Felis ISSN 2398-2950

Fibrocartilaginous embolism

Synonym(s): Fibrocartilaginous embolic neuropathy, Ischemic myelopathy, FCE

Contributor(s): Paul Cuddon, Simon Platt, Harry Scott, Laurent Garosi

Introduction

  • Peracute onset disease, usually marked lateralization of deficits, although bilateral signs are often seen initially.
  • Cause:
    • Ischemic necrosis of spinal cord associated with fibrocartilaginous emboli in blood vessels.
    • Cervical and lumbar spinal cord enlargements commonly involved, but can occur anywhere along spinal cord.
  • Signs:
    • Peracute (<6 hours) onset of non-painful, non-progressive (after 24 hours) and often asymmetric myelopathy.
    • Reflect the location of the lesion. Can be UMN or LMN paresis/plegia.
Print off the owner factsheet on Ischemic myelopathy Ischemic myelopathy to give to your client.

Pathogenesis

Etiology

  • Mechanism unknown - embolism most commonly occurs in the spinal cord arteries, although can be associated with veins or both arteries and veins.
  • Fibrocartilaginous emboli thought to be intervertebral disk material (nucleus pulposus).
  • In very young animals growth plate cartilage is another possible source.
  • Possible increases in intra-abdominal pressure may alter blood flow dynamics and direction to the spine, intervertebral disks and spinal cord, allowing discal embolization of the spinal cord to occur.
  • Hyaline arteriopathy in older cats with cervical ischemic myelopathy. Hyaline degeneration affecting the ventral spinal artery, basilar artery or associated branches.

Predisposing factors

General

  • None known in cats.

Specific

  • None known in cats.

Pathophysiology

 
  • Fibrocartilaginous embolism in vessel of spinal cord  →  infarction  →  ischemia or hemorrhage  →    malacia and necrosis of cord, gray and white matter  →   interruption of neural integrity  →  loss of function of target organs of affected neurones  →  loss of skin sensation, motor function and spinal reflexes.
  • Hyaline degeneration in older cats affecting the ventral spinal artery, basilar artery or associated branches → aneurysmal dilation, thrombosis and ischemic degeneration and necrosis of the spinal cord.

Timecourse

  • Immediate onset following location of embolus.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Rylander H, Eminaga S, Palus V et al (2014) Feline ischemic myelopathy and encephalopathy secondary to hyaline arteriopathy in five cats. J Feline Med Surg 16 (10), 832-839 PubMed.
  • Simpson K M, De Risio L, Theobald A et al (2014) Feline ischemic myelopathy with a predilection for the cranial cervical spinal cord in older cats. J Feline Med Surg 16 (12), 1001-1006 PubMed.
  • Theobald A, Volk H A, Dennis R et al (2013) Clinical outcome in 19 cats with clinical and magnetic resonance imaging diagnosis of ischemic myelopathy (2000-2011). J Feline Med Surg 15 (2), 132-141 PubMed.
  • Nakamoto Y, Ozawa T, Mashita T et al (2010) Clinical outcomes of suspected ischemic myelopathy in cats. J Vet Med Sci 72 (12), 1657-1660 PubMed.
  • MacKay A D, Rusbridge C, Sparkes A H et al (2005) MRI characteristics of suspected acute spinal cord infarction in two cats, and a review of the literature. J Feline Med Surg (2), 101-107 PubMed.
  • Abramson C J, Platt S R, Stedman N L (2002) Tetraparesis in a cat with fibrocartilaginous emboli. J Am Anim Hosp Assoc 38 (2), 153-156 PubMed.
  • Scott H W, O'Leary M T (1996) Fibro-cartilaginous embolism in a cat. J Small Anim Pract 37 (5), 228-231 PubMed.
  • Turner P V, Percy D H, Allyson K (1995) Fibrocartilaginous embolic myelopathy in a cat. Can Vet J 36 (11), 712-713 PubMed.

Other sources of information

  • Neer T M (1992) Fibrocartilaginous emboli. Vet Clin North Am Small Anim Pract 22 (4), 1017-1026 PubMed.
  • Cook J R Jr. (1988) Fibrocartilaginous emboli. Vet Clin North Am Small Anim Pract 18 (3), 581-592 PubMed.


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