I am cross posting from the VetRehab site to cast as wide a net as possible to get some expert advice!!
Hey there everybody!
I need some expert input!!
I am going to see a dog next week ( 5 yr old male Aussie) that slipped and fell on wet deck steps on June 1st. He was limping on his LR and she thought he blew his cruciate because he had blown the opposite CCL a few years earlier.
She went to the ER and the vet told her she should go to a neurologist because the dog had uneven pupil size.
She did that and the neurologist had her do an MRI. She tells me there was an FCE lesion at C7-T1 which is causing the lameness in the rear end. I asked her if he ever was lame in the LF and she said slightly but it's gone now. The eyes are normal now and he is on gaba 100mg BID.
I asked her what is going on on the LR and she says "he is still toe touching"
It all sounds so weird to me- I am not an FCE expert.
If she had not had the MRI, based on the symptoms, I would have said he banged his neck up enough to have a temporary Horner's in the eye and did indeed have a CCL injury.
This all sounds so weird to me- Do FCE's recover this fast? He has had no other meds except for the Gaba and no rehab therapy yet. Far be it for me to counter a neurologist, I haven't even seen the dog yet and I guess MRI's don't lie…
Thanks in advance!
Carole Nicholson DVM, CCRT, CVSMT
Question on FCE
Re: Question on FCE
Hey Carole!
So what did they see on MRI that suggested an FCE? I've not heard of any local FCE cases being sent for MRI. But this case sounds really interesting. I wonder how many undiagnosed transient FCE's exist out there!?
So, I have seen some very quick resolving FCE's. I think of them as quick small disc extrusions (like a Hansen's Type 3 disc, but hitting a blood vessel versus the spinal cord). So, since damage can be all over the map, and recovery can be fast or slow, you really can get all sorts of progressions with an FCE.
Now, what doesn't make sense is an FCE in the neck causing a unilateral hind leg lameness. Follow me her... an neck lesion can only cause an UMNL in the rear leg... and an UMNL does not 'toe touch'. An UMNL is a leg drag, a weakness, ataxia, etc. Not toe touching. Toe touching is a voluntary positioning and is not neurologic. It is most typically a pain response.
MRI's lie all the time! An MRI is only a picture. It is useless if not matched with a history, clinical signs, and a thorough physical examination. MRI's show you all sorts of subclinical asymptomatic things all the time! Check out FourLeg News Nov-Dec 2014 - The VOMIT edition (Victim of Medical Imaging Technology).
So this dog may have had something on imaging that made the neurologist suspect an FCE, but making a cervical FCE and a toe touching rear leg lameness a cause & effect scenario just doesn't make sense. So maybe the abnormality of the neck (as seen on MRI) was there all along and your thoughts on what happened are actually correct!
My money's on you Carole! Update us here when you see the case!
Cheers,
Laurie
So what did they see on MRI that suggested an FCE? I've not heard of any local FCE cases being sent for MRI. But this case sounds really interesting. I wonder how many undiagnosed transient FCE's exist out there!?
So, I have seen some very quick resolving FCE's. I think of them as quick small disc extrusions (like a Hansen's Type 3 disc, but hitting a blood vessel versus the spinal cord). So, since damage can be all over the map, and recovery can be fast or slow, you really can get all sorts of progressions with an FCE.
Now, what doesn't make sense is an FCE in the neck causing a unilateral hind leg lameness. Follow me her... an neck lesion can only cause an UMNL in the rear leg... and an UMNL does not 'toe touch'. An UMNL is a leg drag, a weakness, ataxia, etc. Not toe touching. Toe touching is a voluntary positioning and is not neurologic. It is most typically a pain response.
MRI's lie all the time! An MRI is only a picture. It is useless if not matched with a history, clinical signs, and a thorough physical examination. MRI's show you all sorts of subclinical asymptomatic things all the time! Check out FourLeg News Nov-Dec 2014 - The VOMIT edition (Victim of Medical Imaging Technology).
So this dog may have had something on imaging that made the neurologist suspect an FCE, but making a cervical FCE and a toe touching rear leg lameness a cause & effect scenario just doesn't make sense. So maybe the abnormality of the neck (as seen on MRI) was there all along and your thoughts on what happened are actually correct!
My money's on you Carole! Update us here when you see the case!
Cheers,
Laurie
LAURIE EDGE-HUGHES
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cansk8@ac.com
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Re: Question on FCE
OK- so I saw the dog today- I forgot to mention in the initial post that he had anisocoria. I am guessing that has something to do with the lesion in the lower cervical affecting the sympathetic trunk?
Anyway, the dog was not toe touching at all- I don't know why she said that!!
He is walking pretty well but he has decreased CP in the LR and is tripping on the cavalettis she had set up. I told her to lower them because she just had it set too high.
