Necrotising meningoencephalitis in Pugs: clinical keys
2-year-old Pug with increasingly frequent seizures, disorientation, circling and blindness with preserved pupillary light reflexes, progressing over 3 weeks.
Which statement about necrotising meningoencephalitis (NME) is correct?
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A. It mainly affects the forebrain cortex, is progressive and has a guarded prognosis; seizures are often difficult to control
Correct. NME is a subtype of MUO with necrosis of the cortex and subcortical white matter, which is why forebrain signs dominate (seizures, central blindness, behavioural change). It is treated with immunosuppression and antiepileptic drugs, but survival is usually shorter than in other forms.
B. It mainly affects the brainstem white matter, so seizures are rare
This better describes necrotising leucoencephalitis of the Yorkshire Terrier. In Pug NME the cortex is affected and seizures are the most characteristic sign.
C. It is caused by canine distemper virus and confirmed by CSF PCR
NME is immune-mediated, with a genetic predisposition (associated with DLA class II). PCR for infectious agents is used to rule them out, not to confirm NME.
D. It has a good prognosis: most dogs are cured with a short course of corticosteroids
It is the MUO form with the worst prognosis; it requires prolonged immunosuppressive treatment, and even so many dogs die or are euthanased for refractory seizures.
lightbulb Key takeaway
NME mainly affects young Pugs, as well as Maltese, Chihuahuas and other toy breeds. Diagnosis in life is presumptive (MRI with asymmetric cortical and subcortical lesions, inflammatory CSF); definitive diagnosis is histopathological. Give the owner a guarded prognosis from the outset.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.