Medical treatment for suspected FC embolism

Re: Medical treatment for suspected FC embolism

Mark Lowrie — Wed, 30 Nov 2011 14:12:13 GMT

FCE classically doesn’t cause pain although occasionally there is mention in some texts of spinal hyperaesthesia for the first few hours at most. However, whether this is truly pain is difficult to determine. When I see cases of FCE the dogs can look very startled and stressed if presented immediately following the problem but I always feel this has more to do with their inability to use their legs and their current predicament rather than an actual pain response. My reason for this is palpation of the spine over the lesion is rarely painful. Administration of opioids in this small window certainly wouldn’t be detrimental and the cases where I have done this allow the dog to settle nicely – but I always think this is more due to the sedative rather than the analgesic properties of the drug. As for where the pain comes from in the rare cases where it is seen, who knows? In general, FCE is best considered as a non-painful disease.

For those with access there are two nice recent articles on the disease:

De Risio et al JVIM 2007; 21: 1290-1298

De Risio et al JAVMA 2008; 233: 129-135

Re: Medical treatment for suspected FC embolism

David Mills — Tue, 29 Nov 2011 17:43:20 GMT

Each and every FCE (MRI/CT dx) I've seen (10+) has been painful for 24-36h, something I presumed was due to iscahemia/infarction from vessel occlusion. If not vascular, then what's the mechanism? And it surely then can't be an FCE (by definition, if not vascular)?

My only text to hand, BSAVA Neurology, agrees with my version of events. Have things moved on?

Re: Medical treatment for suspected FC embolism

KathW — Tue, 29 Nov 2011 10:02:07 GMT

Sorry . My fault for being lazy and not typing out the full name. FCE = fibrocartilaginous embolism.

Re: Medical treatment for suspected FC embolism

Hannah Wynne Richards — Tue, 29 Nov 2011 09:47:03 GMT

Having read Mark's reply,I'm begining to wonder if I've misunderstood these damn abbreviations !!!!!!!!!!!!!!!!!!!!!!!!!!

I thought embolism +deep pain + hind limb paresis +F (femoral ?) and assumed a femoral, or femoral bifurcation clot

If it's not that, what is it ?

The senior staff weren't so keen on acronyms when I was a student

Wynne

Re: Medical treatment for suspected FC embolism

Andrew Kent — Tue, 29 Nov 2011 07:55:20 GMT

Wynne - have you found fragmin to make a difference? My understanding is that this isn't a thromboembolic event and so there should be no benefit to it. Andy

Re: Medical treatment for suspected FC embolism

KathW — Mon, 28 Nov 2011 22:33:32 GMT

Thanks for the replies. This particular dog has improved to some extent over 48 hrs so looking more hopeful. Haven't seen one like this for a while so it made me re consider what if anything I should give apart from cage rest (+ bladder management + general nursing).

Re: Medical treatment for suspected FC embolism

Mark Lowrie — Mon, 28 Nov 2011 11:28:35 GMT

If you are suspicious of an FCE (acute onset of non-painful weakness/paralysis to back legs/all four legs) and have no money for investigations then I would tend to cage rest and nurse the dog incorporating bladder management (more important when dog is paralysed rather than weak/paretic) and physiotherapy of legs involved. A dog with an FCE should not be painful so I do not use pain-relief (e.g. opiates or NSAIDs or steroids etc). If the dog is painful then I would reconsider the diagnosis as this is not typical of an FCE.

Other possibilities for an acute onset of a non-painful weakness/paralysis are numerous but the most common causes include disc disease (in a very stoical dog!) or a tumour. The most important thing to consider in FCE patients is they should not get any worse, therefore if managing a suspected FCE case and the patient is deteriorating then this is not an FCE – a disc or tumour would be more likely. A good imporvement should be seen within 10-14 days but this varies depending on disease severity at onset.

Re: Medical treatment for suspected FC embolism

Hannah Wynne Richards — Mon, 28 Nov 2011 11:13:07 GMT

Fragmin and opiate

Wynne