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Topic:Neurological Diseases

Neurological diseases in horses encompass a range of disorders affecting the central and peripheral nervous systems. These conditions can arise from various etiologies, including infectious agents, genetic predispositions, trauma, or metabolic imbalances. Common neurological diseases in horses include equine protozoal myeloencephalitis (EPM), equine herpesvirus myeloencephalopathy (EHM), and cervical vertebral stenotic myelopathy (CVSM), also known as wobbler syndrome. Clinical signs associated with these diseases may include ataxia, weakness, altered gait, and changes in behavior or mental status. Diagnosis typically involves a combination of clinical evaluation, imaging techniques, and laboratory testing. This page compiles peer-reviewed research studies and scholarly articles that investigate the pathophysiology, diagnostic approaches, and treatment options for neurological diseases in equine populations.
Western equine encephalitis virus: A comprehensive review of epidemics, transmission, hosts, and strategies for mitigation.
Virulence    November 3, 2025   Volume 16, Issue 1 2580162 doi: 10.1080/21505594.2025.2580162
Wang L, Zheng R, Li Z, Zhang L.Recent increases in cases of western equine encephalitis (WEE) in South America have raised significant concerns about the virus's potential to cause an endemic disease due to its adaptation to mosquito vectors. Currently, there are no effective vaccines or treatments for WEEV, despite ongoing research into various biochemical products in animal models. The virus presents different pathological effects depending on the host. In humans, WEEV infection leads to central nervous system damage, resulting in encephalitis and severe neurological sequelae, which underscores the need for further resear...
A multiplex real-time PCR assay for detection of equid herpesvirus 1 and 4.
Scientific reports    October 31, 2025   Volume 15, Issue 1 38201 doi: 10.1038/s41598-025-22043-w
Tallmadge RL, Laverack M, Lejeune M, Crossley B, Diel DG.Equid herpesvirus (EHV) 1 and -4 are common viral pathogens of horses that can cause upper respiratory disease, neurological disease, abortion, and death. As characteristic alphaherpesviruses, both EHV-1 and EHV-4 can establish latency, resulting in a lifelong carrier state in infected animals. Here we describe the development and validation of a rapid and sensitive multiplex real-time PCR assay (EHV1-4MP) that simultaneously detects EHV-1 and EHV-4 and includes an endogenous internal control - melanocortin 1 receptor (MC1R) - targeting the equid genome. The EHV1-4MP assay analytical sensitiv...
First report of West Nile virus infections in horses in Tunisia from 2018 to 2023.
Virology journal    October 1, 2025   Volume 22, Issue 1 318 doi: 10.1186/s12985-025-02918-0
Badr C, Handous M, Nsiri J, ElBehi I, Arbi M, Maaroufi A, Bennour MA, Ben Osman R, Dachraoui K, Abbes M, Mahmoudi A, Khosrof I, Abrougui S, Lachheb J....West Nile virus (WNV) is an arthropod borne virus, the most widely distributed of the encephalitic Orthoflaviviruses. It can cause severe neurological symptoms in both humans and horses. It poses an emerging threat to both public and animal health. In this study, we retrospectively screened 25 suspected WNV samples collected from 2018 to 2023. Methods: A total number of 25 samples (brain tissue and blood) were collected from clinically affected horses and those already deceased across several locations in Tunisia. All samples were tested for the presence of WNV NS2A gene using qRT-PCR. Eleven ...
Feasibility and safety of intrathecal transplantation of allogeneic bone marrow mesenchymal stem cells in horses.
Veterinary research communications    September 29, 2025   Volume 49, Issue 6 333 doi: 10.1007/s11259-025-10920-8
de Oliveira Ferreira LV, Maia L, Barberini DJ, Takahira RK, de Vasconcelos Machado VM, Machado GF, de Melo GD, Amorim RM.Mesenchymal stem cells (MSCs) have emerged as a promising alternative for treating neurological disorders due to their neuroprotective, neuroregenerative, immunomodulatory, anti-inflammatory, and anti-apoptotic properties. The use of allogeneic MSCs offers advantages such as the selection of specific cells and their immediate availability. This study aimed to evaluate the safety and feasibility of intrathecal transplantation of allogeneic equine bone marrow-derived MSCs (EqBM-MSCs) in healthy horses. Ten healthy horses (five-12 years old) were randomly divided into two groups. In the control g...
