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Fibrocartilaginous infarct
Fibrocartilaginous infarct in Lab
Fibrocartilaginous embolism
Fibrocartilaginous infarct
Paralyzed limbsalso see Neurological problems
also see spinal problems
Fibrocartilaginous infarct in Labrador Retriever - continued problems with legs
Question: Dear Mike:
I have a question about my 5 year old chocolate lab, who seems to be an
enigma for her vet as well as a neurologist she has been seeing. Rocky
had a fibrocartilaginous embolism in march of 99, which left her with partial
nerve damage to her right rear leg. She recovered quickly, though the prognosis
was unsure, since at the time none of her doctors had ever seen this. She was
standing within 4 days, walking in ten and back to using all legs well,
within a month.
She has been battling lick granulomas on her good rear leg which began
with a bee sting which she aggravated. Over the course of 10 months, she
has tried prednisone and antibiotics to help clear it up, and it has gotten
better until a new bite. It has gotten worse.
To make matters worse, she started having partial seizures where the
leg with the neurological deficit shoots out backwards, 5 or so times.
Sometimes, she will stop and curl into a ball till it is over, sometimes she will fall
and sometimes she will try to run. It seems like she is confused and
doesn't know what to do. I watch her intensely when it happens and sometimes she
will turn and look at her leg, but mostly she acts frightened. It can happen as
often as every 5 minutes or only a few times per day. I have noticed that
activity makes it happen more, so she has begun to avoid it, including
wanting to go outside, even to the bathroom. This is a dog who used to
be an athlete, and in only 1 and 1/2 years looks and acts much older.
Her neurologist put her back on prednisone and it stopped the movements
within 2 days but she got very sick from the prednisone, throwing up and
lost bladder control so she was weaned off. The seizures returned after 5 weeks
of no medication. She began prozac one week ago to try to stop the biting and
licking. Now she needs to be treated for the leg seizures.
The vet and neurologist don't agree on the next course of action, and I
do not know what to do. Are these three events related? Is it trial and
error? Have you ever heard of this sequence of events?Your response will be greatly appreciated. Dale
Answer: Dale-
I can see why your vet and the neurologist are confused. I can't find any
reports of long term problems associated with fibrocartilagenous infarcts
affecting one leg in this manner. On the other hand, it does seem like the
most likely cause based on the history.I tried to think of other causes for the symptoms. Labrador retrievers do
have a congenital myopathy (muscle disease) problem but it usually shows up
in puppies and usually results in general weakness. Another problem that
may be possible, based on the increased incidence of problems associated
with exercise would be exertional myopathy. Labrador retrievers are prone
to this problem. It is not easy to diagnose definitively (I am not even
sure it can be diagnosed definitively) but increased lactate and pyruvate
levels in the blood stream after exercise would be an indication that it
may be the culprit.There are a whole lot of individual case reports of problems affecting a
single muscle or a small muscle group and causing long term problems with
lameness or leg tremoring but none of these reports that I could find had
quite the symptoms you describe.It is also tempting to consider immune mediated myopathies and immune
mediated polyarthritis conditions (although these usually affect more than
one leg), especially since prednisone seemed to help. These might be
possible to diagnose with muscle biopsies or examination of joint fluid, if
any joints really seem to be the cause of the pain.Since prednisone worked, it might be worthwhile to consider an alternative
medication that has immunosuppressive effects, such as azathioprine or
cyclosporin but these have side effects, too. So it would be something
you'd have to discuss carefully with your vet and/or the veterinary
neurologist. Prednisone is often more effective than these medications and
it may help just to use a lower dosage than you were using previously,
since your Lab is sensitive to the site effects.Sometimes lick granulomas occur in dogs who are in pain and don't have a
good way of dealing with it. At least this seems to be the case, because
sometimes good pain-relief medications will result in resolution of the
lick granuloma. We have used hydrocodone (Hycodan Rx), carprofen (Rimadyl
Rx) and once even a fentanyl patch (Duragesic Rx) with success, in a small
percentage of the dogs that we have treated for lick granuloma. There are
unfortunately a lot of other possible causes of this behavior.You have taken the right steps in dealing with this problem, seeking the
help of a specialist and working with the specialist and your own vet. I
know that this is frustrating advice, but you may want to consider getting
a third opinion from an orthopedic specialist, an internal medicine
specialist or even another neurologist, if that is possible in your area.I wish I could help more with this.
Mike Richards, DVM
7/24/2000
Fibrocartilaginous embolism in Lab
Question: Dear Dr Mike,
My dog, a black Labrador, has suddenly lost all feeling in its rear end and
legs. The vet diagnosis through an mylogram is some sort of spinal trauma,
haemorrhage or embolism within the spinal column with now external damage.
My dog (Tag) has not been in any sort of accident nor has had a sudden
shock. He was very fit, strong and healthy on Sunday 10th of Oct and then
that evening he started to limp a little and in a couple of hours he lost
all use of his rear legs. Do you know if this has ever happened before? Is
their a cure? Should I have him put down? What about alternative
treatment/medicine?Below is a copy of the vets original report. Tag has since had an MRI which
has confirmed that his paralysis was caused from an fibro cartilegenlous
embolism.Vets report:- "Tag", 9 Yo Labrador, Neutered Male.
Problem.
Acute onset flaccid hindleg paralysis, progressed from left hind paresis to
bilateral paralysis within one hour. No overt signs of pain.Treatment.
Primary treatment, Methylprednisolone 30mg/kg i/v at time of hindlimb
collapse.
Referral examination 36 hours post onset.
Flaccid hindlimb paralysis with urinary retention and overflow. No
proprioception, no nociception, absent patella, cranial tibialis and
withdrawl reflexes. Flaccid anus, no perineal reflexes, flaccid tail. No
orthopaedic abnormalities found. Panniculus reflex intact.
