Sudden paralysis due to a fall - advice needed

[TanMorris]

Hi all

I'm so glad I found you. Two days ago our lurcher slipped and fell (her hind legs giving way underneath) whilst out on a walk. My husband had to carry her home and the vet was here in 15 minutes. At the time of presenting, she had no pain sensation present in either rear paw. After a standard x-ray the vet said that it was clear she had damaged two discs lower thoracic/high lumbar area. They have suggested a conservative approach. She is currently admitted receiving steroids, pain relief etc. Yesterday they called to say she now has some pain reflex back in one paw but as yet nothing in the other. She is paralysed from the waist down also with urinary incontinence. When lifted, she knuckles.

My gut instinct is that she needs a CT or MRI as I'm concerned about the lack of pain sensation, so we can at least see what is happening. I understand that spinal bruising can contribute to the nerve compression, but I'm worried that as it was a sudden fall, there may be something more serious. I've read timing can be crucial for some spinal injuries in terms of permanent damage.

Obviously I'm very anxious, but is it unreasonable to demand referral to a specialist (luckily we have one only 10 minutes away)?

I'm in a state of limbo, not knowing whether to wait or insist. Any thoughts would be really appreciated.

Thanks

Tania

[CarolC]

It is not unreasonable if you can afford it, and if you trust the specialist.

It's important to keep in mind that surgery is no guarantee. It does not always work. It also complicates things that deep pain is sometimes hard to assess, they could be missing it. But it might be good to have a specialist repeat the office test.

They say surgery is less likely to be successful in large breeds, as explained in paragraph 14 here:
http://sturgisvet.com/smallanimalclinic ... sease.html

The MRI is less invasive than the CT if you can get it. They normally sedate the dog for an MRI. One reason for an MRI/CT would be to rule out a fibrocartilaginous embolism (FCE), which is like a spinal stroke The dog is suddenly paralyzed but the disks are fine. The great majority of dogs recover from FCE. You do not do surgery for FCE, you do physical therapy. So it would be good to have the MRI just to know what is going on, as you said.

In your position I would probably go to the specialist, but I have been disappointed with treatment we've had from specialists here where I live, the last few times I've gone. Maybe they are better where you are. I have also seen quite a few posts on this forum from distressed people whose dog had surgery and is not walking (that would not be surprising soon after surgery) or seems worse than before (you can imagine how upsetting that would be).

If this is a pretty senior dog, I might be inclined to continue the conservative therapy.

I wish there was a way to guarantee the best decision on this, but it isn't that straightforward, so these comments probably are not a lot of help.

Best wishes, whatever you decide.

[TanMorris]

Thanks Carol

We've had an update today and she is now testing positive to all deep pain tests, so we are hugely relieved and a big step forward. She's not showing any other movement in her legs or tail, but know it's early days. We've agreed with the vet that if there is no further change by Monday , we will refer her to a specialist for a 2nd opinion. I don't really want to go down the surgery route as she's a very deep chested dog and anesthetic is more risky and agree it may not be suitable, but I don't want to miss anything by just going off the x-ray alone. If anything the specialist will put my mind at rest I think. She's only 5, so has her whole life ahead of her.

We're all geared up for home rehab. We have 4 special needs rescues, Spooky herself is completely deaf, Peg a tri-paw with one eye, Scrappy with no bottom jaw, teeth or soft palate and a traumatised Spanish dog. I guess we're a special family . She'll have everything she needs to continue a great life whatever the outcome, just a worried fur mum at the moment. We're pretty lucky with care locally, as both our vet and specialist are both within a 10 mins drive and the specialist has full rehab facilities will pool, physio etc. She can't get any worse at the moment as she is totally paralysed, unless the deep pain sensation disappears again. Just hoping for a tiny sign but I know it will takes weeks if not months of crate rest.

x

[critters]

It sounds like she's already in the perfect family, and that family lives in the perfect place!!

I wonder if she wasn't getting some symptoms BEFORE she fell (and maybe causing the fall)?

[TanMorris]

Hi all

We did get an emergency referral and she had her MRI. The findings aren't good. Here's the report, "MRI of the thoracolumbar spine was most consistent with a hydrated nucleus pulpous disc extrusion at T13-L1. On merge images there is a large (approximately two third the cross sectional area of the cord) region of signal void, compatible with intraparenchymal haemorrhage which could be indicative of focal myelomalacia. Extradural signal void is also identified at this level, which appears as an irregular region of extradural material on T2w image..."

