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Posted on 10-15-2015
Meet Wilson! Wilson is a 9 year old Golden Retriever that presented to All Pets Animal Hospital for sudden lameness in both of his hind limbs. Wilson has always been a very active pup, with a love of chasing his ball, running with his Dad, and playing in the outdoors. On this day, Wilson was out playing ball with his Dad. When he went to jump in the air to catch the ball, his Dad heard him cry out. His Dad ran over to check on him and noticed Wilson was suddenly unable to use his back legs very well, and was unable to get up and walk. By the next morning, Wilson wasn’t able to use his back legs at all, although he didn’t seem to be in any pain.
On physical exam, Wilson was very weak in both of his rear legs, and especially the left rear limb. He was still able to move his legs a bit and did show signs of feeling pain in the legs, as well. To help diagnose his condition, we performed a test called a “conscious proprioception” test. Holding him in a standing position, we flipped his back feet over (so he was standing on the tops of his toes) to see how he would react. Most dogs immediately turn their feet over, but Wilson did not. This indicated that the signal was not being sent from the nerves in his feet, via the spinal cord, to the brain. Additionally, his spinal reflexes were all overexaggerated. Throughout all of these tests, his left hind limb was much worse when compared to the right. Taken together, his clinical signs and physical exam findings demonstrated that Wilson likely had an insult to a specific area in his spinal cord due to an underlying disease process called fibrocartilaginous embolism (FCE).
FCE is a fairly common disorder in which a piece of fibrous cartilage from one of the disks in the spike breaks off and lodges in one of the blood vessels which feed the spinal cord. The fibrous clot obstructs the blood vessel, decreasing or stopping blood flow to that area of the spinal cord. When the flow of blood to the spinal cord is decreased or stopped, that part of the spinal cord goes without oxygen and nutrients. The affected nerve cells become dysfunctional and can even die off, leading to the clinical signs we were seeing in Wilson. It is like a “stroke” to the spinal cord.
FCE often occurs during times of activity like running or jumping for a ball. Often the pet is normal one minute and abnormal the next. The majority of dogs may yelp once, but after the initial insult there is usually no pain associated with the disease. Clinical signs are usually a very abrupt loss of function to one or more limbs (depending on what part of the spinal cord is affected) and usually one side of the body is significantly worse when compared to the other. In most cases, clinical signs (weakness of the limb or limbs) will stabilize after 12-24 hours, and generally do not progress after that time period.
FCE is diagnosed based on a complete history, physical exam and neurologic examination. With a sudden onset of neurological weakness, absence of pain, and usually seeing one side of the body more affected than the other, a FCE is the most likely diagnosis. In some cases, a referral to a neurologist for an MRI (magnetic resonance imaging) can help to diagnose the part of the spinal cord that is affected, and helps to confirm the diagnosis while ruling out other possible causes for the clinical signs. Additionally, an MRI can help us determine a prognosis for the return of function to the limbs based on the size of the area of the “stroke.” In Wilson’s case, we performed routine diagnostic tests including lab work and spinal x-rays to rule out more severe causes – like a fracture or other trauma. Luckily, his lab work looked great! On x-rays there were no signs of a fracture, tumor or other underlying disease processes.
With FCE there is no direct treatment or therapy since we do not have a way of removing the fibrocartilage from the blood vessels in the spinal cord that is causing the problem. We rely on time to allow the spinal cord to generate new blood vessels or to open up the obstructed vessel. However, physical therapy, electroacupuncture, and laser therapy have in some cases been shown to be key in the recovery phase. Physical therapy exercises such as using an underwater treadmill, wobble board, stretching exercises, passive range of motion, weave poles and Cavaletti poles can be very beneficial for the pet in regaining function in the affected limbs. Electroacupuncture has been shown to help regenerate new nerve cells as well as blood vessels, and laser therapy can also help with tissue regeneration.
For Wilson, it was heart breaking for his family to watch their usually very active dog, struggle to even get up to walk. Wilson’s pet family opted for an intense physical therapy program using the physical therapy exercises listed above along with electroacupuncture. His family was devoted to working with him every day, and was diligent about working on his physical therapy exercises at home. He received electroacupuncture treatments once a week, and serial neurological examinations were performed each week to track his improvement over time.
Over about 2-6 weeks we watched as Wilson steadily improve. Over time, he got to the point where he was able to walk and even run again with his Dad! The long term prognosis for FCE is good for returning to walking in most cases, (depending on the severity of the insult to the spinal cord) and the chances of Wilson having a second FCE in the future is slim. Cheers to Wilson and his pet family for their positive attitudes, love, and commitment to helping Wilson achieve a full recovery! We wish you the best as you go play and have fun in the San Diego sun!
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