He still has a degree of anisocoria ( left smaller than right) I don't know how bad it was originally- His indirect pupillary response from left to right is diminished. I can understand inflammation from a whack on the neck causing this because she told me he slipped down this beautiful spiral stair case she has in her back yard. I don't get how a vascular event in the lower neck causes this do you?
Ortho exam normal
No deficits in the LF. Laurie, can you explain how the symptoms from an FCE lesion at the lower cervical skips the front leg and affects the back leg? You are very good at reasoning things out and I just don't get it!!
So I did some homotox/acupuncture- showed her a few exercises like lifting individual legs, diagonals, ipsilaterals, dog squats, weight shifting- It all doesn't seem enough!!
Anything more specific? He kinda parks his LR under his belly but she said he did that even before this event..
I do more ortho stuff than neuro except for the typical down Dachshund where I usually do acupuncture.
Do you have to do any gait repatterning stuff? I really do need to review my notes!!
Anyway, the dog was not toe touching at all- I don't know why she said that!!
He is walking pretty well but he has decreased CP in the LR and is tripping on the cavalettis she had set up. I told her to lower them because she just had it set too high.
He still has a degree of anisocoria ( left smaller than right) I don't know how bad it was originally- His indirect pupillary response from left to right is diminished. I can understand inflammation from a whack on the neck causing this because she told me he slipped down this beautiful spiral stair case she has in her back yard. I don't get how a vascular event in the lower neck causes this do you?
Ortho exam normal
No deficits in the LF. Laurie, can you explain how the symptoms from an FCE lesion at the lower cervical skips the front leg and affects the back leg? You are very good at reasoning things out and I just don't get it!!
So I did some homotox/acupuncture- showed her a few exercises like lifting individual legs, diagonals, ipsilaterals, dog squats, weight shifting- It all doesn't seem enough!!
Anything more specific? He kinda parks his LR under his belly but she said he did that even before this event..
I do more ortho stuff than neuro except for the typical down Dachshund where I usually do acupuncture.
Do you have to do any gait repatterning stuff? I really do need to review my notes!!
Re: Question on FCE
Hi Carole,
So I'm not sold on the diagnosis.
And maybe you'll never make it add up and you'll have to just treat the dog in front of you without every knowing. Make me think of a doberman I saw years ago. He was in one of my classes - at home at the Canine Fitness Centre - he was another therapist's client. Anyways, he had been diagnosed with an FCE of multiple levels in the thoracic spine. However his one hind leg looked like your typical UMNL signs and the other rear leg was weak with mixed UMNL & LMNL. Anyways, long story short, he also had a SIJ dysfunction that was manifesting the LMNL signs. We fixed that and then it was just the UMN signs that we had to deal with and the recovery was smooth thereafter!
So, look for other issues... and I'm not sure the anisocoria can come from an FCE - especially if the signs / symptoms are not more catastrophic. (BTW I read that this is 'normal' in 20% of the human population - could this be similar in dogs?)
As far as a neck showing only rear signs. We know this occurs with discs in dogs - because the proprioceptive tracts for the rear legs are more superficial than the tracts for the front limbs - so it is possible that a neck FCE could show a rear end issue... but that being said, I've never seen it or heard of it, and hence my recommendation to look for other issues or simply treat for function and neuro retraining. Lots of patterning and strengthening. Check out the neuro videos to refresh your memory and come up with some ideas! (I'd do the 'placing' retraining).
Cheers,
Laurie
So I'm not sold on the diagnosis.
And maybe you'll never make it add up and you'll have to just treat the dog in front of you without every knowing. Make me think of a doberman I saw years ago. He was in one of my classes - at home at the Canine Fitness Centre - he was another therapist's client. Anyways, he had been diagnosed with an FCE of multiple levels in the thoracic spine. However his one hind leg looked like your typical UMNL signs and the other rear leg was weak with mixed UMNL & LMNL. Anyways, long story short, he also had a SIJ dysfunction that was manifesting the LMNL signs. We fixed that and then it was just the UMN signs that we had to deal with and the recovery was smooth thereafter!
So, look for other issues... and I'm not sure the anisocoria can come from an FCE - especially if the signs / symptoms are not more catastrophic. (BTW I read that this is 'normal' in 20% of the human population - could this be similar in dogs?)
As far as a neck showing only rear signs. We know this occurs with discs in dogs - because the proprioceptive tracts for the rear legs are more superficial than the tracts for the front limbs - so it is possible that a neck FCE could show a rear end issue... but that being said, I've never seen it or heard of it, and hence my recommendation to look for other issues or simply treat for function and neuro retraining. Lots of patterning and strengthening. Check out the neuro videos to refresh your memory and come up with some ideas! (I'd do the 'placing' retraining).
Cheers,
Laurie
LAURIE EDGE-HUGHES