Computed Tomography Angiography Diagnosis of a Congenital Intrahepatic Central Divisional Portocaval Shunt in an Arabian Filly. Cournoyer N, Hostnik ET, Urion R.A 1-month-old Arabian filly presented for central neurologic signs that developed shortly after birth. Hyperammonemia and elevated bile acids were identified, prompting abdominal computed tomography angiography (CTA) evaluation on suspicion of congenital portosystemic shunting (PSS). CTA revealed an anomalous vessel connecting the intrahepatic central divisional portal branch and caudal vena cava, with microhepatica and bilateral renomegaly. Necropsy confirmed a single, congenital, and intrahepatic central divisional portocaval shunt. Imaging literature addressing PSS in foals is sparse, with ...
Introduction of West Nile virus lineage 2 leads to neuroinvasive cases in humans and horses in Sicily, 2022-2023.
Veterinary research    September 25, 2025   Volume 56, Issue 1 177 doi: 10.1186/s13567-025-01575-z
In Italy, West Nile virus (WNV) has been consistently causing disease in humans, horses, and birds since 2008; it was initially confined to the northeast of the country and then spread gradually to the western and southern regions. WNV lineage 1 (WNV-L1) virus was the only lineage that circulated in Italy until 2011, but it was progressively replaced by WNV lineage 2 (WNV-L2). WNV disease in humans was not observed in Sicily, southern Italy, until 2016, when the first case of West Nile neuroinvasive disease (WNND) due to WNV-L1 was reported. Our results demonstrate the introduction of WNV-L2 i...
Analysis of IgG responses to Sarcocystis neurona in horses with equine protozoal myeloencephalitis (EPM) suggests a Th1-biased immune response.
Veterinary immunology and immunopathology    September 24, 2025   Volume 289 111009 doi: 10.1016/j.vetimm.2025.111009
Angwin CJ, de Assis Rocha I, Reed SM, Morrow JK, Graves A, Howe DK.Equine protozoal myeloencephalitis (EPM) caused by Sarcocystis neurona is one of the most important neurological diseases of horses in the Americas. While seroprevalence of S. neurona in horses is high, clinical manifestation of EPM occurs in less than 1 % of infected horses. Antemortem diagnosis has proven challenging as serum antibodies against S. neurona are an indicator of infection but not necessarily disease. Factors governing the occurrence of EPM are largely unknown, although horse immunity might contribute to EPM pathogenesis. Immunoglobulin G is the predominant antibody class in eq...
A retrospective study of 171 cases of equine meningoencephalomyelitis in the United States, 1996-2023. Countrymann K, Ruby R, Miller AD.Equine meningoencephalomyelitis is an important cause of morbidity and mortality and is associated with a wide variety of infectious etiologies. Because of the lack of large retrospective studies, the prevalence and incidence of these diseases are unknown. Here we describe 171 cases of meningoencephalomyelitis in horses submitted to the Section of Anatomic Pathology at the New York State Animal Health Diagnostic Center (Cornell University, Ithaca, NY, USA) from 1996-2023. Neuroinflammatory disease was identified in 5.4% of submitted horses with a wide breed, age, and sex distribution. A parasi...
Cone beam computed tomographic myelography in horses with cervical vertebral compressive myelopathy.
Equine veterinary journal    September 18, 2025   doi: 10.1111/evj.70094
González-Medina S, Barrett MF, Aboellail TA, Nelson BB, Nout-Lomas YS.While computed tomographic (CT) myelography is increasingly available and has been evaluated in alive horses, objective criteria for diagnosing cervical vertebral compressive myelopathy (CVCM) are lacking. Objective: To establish morphometric dimensions of the cervical vertebral canal and spinal cords from horses with CVCM and compare those to unaffected horses with the use of cone beam CT (CBCT). Methods: Prospective observational study. Methods: Four control horses and ten horses with CVCM underwent diagnostic imaging and histopathology. Morphometric measurements were obtained from cervical ...
Immunohistochemical and molecular confirmation of West Nile Virus associated polioencephalomyelitis in a mule from Southern Brazil.
