Answers and Discussion

Answers and Discussions to the Questions:

• Describe the typical presentation (signalment, history, etc.) associated with an FCE.
  
  FCE is usually associated with young to middle-aged large-breed dogs.   However, Schnauzers and Shelties also commonly have FCE's associated with their tendency to develop hyperlipidemia syndromes.  Onset is acute and signs do not progress.  Although the animal cries out in pain at the initial insult,  he is non-painful after that.  FCE is usually associated with vigorous activity (running, jumping, etc.) or trauma.
  
• What differential diagnoses should you consider in this case and what diagnostics would you perform?
  
  Differentials should include trauma, intervertebral disc disease, neoplasia, hemorrhage secondary to trauma or coagulopathy, and FCE.  Diagnostics should include a myelogram +/- a CT scan, and a CSF tap.  Since neoplasia is common with older dogs, we recommend taking chest and abdominal radiographs first before proceeding with the myelogram.  They may reveal metastases and the owner may change the direction of the case instead of proceeding with over $1000 of diagnostics.
  
• If "Mellow" had presented to you within 8 hours of the incident, which drug would you have given for spinal cord injury?
  
  Solumedrol (methylprednisolone sodium succinate) should be given at 30 mg/kg IV.   Then at 2 and 6 hours later, it should be given again at 15 mg/kg IV and that dose should be continued QID for 24-48 hours.  There is another option of giving Solumedrol at 5.4 mg/kg/hr IV CRI for 24-48 hours after the initial 30 mg/kg dose.   Solumedrol has been shown to be beneficial if given within 8 hours of the incident, but not really beneficial after that time.  Also, other steroids, especially dexamethasone, are not beneficial to the animal and actually damage the GI tract quite a bit.
  
• Describe the nursing care procedures "Mellow" needs while she is paralyzed.
  
  "Mellow" needs a lot of padding to sit on to prevent ulcers.   Urinary catheterization will help prevent urine scald as well as an over-full bladder. 
  
• What is "Mellow's" prognosis?
  
  Prognosis is usually good.  Patients usually improve within 7-14 days but full recovery may take weeks to months.  However, in cases with severe lower motor neuron signs or where deep pain has been lost, prognosis is poor. 

• Follow-Up: "Mellow" began to recover nicely.  In a few days she could stand on her own and take a few steps before getting tired.  She improved more on her right hind leg than her left.  She was soon able to urinate and defecate on her own.  She went home to finish her recovery.

Fibrocartilaginous Embolism Pearls

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Copyright 2000, Wayne E. Wingfield, Colorado State University   
This page was last edited:  03/01/00