to a 24/7 ER and checked him in overnight. On the way to the vet he had a very bad seizure in the car. They administered Keppra for the seizures and he didn't have another until the next afternoon. That one was also very bad and stopped his heart and that's when we lost him. It was all very sudden and without cause which was very scary.
Necrotizing Meningoencephalitis Average Cost
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