Microbial pathogenesis    September 8, 2025   Volume 208 108025 doi: 10.1016/j.micpath.2025.108025
de Mello Zanim M, Rodriguez MC, Martins FDC, Camargos MF, Headley SA.West Nile fever is a zoonotic arboviral disease caused by the West Nile Virus (WNV), responsible for deaths in humans, mammals, and birds with associated neurological manifestations. All previous investigations of WNV from Brazil were based primarily on serological and molecular analyses and in humans, equids, and birds in the northern and southeastern regions of the country. This study describes the pathological and molecular findings observed in a mule, from the state of Paraná, southern Brazil, that died during an outbreak involving equids with clinical manifestations of a neurological dis...
Commercial cytokine assay on equine cerebrospinal fluid does not distinguish equine degenerative myeloencephalopathy from cervical vertebral stenotic myelopathy.
American journal of veterinary research    September 5, 2025   Volume 86, Issue 12 ajvr.25.06.0212.xml doi: 10.2460/ajvr.25.06.0212
Payette F, Kulp JC, Graves A, Janes J, Morrow J, Orr K, Reed S, Ruby R, Stefanovski D, Johnson AL.To measure and compare CSF cytokine concentrations among horses with equine neuroaxonal dystrophy (eNAD)/equine degenerative myeloencephalopathy (EDM), horses with cervical vertebral stenotic myelopathy (CVSM), and control horses and to evaluate for associations with clinical parameters. Unassigned: Banked equine CSF samples from horses with neurologic disease that underwent a complete neurologic examination and postmortem diagnosis confirmation of CVSM or eNAD/EDM or from control horses were included. Cytokines were measured with an equine-specific cytokine/chemokine magnetic bead multiplex p...
Traumatic brain abscess due to Streptococcus equi subspecies zooepidemicus in a Foal.
Veterinaria italiana    September 4, 2025   Volume 61, Issue 3 doi: 10.12834/VetIt.3725.34811.2
Poci Palumbo MI, Maciel Cavalcante R, Martins Amorim R, De Vasconcelos Machado VM, Sousa Rocha N, Garcia Ribeiro M, Cagnini DQ, Secorun Borges A.Bacterial infection of the equine central nervous system is rare. This report describes the clinical features, computed tomography (CT) findings, and postmortem results of a 3-month-old female Quarter Horse with an intracranial abscess. Clinical signs included seizures, depression, and bilateral blindness. CT imaging demonstrated a large space-occupying lesion in the left cerebral hemisphere, associated with a frontal bone fracture. Necropsy and histopathology confirmed the presence of an abscess secondary to head trauma. Bacterial culture identified Streptococcus equi subsp. zooepidemicus as...
Fistulous withers causing spinal epidural abscess in a Thoroughbred mare.
Journal of equine veterinary science    August 30, 2025   Volume 154 105680 doi: 10.1016/j.jevs.2025.105680
Ceriotti S, Clark-Price S, Cole R, Kramer A, Sandey M, Mora M.This case describes a 15-year-old Thoroughbred mare with fistulous withers that progressed to vertebral osteomyelitis and spinal epidural abscess (SEA), a severe complication that has yet to be reported. Initially treated with antibiotics and anti-inflammatory medication, the mare developed acute hindlimb ataxia and spastic paresis, suggesting spinal cord compression at T3-L3. Diagnostic imaging revealed vertebral fractures and abscessation, but vertebral canal involvement could not be confirmed. Despite aggressive medical therapy, including antimicrobials, corticosteroids, and neuroprotective...
V4020 Venezuelan Equine Encephalitis Vaccine: Mitigating Neuroinvasion and Reversion Through Rational Design.
Viruses    August 19, 2025   Volume 17, Issue 8 1136 doi: 10.3390/v17081136
Centers A, Barnaby K, Goedeker S, Pignataro A, Tretyakova I, Lukashevich I, Pushko P, Chung D.There is a need for safe and effective vaccines against the Venezuelan equine encephalitis virus that infects both humans and equines. However, development of a live-attenuated vaccine using the TC-83 strain has been hampered by substantial reactogenicity and the potential for neuroinvasion. In this study, we demonstrate that V4020, a new TC-83-based investigational VEEV vaccine with redundant safety features preventing neuroinvasion and reversion, exhibited no neuroinvasion potential in a murine model. Following subcutaneous or intramuscular administration, a subset of mice that received the ...
Seroprevalence and Passive Clinical Surveillance of West Nile Virus in Horses from Ecological High-Risk Areas in Western Romania: Exploratory Findings from a Cross-Sectional Study.