Biochemistry, Haematology and electrolyte panel within normal limits. CSF
within normal limits.Radiology.
Plain radiographs of spine unremarkable. Cisternal myelogram indicated
shortened thecal sac or cauda equina compression, (regarded as
co-incidental) suspicion of intra-medullary mass effect L4/5 segement,
though subjective as good contrast columns present past region.Differential dagnosis considerd. Fibrocartilagenous embolism, (ischaemic
myelopathy,) intramedullary haemorrhage.Further investigation considered, MRI, EMG, Exploratory surgery, (durotomy).
Your response would be most welcomed.
Regards, D.R.
Answer: D.R.-
Fibrocartilaginous infarcts are not a common problem but they occur often
enough that most vets see a few cases in their careers. There is no really
effective treatment for this condition that I am aware of. Physical therapy
to keep the muscles of the rear limbs flexible and maintain some strength
seems to help in the dogs that recover use of the rear legs. I can not give
you statistics on the recovery rate but enough dogs do recover, often
nearly fully, to make it worth waiting to see what happens.Recovery is more likely if the dog has upper motor neuron damage (usually
have exaggerated patellar reflexes with this) rather than lower motor
neuron damage (lack of or poor reflexes). Unfortunately, Tag appears to
have lower motor neuron damage based on the neurologic exam findings. This
does not eliminate the possibility of a recovery but it does make it less
likely.Most dogs that recover start to show improvement within a week to ten days.
Many dogs recover partially, with some residual weakness or neurologic
deficits in the affected limbs.Good nursing care during the recovery period is very important, especially
making sure the urinary bladder is emptied on a regular basis and good skin
care for the areas that are in contact with bedding, etc. while little
feeling is present.I wish that I had a better treatment answer or a better prognosis to offer.
I am not aware of any huge success with alternative therapies but view this
as a reasonable time to try them, since I know of no successful
conventional therapy.Mike Richards, DVM
10/22/99
Fibrocartilaginous infarct or other spinal injury French Bulldog
Q: Dear Friends,
I beg Your help for my dog.
His breed is french bulldog and his breed is Ara (armenian male name).He is seven years old, and from five days is with paralyzed pelvic limbs.
Under the X-ray photograph made in Higher Institute of Veterinary
Medicine was settled a little cartilaginous growth between fifth and
sixth lumbar vertebra, which presses nerve endings and this leads to his
pelvic limbs immobility.
It was prescribed to him an irradiation treatment with ultra short waves
and laser and the bulgarian medicine Nivalin.
I beg your help with advice about his medical treatment and possibly
with remedy/medicine, because that kind of cases are very rare in
Bulgaria and there have no medicine and enough information.My name is Hazaros from Plovdiv, Bulgaria.
My dog means extremely much for me and my family.Cherish Hopes,
H.G.
A: H.G.-
I wish that there was some help that I could offer but I am not sure what
the diagnosis is, unfortunately.If this is a problem known as a fibrocartilaginous infarct here in the
United States then there is no sure treatment that I am aware of. This is a
disorder in which arteries and veins that supply nutrients to the spinal
cord are blocked by fibrocartilaginous material that is thought to
originate in the discs between the vertebrae. Most dogs that recover show
significant improvement within the first one to three weeks. Recognition of
pain in the paralyzed limbs (like looking when a toe is pinched) is a good
sign if it is present. Dogs do recover from these injuries frequently
enough to make it worth waiting several weeks to see what will happen.The other possible problem may be disc injury causing pressure on the
spine. If this is the problem and paralysis is present I am pretty sure
most U.S. vets would agree that surgery to relieve the pressure on the
spine would be best. Surgery works better when it is done within the first
24 to 48 hours but may have benefits later.I wish I could help more.
Mike Richards, DVM
6/20/99
Paralyzed limbs in French Bulldog - fibrocartilaginous infarct possible
Q: Dear Friends,
I beg Your help for my dog.
His breed is french bulldog and his breed is Ara (armenian male name).
He is seven years old, and from five days is with paralyzed pelvic
limbs.
Under the X-ray photograph made in Higher Institute of Veterinary
Medicine was settled a little cartilaginous growth between fifth and
sixth lumbar vertebra, which presses nerve endings and this leads to his
pelvic limbs immobility.
It was prescribed to him an irradiation treatment with ultra short waves
and laser and the bulgarian medicine Nivalin.
I beg your help with advice about his medical treatment and possibly
with remedy/medicine, because that kind of cases are very rare in
Bulgaria and there have no medicine and enough information.
My name is Hazaros C.. I'm 34 y.o., economist, from Plovdiv,
Bulgaria.
My dog means extremely much for me and my family.Cherish Hopes,
H.G.C
A: H.G.-
I wish that there was some help that I could offer but I am not sure what
the diagnosis is, unfortunately.If this is a problem known as a fibrocartilaginous infarct here in the
United States then there is no sure treatment that I am aware of. This is a
disorder in which arteries and veins that supply nutrients to the spinal
cord are blocked by fibrocartilaginous material that is thought to
originate in the discs between the vertebrae. Most dogs that recover show
significant improvement within the first one to three weeks. Recognition of
pain in the paralyzed limbs (like looking when a toe is pinched) is a good
sign if it is present. Dogs do recover from these injuries frequently
enough to make it worth waiting several weeks to see what will happen.The other possible problem may be disc injury causing pressure on the
spine. If this is the problem and paralysis is present I am pretty sure
most U.S. vets would agree that surgery to relieve the pressure on the
spine would be best. Surgery works better when it is done within the first
24 to 48 hours but may have benefits later.I wish I could help more.
Mike Richards, DVM
4/16/99
Last edited 08/30/02
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