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West Nile virus (WNV) is an arthropod-borne flavivirus that is endemic in Africa, Europe, and Eastern Asia. The recent introduction and rapid dissemination of the virus in the United States as well as an increase in WNV outbreaks in Europe, has raised concerns for its spread in Europe. A surveillance system was developed to allow timely detection of an introduction of WNV infections in The Netherlands. This program focuses on cases presenting with neurological disease and includes the monitoring of hospital discharge diagnoses, trends in cerebrospinal fluid (CSF) diagnostic requests, laboratory testing of CSF, and monitoring of neurological disease in horses. Retrospective data from the hospital discharge records showed yearly peaks of unexplained meningitis and (meningo)encephalitis in the summer. A total of 781 CSF samples from humans and 71 serum and/or CSF samples from horses presenting with neurological disease of suspected viral etiology tested negative for the presence of specific antibodies to WNV. With a coverage rate of 59% in 2003, the probability that a cluster of five WNV cases presenting with neurological symptoms would have been detected was 99%. We conclude that, from 1999 to 2004, no evidence of WNV infection could be found in either humans or horses in The Netherlands.

The presence of toxins or infectious agents combined with environmental factors in combination with a susceptible host can be the cause for neurological disease in groups of horses. During a 5 year observational period outbreaks of neurological diseases among horses were evaluated. Causes of occurring neurological diseases were equine botulism, lolitrem intoxications, equine herpesvirus type 1-associated myelo(encephalo)pathy, and encephalitis caused by (disseminated) Streptococcus equi subspecies equi infection. This article focuses on the first three syndromes because of their predominant influence on locomotion. The pathogenesis of each disease is presented, followed by a description of a general presentation of the diseases as encountered under Dutch circumstances.

Equine protozoal myeloencephalitis (EPM) was diagnosed in a Dutch Warmblood gelding a few months after its export to the United States. The horse came back and was treated here. Additionally, an overview of the disease complex 'EPM' is given. Mode of infection, diagnosis of disease and its differential diagnoses, and general therapeutic options are presented. Although EPM due to infection with Sarcocystis neurona in Europe seems restricted to those horses that return or are imported from North America, the possibility of future cases of EPM caused by an infection with Neospora spp. is briefly discussed.

In the course of several days most of the 40 riding-school horses turned out in paddocks developed ataxia of variable severity. Five of these horses showed severe ataxia and tremors, became paralyzed and were euthanized. Eleven privately-owned horses which were stabled on the same premises showed no clinical signs. The most likely diagnosis seemed to be the 'neurological form of EHV1', although the signs were not entirely typical. A few weeks later a second outbreak occurred among the riding-school horses and one of the privately-owned horses also showed signs of ataxia. In the meantime it had been shown that EHV1 titers in paired serum samples had not increased and that the cerebrospinal fluid of one of the severely affected horses was normal. Toxicological examination of hay, delivered just before the first outbreak and stored for the winter, showed a significantly increased concentration of lolitrem B mycotoxin (5-6 mg/kg). The hay appeared to have been made of ryegrass used for lawns and playing fields. Retrospectively it became probable that this hay occasionally been fed to the horses just before the onset of clinical problems. It is concluded that the horses showed the 'ryegrass-stagger syndrome'.

A 2 day old foal was presented with central nervous depression (coma) after moxidectin overdose. Moxidectin belongs to the milbemycin anthelmintics which elicit their working mechanism through a GABA (gamma-aminobutyric acid)-stimulatory mode of action. The foal developed profound hypothermia, bradycardia and hypoventilation. Absence of urine voiding and mild abdominal distension suggested a ruptured bladder, which was confirmed by transabdominal ultrasound and clinical-pathologic parameters. Repeat auscultation of the ventral lung parts and the occurrence of gastric reflux were suggestive of an aspiration pneumonia. The foal underwent surgical bladder repair, however, did succumb due to mixed acidosis and early signs of sepsis postoperatively. The findings in this foal are suggestive for moxidectin overdosing. The GABAergic working mechanism of moxidectin does explain the development of profound central nervous depression and its sequels hypothermia, bradycardia, hypoventilation and paralytic ileus. Dyssynergia was unexpected, however, has to be related to a central nervous problem, rather than a peripheral nervous problem.

Laparoscopic herniorrhaphy is a new and presently evolving technique applied to the repair of inguinal defects. Many different authors have described various methods by which this can be achieved. Some of these include the transabdominal preperitoneal approach, the plug technique, the intraperitoneal onlay of mesh, and the extraperitoneal approach. The authors have performed 252 laparoscopic hernia repairs utilizing a form of the transabdominal preperitoneal procedure that is referred to as the "transperitoneal anatomic approach." The development of new procedures or the modification of existing procedures can create new problems or alter the pattern of traditional complications. These problems must be thoroughly evaluated and reported if repetition of these errors is to be avoided. Five cases of meralgia paresthetica are reported that resulted from staple entrapment of the lateral femoral cutaneous nerve during laparoscopic herniorrhaphy. An understanding of the preperitoneal inguinal anatomy and precise placement of staples will allow avoidance of this complication.