Microorganisms    August 16, 2025   Volume 13, Issue 8 1910 doi: 10.3390/microorganisms13081910
This cross-sectional study evaluated the seroprevalence and clinical impact of West Nile virus (WNV) infection in horses from three ecologically high-risk counties in western Romania (Timiș, Arad, and Bihor) between 2023 and 2025. A total of 306 unvaccinated horses were tested using a commercial ELISA, with 8.17% testing positive for WNV antibodies, indicating prior exposure. Passive surveillance for clinical signs during mosquito seasons identified 16 horses with acute neurological symptoms, four of which were confirmed as clinical cases based on WNV-specific IgM positivity, suggesting proba...
First Equine Herpes Myeloencephalopathy (EHM) Outbreak in Chile.
Animals : an open access journal from MDPI    August 11, 2025   Volume 15, Issue 16 2344 doi: 10.3390/ani15162344
Durán MC, Suazo M, Maturana A, Vargas MP, García A, Ahumada C, Pezoa A, Goehring LS, Lara F.Equine herpes myeloencephalopathy (EHM) is a neurological disease in horses caused by Equine herpesvirus type 1 (EHV-1). It is a serious condition, often resulting in severe neurological deficits, and can be fatal. In this report, we discuss the first outbreak of EHM in Chile (clinical signs, epidemiology, diagnosis, and control measures). A total of 567 polo horses were kept at the facility: 58.4% mares, 41.6% geldings, and stallions. Mean age was 9.7 ± 0.132 years. Thirteen horses showed clinical signs of EHV-1, eight had fevers (1.4%), and eleven developed EHM (1.9%). Only six of the eleve...
Cellular Immune Response in Horses After West Nile Neuroinvasive Disease.
Animals : an open access journal from MDPI    August 11, 2025   Volume 15, Issue 16 2352 doi: 10.3390/ani15162352
Tolnai C, O'Sullivan C, Lőrincz M, Karvouni M, Tenk M, Marosi A, Forgách P, Paszerbovics B, Wagenhoffer Z, Kutasi O.West Nile virus (WNV) is a mosquito-borne neurotropic virus that causes neurologic disease in both humans and horses. Yet the long-term cellular immune response following natural infection in horses remains poorly understood. This study aims to evaluate the WNV-specific T-cell response in horses recovered from West Nile neuroinvasive disease (WNND). Twelve client-owned horses (4 Hungarian sport horses, 2 Lippizaners, 1 KWPN, 1 Shagya Arabian, 1 Friesian, 1 Gidran, 1 Andalusian, and 1 draft cross horse) with confirmed clinical WNV infection were enrolled, and peripheral blood mononuclear cells ...
Screening for Borna disease virus 1 (BoDV-1) in Austria: Absence of human cases in a retrospective case-finding study. Bauswein M, Arnold L, Springer DN, Redlberger-Fritz M.Borna disease virus 1 (BoDV-1) is a zoonotic virus with a recently confirmed potential to cause rare but severe cases of encephalitis in humans. While the bicolored white-toothed shrew (Crocidura leucodon), which represents the reservoir, is widely distributed over eastern, central, and southern Europe as well as south-west Asia, human infections have so far only been reported from Germany. As infections in sentinels such as horses indicate the endemic circulation of the virus also in circumscribed regions of neighboring countries (Austria, Liechtenstein, Switzerland), we initiated a retrospec...
Detection of Novel Orthobunyavirus Reassortants in Fatal Neurologic Case in Horse and Culicoides Biting Midges, South Africa.
Emerging infectious diseases    June 26, 2025   Volume 31, Issue 7 1455-1459 doi: 10.3201/eid3107.241800
Rakaki ME, van der Walt M, Williams J, Venter M.We detected Shuni virus in horses and ovine fetuses and Shamonda virus in a caprine fetus in South Africa. We identified a Shuni/Shamonda virus reassortant in a horse and Shuni/Caimito, Shamonda/Caimito, and Shamonda/Sango virus reassortants in Culicoides midges. Continued genomic surveillance will be needed to detect orthobunyavirus infections in Africa.
A Pilot Study on Blood Concentration of β-Amyloid (40 and 42) and Phospho-Tau 181 in Horses.
