猫特发性面神经病：临床表现、磁共振成像发现及结局

文献信息

中文摘要

背景： 特发性面神经病（IFN）在犬中常见，但关于猫的信息缺乏。
假设/目的： 描述诊断为IFN的猫的临床表现、磁共振成像（MRI）发现及结局。
动物： 13只推定诊断为IFN的猫。
方法： 多中心回顾性描述性研究，采用基于问卷的随访。磁共振成像由一名对临床症状不知情的作者评估。
结果： 中位年龄为30个月（范围6-142）。从发病到就诊的中位时间为6天（范围1-150）。面部轻瘫或瘫痪在10例中为单侧，3例为双侧（16侧受累）。临床症状包括眼睑反射消失（11/16）或减弱（2/16）；唇下垂（5/16）；耳运动消失或减弱（报告3/6）。8只猫有前庭症状，包括头倾斜（6/13）、前庭性共济失调（6/13）、头部摇摆（2/13）和水平性眼球震颤（3/13）。MRI发现包括面神经增粗（4/16）或对比增强（7/16）或两者兼有，以及二腹肌后腹较小（9/16）。脑脊液（CSF）在11只猫中的10只正常。治疗包括眼部润滑（11/13）和抗炎剂量的泼尼松龙（3/13）。13只猫中有9只获得随访（中位13个月；范围2-91）。达到最大恢复的中位时间为20周（范围2-24）。自主眨眼恢复在12只眼中7只完全，2只部分，3只未恢复。3只猫有持续的唇、面部、耳或这些部位组合的异常。所有前庭症状均消退，但1只猫因复发而被安乐死。
结论及临床意义： 特发性面神经病似乎主要影响年轻猫，常为单侧，并常伴有前庭症状。自发改善是可能的，但可能遗留持续性神经功能缺损。

英文摘要

BACKGROUND: Idiopathic facial neuropathy (IFN) is commonly described in dogs, but information in cats is lacking.
HYPOTHESIS/OBJECTIVES: Describe clinical presentation, magnetic resonance imaging (MRI) findings and outcome in cats diagnosed with IFN.
ANIMALS: Thirteen cats with presumptive diagnosis of IFN.
METHODS: Multicenter retrospective descriptive study with questionnaire-based follow-up. Magnetic resonance imaging was assessed by a single author blinded to clinical signs.
RESULTS: Median age was 30 months (range, 6-142). Median time of onset to presentation was 6 days (range, 1-150). Facial paresis or paralysis was unilateral in 10 cases and bilateral in 3 (16 sides affected). Clinical signs included absent (11/16) or decreased (2/16) palpebral reflex; lip ptosis (5/16); absent or decreased ear movements (3/6 reported). Eight cats had vestibular signs, including head tilt (6/13), vestibular ataxia (6/13), head swaying (2/13), and horizontal nystagmus (3/13). Findings on MRI included thickened (4/16), or contrast-enhancing (7/16) facial nerve or both and smaller caudal belly of the digastricus muscle (9/16). Cerebrospinal fluid (CSF) was normal in 10 of 11 cats. Treatments included eye lubrication (11/13) and anti-inflammatory doses of prednisolone (3/13). Follow-up was available for 9 of 13 cats (median, 13 months; range, 2-91). Median time to maximal recovery was 20 weeks (range, 2-24). Recovery of spontaneous blinking was complete in 7 out of 12 eyes, partial in 2 out of 12 and absent in 3 out of 12. Three cats had persistent abnormalities of the lips, face, ears or some combination of these. All vestibular signs resolved but one cat was euthanized because of relapse.
CONCLUSION AND CLINICAL IMPORTANCE: Idiopathic facial neuropathy appears to affect mostly young cats, often unilaterally and frequently with vestibular signs. Spontaneous improvement is likely, but persistent neurologic deficits are possible.