title: Equine protozoal myeloencephalitis due to Neospora hughesi and equine motor neuron disease in a mule.
abstract: METHODS
  A 23-year-old female mule was presented for bilateral ocular abnormalities and an abnormal pelvic limb gait.
  
  
  RESULTS
  Anisocoria, unilateral enophthalmos, medial strabismus, ptosis, pupillary light reflex deficits, and bilateral reticulated pigmentary retinopathy were observed on ophthalmic examination. Neurologic abnormalities included right-sided facial nerve paralysis, extensive symmetric muscle atrophy, and asymmetric pelvic limb ataxia with an abnormal pelvic limb gait. A positive titer (1:40) for equine protozoal myeloencephalitis (EPM) associated with Neospora hughesi was obtained from cerebrospinal fluid with minimal (<1 red blood cell/microL) blood contamination. Muscle biopsies of the sacrocaudalis dorsalis medialis muscle revealed predominantly type I neurogenic muscle atrophy, consistent with a diagnosis of equine motor neuron disease (EMND).
  
  
  RESULTS
  Treatment included a 2-month course of ponazuril (5 mg/kg PO q24 h), vitamin E (8000 IU PO q24 h), and selenium (2 mg PO q24 h). Clinical improvement was not observed after 2 months although the mule remained stable. Clinical deterioration was reported upon discontinuation of the ponazuril after a 2-month course.
  
  
  CONCLUSIONS
  Concurrent disease with EPM associated with N. hughesi and EMND should be considered in cases demonstrating cranial nerve abnormalities, pronounced symmetric muscle atrophy, unusual asymmetric gait abnormalities, and reticulated pigmentary retinopathy.
authors.affiliation: William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616, USA. cjfinno@vmth.ucdavis.edu
authors.forename: Carrie J
authors.initials: CJ
authors.lastname: Finno
authors.forename: Joshua Seth
authors.initials: JS
authors.lastname: Eaton
authors.forename: Monica
authors.initials: M
authors.lastname: Aleman
authors.forename: Steven R
authors.initials: SR
authors.lastname: Hollingsworth
mesh_terms: D000818:Animals; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D003048:Coccidiosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000662:veterinary*; D004679:Encephalomyelitis / Q000469:parasitology / Q000662:veterinary*; D018397:Equidae / Q000469:parasitology*; D005128:Eye Diseases / Q000175:diagnosis / Q000469:parasitology / Q000662:veterinary*; D005260:Female; D016472:Motor Neuron Disease / Q000469:parasitology / Q000662:veterinary*; D018688:Neospora; D014227:Triazines / Q000627:therapeutic use
chemical_list: D000981:Antiprotozoal Agents; D014227:Triazines; C415002:ponazuril