Veterinary sciences    June 23, 2025   Volume 12, Issue 7 610 doi: 10.3390/vetsci12070610
Gazzano V, Curadi MC, Capsoni S, Baragli P, Kêdzierski W, Cecchi F, Gazzano A.In humans, aging is often accompanied by cognitive decline, as seen in Alzheimer's disease. In contrast, the aging process in horses remains poorly characterized. This study aims to explore the presence of blood-based biomarkers associated with cognitive degeneration in this species. Twenty-three Arabian horses were enrolled, and 5 mL of blood was collected from each to measure serum levels of β-amyloid peptides (Aβ40 and Aβ42) and phosphorylated tau protein (pTau181), both considered reliable indicators of cognitive impairment in other species. Aβ42 was undetectable in all samples, while ...
Equine-Assisted Intervention and Alzheimer’s Disease: A Non-randomized, Controlled, Multicenter Study.
Journal of applied gerontology : the official journal of the Southern Gerontological Society    June 18, 2025   Volume 45, Issue 4 655-664 doi: 10.1177/07334648251351697
Badin L, Bailly N.This study evaluated the psychological benefit of equine-assisted intervention (EAI) for older adults living with Alzheimer disease (AD). A non-randomized, controlled, multicenter study was conducted in 14 nursing homes. A total of 74 older adults were recruited and divided into three groups: a group benefiting from an EAI program, a group following an adapted physical activity program (APA), and a control group continuing their daily activities (CG). Psychological health was assessed. The results showed reduced psychobehavioral disorders by week six of EAI, improved quality of life, and sligh...
Equine botulism.
Equine veterinary journal    June 15, 2025   doi: 10.1111/evj.14542
Slavik K, Whitlock R, Johnson A.Botulism is a severe and often fatal disease in equine patients worldwide. Clostridium botulinum is a ubiquitous soil organism which produces a potent neurotoxin resulting in neuromuscular blockade and flaccid paralysis in affected animals. Definitive diagnosis is often impractical or impossible, leading to diagnosis and treatment based on clinical experience and presenting signs. Delay in case identification and treatment results in rapid deterioration of the patient. Treatment of recumbent equine botulism cases presents challenges due to patient size and requires intensive nursing care. This...
[Diagnostic imaging of the equine cervical spine and clinical significance of findings – review of literature – Part two: Ultrasonography, myelography, computed tomography, magnetic resonance tomography, and nuclear medicine].
Tierarztliche Praxis. Ausgabe G, Grosstiere/Nutztiere    June 13, 2025   Volume 53, Issue 3 191-196 doi: 10.1055/a-2536-5264
Hellige M, Geburek F.Diagnostic imaging is an important part of the diagnostic approach in equine spinal ataxia especially with the cervical spine being commonly involved. The spinal cord may be affected by a variety of conditions including cervical vertebral malformations, osteoarthritis of the articular process joints or less commonly neoplasia. Advanced imaging techniques such as myelography are more accurate in diagnosing spinal cord compression and may be performed under general anesthesia in neutral, flexed and extended positions of the cervical spine. The use of ultrasound is non-invasive and allows ultraso...
Navigated minimally invasive puncture of the trigeminal cistern in horses-a cadaveric study in preparation for a controlled rhizotomy.
Frontiers in veterinary science    June 13, 2025   Volume 12 1562404 doi: 10.3389/fvets.2025.1562404
de Preux M, Precht C, Becker R, Stieglitz L, Easley J, Koch C.Trigeminal-mediated headshaking is a neuropathic disorder in horses, characterized by signs of regional pain similar to trigeminal neuralgia in humans. The injection of glycerol into the trigeminal cistern to ablate pain-conducting nerve fibers within the trigeminal ganglion -known as glycerol rhizotomy- is a well-established treatment in human medicine. This study compares two approaches to the equine trigeminal cistern using a navigation system for guiding needle placement, a previously described ventral and a newly developed transmandibular lateral approach. The surgical accuracy and risk o...
Review of published research on primary dysautonomia of domestic animals.
The Veterinary record    June 7, 2025   e5499 doi: 10.1002/vetr.5499
Harte T, Smith D, Moore J, Wells B.An article published in 1992 by Marion M. Pollin and I.R. Griffiths reviewed the topic of primary dysautonomias of the autonomic nervous system of unidentified origin in multiple domestic species, specifically cats, dogs and horses. Thirty-one years later, we appear no closer to identifying the causal agents of these strikingly similar diseases. This article reviews the similarities and differences in clinical presentation and pathology of dysautonomia in canids, felids, equids, leporids and other less frequently reported species.
