Fibrocartilaginous Embolic Myelopathy (FCE)
Dr. Erika De Papp
Spinal radiographs. Radiographs (X-rays) are an important part of the diagnostic work-up as they will help rule out fractures, bone tumors, diskospondylitis and possibly disc herniations. Most cases of FCE have completely normal radiographs.
A thorough history and physical exam are imperative to making an appropriate diagnosis. Detailed information about the onset and progression or lack of progression of clinical signs, as well as the possibility of trauma may be useful in developing an accurate list of potential diagnoses. A careful neurologic exam will localize the area of the spinal cord that is abnormal, as well as assess the degree of neurologic compromise. Assessment of mobility as well as the animal's ability to feel a stimulus applied to the limbs also helps determine the prognosis for recovery. More specific tests include:
Myelography. A myelogram is a special type of X-ray that uses a contrast agent (dye) to outline the spinal cord. This contrast demonstrates if the spinal cord is compressed at any point along its path, or if there is a mass (tumor) associated with the spinal cord. This test is very useful in ruling out the other aforementioned disease processes. Many cases of FCE have a normal myelogram. Occasionally there is mild spinal cord swelling associated with the infarct which may alter the appearance of the study, but this occurs early and does not persist. Evidence of significant spinal cord compression is not consistent with a diagnosis of FCE.
CSF analysis. The cerebrospinal fluid of animals with FCE is usually normal, but may have some evidence of hemorrhage or elevated protein levels. Evaluation of CSF cannot provide a diagnosis of FCE but it can be useful in diagnosing other processes such as certain cancers and inflammatory spinal cord diseases (myelitis).
Complete blood count (CBC), biochemical profile and urinalysis. These tests are a routine component of many diagnostic work-ups. The CBC provides information with respect to the red and white blood cells and the platelets. The biochemical profile provides important information with respect to liver and kidney function, as well as electrolyte levels and the urinalysis provides more information with respect to kidney function. These tests are expected to be normal in patients with FCE, but they help rule out other disease processes, and provide a more complete picture of the patient's overall health.
The mainstay of therapy for FCE is supportive care. FCE cannot be definitively diagnosed in a living patient, therefore all other diseases that may present with similar clinical signs must be ruled out using the aforementioned diagnostic tests. There is no surgical procedure to repair the infarcted portion of the spinal cord, so healing must occur on its own. Some treatments may include:
If the patient is presented to the hospital within 6-8 hours of the onset of clinical signs, intravenous treatment with corticosteroids may limit the degree of damage that occurs to the spinal cord. Beyond this early stage, steroid therapy is not indicated for FCE.
Supportive care is crucial for animals that are immobilized by spinal cord disease. Since many animals with FCE are large breed dogs, caring for them during the recovery phase can be challenging. Patients must be able to maintain an upright position to eat and drink. In some cases they may need physical support to stay in an appropriate position. Additionally, if they are lying on one side, they need to be rotated several times a day so that alternate sides of the body are facing up.
Physical therapy on the limbs is important to help maintain good muscle tone.
Attention must be paid to whether the patient is able to urinate normally. Depending on what part of the spinal cord is involved, some animals may either lose the ability to empty their bladder, or may develop urinary incontinence. Manual bladder expression may be required in the former case and frequent cleansing of urine soaked hair and skin may be necessary in the latter case. If urine retention is a problem, animals become prone to urinary tract infection. Foul smelling or discolored urine should be analyzed for the presence of infection. Antibiotics are indicated if infection is documented.
Monitoring for the development of pressure sores should also be performed.
Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up can be critical, especially if your pet does not rapidly improve.
Many pets will recover from FCE, but it can be a slow process. The patient should be evaluated by your veterinarian 10-14 days after discharge from the hospital and approximately once a week thereafter, until marked improvement is noted.
Many animals will start to show signs of improvement in the first 7-10 days. If there is no improvement within three weeks, the prognosis is guarded.
Regularly scheduled re-exams are important for full neurologic evaluation. Subtle changes in your pet's status may go unnoticed until a full exam is performed.
Supportive care started in the hospital must be continued at home. If your pet appears to be getting worse, this should be brought to your veterinarian's attention immediately.