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Acute idiopathic polyradiculoneuritis

icanis
Contributor(s):

Paul Cuddon

Laurent Garosi

Synonym(s): Coonhound paralysis


Introduction

  • One of most common polyneuropathies.
  • Signs: similar to distal denervating disease Distal denervating disease, an acute rapidly progressive generalized lower motor neuron flaccid paresis to paralysis with stabilization of signs after 10 days.
  • Diagnosis:
    • Acute progressive flaccid tetraparesis to tetraplegia with normal bladder and tail function and normal pain sensation.
    • Electrophysiology and lumbar CSF analysis aid in diagnosis.
  • Treatment: supportive care, intense physical rehabilitation.
  • Prognosis: often recover within 3-5 weeks with adequate supportive care.

Pathogenesis

Etiology

  • Strong association with contact with raccoon saliva in some cases.
  • Raw chicken meat consumption is a risk factor in dogs for the development of acute polyradiculoneuritis which potentially is mediated by infection with Campylobacter spp Campylobacter jejuni.
  • Possibly related as well to upper respiratory infections. 
  • Possibly associated with modified live rabies vaccine and distemper-hepatitis-parvovirus-leptospirosis combination vaccine.
  • Dogs with acute polyradiculoneuritis have significantly lower serum 25-hydroxy vitamin D3 concentration compared to a control group. The cause and significance of this altered vitamin D status in dogs with polyradiculoneuritis are unclear and require further investigations.

Specific

  • Possibly vaccination.
  • Contact with raccoons and raccoon saliva.
  • Possibly upper respiratory or gastrointestinal infections.
  • Consumption of raw chicken.
  • Odds of developing acute idiopathic polyradiculoneuritis possibly greater in the autumn and winter compared to spring in one study.

Pathophysiology

  • Disease affects ventral spinal nerve roots more severely with minimal dorsal nerve root involvement.
  • Immune response directed against proteins or lipids in raccoon saliva, bacteria or viruses → immune response cross reaction with similar proteins or lipids found in canine peripheral nerves → axonal degeneration with some demyelination → impaired nerve impulse → decreased muscle tone and tendon reflex → muscular atrophy.
  • Lipopolysaccharides from Campylobacter contain a ganglioside-like epitope that resembles elements of peripheral nerve gangliosides. Molecular minicry and a cross-reactive immune-response may play a role in the pathogenesis.
  • Anti-GM2 ganglioside antibodies in dogs affected with acute polyradiculoneuritis has been demonstrated, reinforcing the hypothesis that this condition is the canine counterpart of Guillain-Barre syndrome in humans.
  • Immune responses directed either at Schmidt-Lanterman clefts, the paranode-node complex or both.
  • Based on infiltrative and non-inflammatory changes, 4 subtypes and/or stages are distinguished, some of which indicate localization of primary target antigens while others represent convergent late stage pictures, as a consequence to epitope spreading.

Timecourse

  • Duration of neurologic dysfunction ranges from several weeks to 4 months and depends on initial severity of neurologic involvement.
  • Histopathological changes in nerves seen within 7-10 days of onset of signs.
  • Signs appear 7-14 days after initiating incident.
  • Paralysis lasts several weeks to 4 months.
  • Incomplete recovery and lack of improvement have been observed.
  • Tetraparesis occurs 24-48 hours after neurological signs first develop.
  • Initial progression of signs occurs over 4-5 days <10 days.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Martinez-Anton L, Marenda M, Firestone S M et al (2018) Investigation of the role of Campylobacter infection in suspected acute polyradiculoneuritis in dogs. J Vet Intern Med 32, 352-360 PubMed.
  • Laws E J, Harcourt-Brown T R, Granger N et al (2017) An exploratory study into factors influencing development of acute canine polyradiculoneuritis in the UK. JSAP 58, 437-443 PubMed.
  • Laws E J, Kathrani A, Harcourt-Brown T R, Granger N et al (2017) 25-Hydroxy vitamin D3 serum concentration in dogs with acute polyradiculoneuritis compared to matched controls. JSAP Nov 24. Doi:10.1111/jasp.12791. [Epub ahead of print] PubMed.
  • Gross S, Fisher A, Rosati M et al (2016) Nodo-paranodopathy, internodopathy and cleftopathy: Target based reclassification of Guillain-Barre-like immune-mediated polyradiculoneuropathies in dogs and catsNeuromuscul Disord 26, 825-836 PubMed.
  • Stanciu G D, Slocan G (2016) Acute idiopathic polyradiculoneuritis concurrent with acquired myasthenia gravis in a West Highland white terrier dog. BMC Vet Res 12, 111 PubMed.
  • Anor S (2014) Acute lower motor neuron tetraparesis. Vet Clin North Am Small Anim Pract 44, 1201-1222 PubMed.
  • Rupp A, Galban-Horcajo F, Bianchi E et al (2013) Anti-GM2 ganglioside antibodies are a biomarker for acute canine polyardiculoneuritis. J Periph Nerv Syst 18, 75-88 PubMed.
  • Hirschvogel K, Jurina K, Steinberg T A et al (2012) Clinical course of acute canine polyradiculoneuritis following treatment with human IV immunoglobulin. JAAHA 48, 299-309 PubMed.
  • Cuddon P A (1998) Electrophysiologic assessment of acute polyradiculoneuropathy in dogs - comparison with Guillain-Barré syndrome in people. J Vet Intern Med 12 (4), 294-303 PubMed.
  • High M E (1996) Acute canine polyradiculoneuritis. Can Vet J 37 (5), 305 PubMed.
  • McGlennon N J (1990) Polyradiculoneuritis and polymyositis due to a toxoplasma-like protozoan - diagnosis and treatment. JSAP 31 (2), 102-104 VetMedResource.
  • Cummings J F et al (1988) Canine protozoan polyradiculoneuritis. Acta Neuropathol (Berl) 76 (1), 46-54 PubMed.
  • Cummings J F et al (1982) Coonhound paralysis. Further clinical studies and electron microscopic observations. Acta Neuropathol (Berl) 56 (3), 167-178 PubMed.
  • Northington J W et al (1982) Acute canine idiopathic polyneuropathy. A Guillain-Barré​-like syndrome in dogs. J Neurol Sci 56 (2-3), 259-273 PubMed.
  • Northington J W et al (1981) Acute idiopathic polyneuropathy in the dog. JAVMA 179 (4), 375-379 PubMed.
  • Chrisman C L (1975) Differentiation of tick paralysis and acute idiopathic polyradiculoneuritis in the dog using electromyography. JAAHA 11 (4), 455-458 VetMedResource.

Other sources of information

  • Merck Veterinary Manual. (1998) 8, 914.
  • Oliver J E (1997) Handbook of Veterinary Neurology 3. pp 187-188.
  • Cuddon P (1997) Coonhound paralysis (polyradiculoneuritis, idiopathic). The 5 minute veterinary consult - canine and feline. pp 476-477.
  • Ettinger S J (1995) Textbook of Veterinary Internal Medicine. 4(1), 716.
  • Schrauwen E (1995) Postvaccinal acute polyradiculoneuritis in a young dog. Prog Vet Neur 6(2), 68-70.
  • Dees C (1984) The immunological basis of Coonhound paralysis. Fed Proc 43(7), 1993.
  • DeLahunta A (1983) Veterinary Neuroanatomy and Clinical Neurology (2), 74-77.

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