Epidemiology and surveillance of West Nile virus in the Mediterranean Basin during 2010-2023: A systematic review.
Current research in parasitology & vector-borne diseases    June 2, 2025   Volume 7 100277 doi: 10.1016/j.crpvbd.2025.100277
Abbas I, Ahmed F, Muqaddas H, Alberti A, Varcasia A, Sedda L.Climate change can cause spatio-temporal shifts in the epidemiology of various vector borne pathogens, especially in vulnerable areas such as the Mediterranean Basin (MB). Among these pathogens, the West Nile virus (WNV) became endemic in the region. This systematic review and meta-analysis study summarizes WNV epidemiology, molecular characteristics, and surveillance in various MB countries, relying on data and scientific articles on WNV published during 2010-2023. The number of published articles varied across the three MB subregions: Southern Europe (n = 153), North Africa (n = 33), and...
Diseases of the nervous system of equids in Brazil: a review. Carvalho KS, de Barros CSL, Mendonça FS, Machado M, Riet-Correa F.In Brazil, CNS diseases in equids were little known until the 1980s. Since then, several diagnostic laboratories have been operating in different universities, initially in the South and Southeast regions and, later, in the Central-West, Northeast and North regions. However, the knowledge accumulated from the diagnoses of nervous system diseases of equids made at these institutions over the years has not been reviewed comprehensively, and many papers are published in Portuguese. Here, we review 18 diseases that occur in the nervous system of equids in Brazil, including some critical infectious...
Can Acute Neurological Disease Cause Cardiomyopathy in Horses?
Animals : an open access journal from MDPI    May 16, 2025   Volume 15, Issue 10 doi: 10.3390/ani15101447
Vitale V, Velloso Álvarez A, de la Cuesta-Torrado M, Neira-Egea P, Vandecandelaere M, Tee E, Gimeno M, van Galen G.In human medicine, neurological diseases have been associated with transient cardiac abnormalities. In horses, myocardial disease is rarely diagnosed and has been associated with a wide variety of causes. The aim of this article is to describe three horses with no previous cardiac disease, which all developed severe cardiomyopathy following neurological disease. A 5-year-old Shetland pony stallion was diagnosed with cardiomyopathy with arrhythmias following an episode of seizures caused by an accidental intra-arterial xylazine injection. A 20-year-old crossbred mare was hospitalised for an ope...
Dysphagia in an equine referral hospital, 182 cases.
Equine veterinary journal    May 15, 2025   doi: 10.1111/evj.14512
Connolly KM, Estell K.Dysphagia describes a clinical sign of pathologies of the oral cavity, pharynx, and oesophagus that carries potentially serious consequences for horses. Given the diversity of differential diagnoses that may cause dysphagia, an understanding of the prevalence of dysphagia in hospitalised patients, the distribution of aetiologies and clinical outcomes could inform diagnosis, treatment, and prognosis. Objective: This study aims to describe the incidence, signalment, history, aetiology, treatment, and outcome of horses presenting to a referral hospital for dysphagia. Methods: Retrospective case s...
Intracerebral hemorrhage (hemorrhagic stroke) secondary to Bothrops spp. snakebite envenomation in a horse.
Toxicon : official journal of the International Society on Toxinology    May 14, 2025   Volume 263 108408 doi: 10.1016/j.toxicon.2025.108408
de Sousa ALV, de Sousa DER, de Macêdo IL, de Albuquerque Cerqueira L, da Fonseca YNG, Oliveira AB, das Chagas LVS, Gonçalves GB, Veado HC....This report describes the first documented case of intracerebral hemorrhage (ICH) in a horse following Bothrops snakebite envenomation. A 3-year-old mare developed acute kidney injury, systemic hemorrhage, and neurological signs before euthanasia. Postmortem findings confirmed massive ICH with intralesional venom identified by immunohistochemistry. Delayed treatment and insufficient antivenom likely contributed to the outcome. This case highlights the potential for cerebrovascular complications following Bothrops snakebite envenomation in horses, which may present as subtle neurological signs....