Presentation
Tress is an 11-month-old Golden Retriever who presented to our ECC department for seizuring. This was the first time that Tress had ever had a seizure, and it presented as a generalised tonic-clonic seizure.
On presentation, Tress appeared as normal and bright as any other 11-month-old Golden Retriever!
Physical exam:
- Temperament: BAR
- Vitals WNL
- Gait: Normal, ambulatory
- Thoracic auscultation normal
- Normal mentation, normal cranial reflexes
CBC/Biochemistry/Ionised Calcium/Electrolytes: largely normal
At this time, we determined that the possible causes included intracranial and idiopathic cause for seizures.
The owner decided to hospitalise Tress with us for one night for seizure watch. Unfortunately, overnight, on 2 separate occasions, Tress started to develop neurological episodes which included an opisthotonus-like posture, vocalisation and horizontal nystagmus, with a brief period of unconsciousness. Tress also deteriorated on physical examination:
- Mentation: obtunded, horizontal nystagmus with fast phase to the left
- Withdrawal reflexes reduced in all 4 limbs
- Left sided positional strabismus
- Pain reaction elicited on manipulation of the neck to the left
- Mild hyperthermia (39.4C)
- Elevated C-Reactive Protein (>10mg/dL)
What are some of your differentials or thoughts at this point?
The neck pain with history of pyrexia and elevated CRP could be suggestive of Steroid Responsive Meningitis Arteritis (SRMA), given it is a disease that most commonly occurs in dogs aged 6 to 18 months.
However, seizures do not usually occur with SRMA – so there is a question of whether there were two separate things going on with Tress, such as a forebrain disease causing seizures alongside SRMA causing neck pain.
Learning point #1:
In a young dog with seizures, on initial presentation, we should not be too quick to write it off as idiopathic epilepsy. These dogs are always worth following up with, to ensure that they do not deteriorate with some other undiscovered issue.
At this point, our criticalists Dr Alex Hatch and Dr Melissa Claus teamed up with our neurologist Dr Sue Fitzmaurice to further investigate Tress’s issues.
To investigate the disease process further, an MRI was performed on Tress.
MRI Findings
CSF Sampling: CSF tap found a bloody sample that did not clot. A bleeding diathesis was suspected. Various tests were done and were negative/normal.
The MRI images of the brain revealed subarachnoid material, as well as increased meningeal enhancement, as below.


It was suspected that the subarachnoid material was haemorrhage, which is an atypical but reported finding in SRMA.
Plan
With the patient’s signalment, progression and MRI findings, the top differential on our list was SRMA. Another differential on the list would be infectious meningitis – however, insufficient CSF sample was taken due to concern about haemorrhage, and it was decided that treatment for suspected SRMA should be started to prevent further deterioration of Tress’s condition.
Prednisolone was started for Tress, which resulted in a dramatic overnight improvement in Tress’s mentation and reduction in clinical sign. With steroids on board, Tress now had normal mentation, normal gait, and intact reflexes, with the only abnormality remaining being an absent left-sided menace response.
Outcome
Tress was discharged 2 days after admission, entering much like the way she came in as, a bouncy 11-month-old Golden Retriever!
She was discharged with Prednisolone and Levetiracetam to decrease ongoing seizure activity, and for prolonged treatment of SRMA.
Since then, two follow-ups have been done with Tress, with her showing great progress even after decreasing prednisolone dose.
Prevalence and Prognosis
SRMA is a systemic immune‐mediated disease characterized by inflammation of the meninges and associated arteries that typically affects dogs 6‐18 months of age. Any breed can develop the disease, although a predisposition has been reported in Beagles, Bernese Mountain Dogs, Border Collies, Boxers, English Springer Spaniels, Jack Russell Terriers, Nova Scotia Duck Tolling Retrievers, Weimaraners, and Whippets. The acute form is manifested by clinical signs of pyrexia, cervical hyperaesthesia and lethargy, marked neutrophilic pleocytosis and increased protein concentration in cerebrospinal fluid (CSF), and resolution of clinical signs with corticosteroid treatment.
Treatment consists of immunosuppressive dosages of corticosteroids – most dogs respond to treatment, although relapses are frequent.
Conclusion
Tress’s case presented to us as a possible epilepsy case, and took a left turn very quickly. Fortunately, due to the timely diagnosis and intervention of our criticalists and neurologist, we were able to rapidly turn Tress around and put her on the road to recovery!
If you have any tricky cases that span across multiple disciplines and co-morbidities, please do not hesitate to give our hospital a call and ask to speak with any of our specialists. Our specialists work together closely across all departments to provide support for each other on cases, and to ensure that the veterinarian with the most appropriate expertise is on the case; we want to be able to provide the same level of support to you as well!