So, not looking good. She's now at home, comfortable and we are nursing her, physio, bladder management etc. She will have a re-exam in four weeks. As long as she is not suffering pain, euthanasia will not be an option as we will give her a quality of life in a dog wheelchair and ongoing care as needed. She's only 5 years old and we won't give up on her.

She has been twitching her rear legs last night in a running dream, and stretched out her right leg during physio - some signals are getting through, although whether she gains motor function is unknown at this point.

Is there anyone out their with a similar diagnosis?

Thanks

Tan

[critters]

She has been twitching her rear legs last night in a running dream, and stretched out her right leg during physio - some signals are getting through, although whether she gains motor function is unknown at this point.

I would say that she already has motor function, but whether this leads to walking is unknown. A complete paraplegic doesn't have twitching and/or stretching, but, in my experience, these are the first things we tend to see in recovery. They need to strengthen, and possibly become more consistent, to lead to walking. The good news is that I don't think there would be any movement if the paralysis were complete.

[TanMorris]

Thanks so much, that does give us hope!!!

Am I right in thinking focal myelomalacia means if it progresses, it will be downwards rather than up? Trying to find a definition of focal myelomalacia is proving a bit of an impossibility!

[critters]

Thanks so much, that does give us hope!!!

Am I right in thinking focal myelomalacia means if it progresses, it will be downwards rather than up? Trying to find a definition of focal myelomalacia is proving a bit of an impossibility!

As far as I know, myelomalacia is death of the spinal cord. "Focal" should mean that it's only in a location, rather than diffuse (all over). If it should progress, I don't know that anybody could tell you which way it would go. If she's twitching, she's not even a complete paraplegic, so I wouldn't be overly concerned; I would just be aware. The way I read what you wrote, it's only a "could be indicative of focal myelomalacia," so it's not for sure. Myelomalacia seems to be pretty uncommon.

[CarolC]

I know nothing about "focal myelomalacia" but I went to Google Scholar and typed in '"focal myelomalacia" definition' and found this:

Canine intervertebral disc (IVD) extrusion, a spontaneous large animal model for acute spinal cord injury (SCI) [1DOI: http://dx.doi.org/10.1089/neu.2010.1645][1], leads to damage of the spinal cord ranging from mild changes of gray and white matter to significant structural disruption and softening of the spinal cord, referred to as myelomalacia [2DOI: http://dx.doi.org/10.1016/j.tvjl.2013.04.003][2]. The pathophysiology of traumatic myelomalacia involves primary mechanical damage to the cord which is followed by secondary damage caused by decreased vascular perfusion, electrolyte shifts, and release of free radicals, cellular enzymes, and vasoactive substances [[3]DOI: http://dx.doi.org/10.3171/jns.1997.86.3.0483, [4], [5]DOI: http://dx.doi.org/10.1111/j.1476-4431.2012.00723.x]. As in experimental SCI, where the initial lesion expands transversally as well as longitudinally [[6]DOI: http://dx.doi.org/10.1089/neu.2013.2906, [7]DOI: http://dx.doi.org/10.1016/j.brainres.2014.04.033], in canine IVD extrusion, focal myelomalacia may ascend or descend, involving multiple additional spinal cord segments [[8]DOI: http://dx.doi.org/10.1111/j.1748-5827.1972.tb06870.x, [9], [10], [11]] or even the whole spinal cord. The pathophysiology of this phenomenon remains poorly understood.

Here is another reference, that I couldn't copy, so including a screenshot:

https://books.google.com/books?hl=en&lr ... on&f=false

click photo to enlarge

[TanMorris]

Thanks for this...she has a re-exam in 4 weeks, so I'm hoping for another MRI to see if there has been any advances and a definitive diagnosis on the myelomalacia. This will make all the difference to her. The Neurologist did say it was very rare, 5% - 10% of cases.

Yesterday during physio she stretched both back legs out like a morning stretch, and moved her tail towards her by about an inch (I put it out of the way and she slightly dragged it back). There are signals, we just only hope we can continue xxx

[critters]

Stretching and tail moving are both VERY good!

[TanMorris]

Today was a step forward for us. Her tail is back.....not as strong, but she is now slapping it against the floor when I come home from work, most definitely a controlled wag If I move it, she moves it back...I never thought I'd be so excited to see it wag again.

Something interesting is also happening with her right leg. There's a definite difference between them. When we stand her, and position her feet she is planting it more than the left. Today for just a second or two, she took some of her body weight. We'd noticed this yesterday, although very slight, but today is was stronger.

She's having running dreams and the back legs are moving although I'm not sure how much that is due to reflex, but doesn't seem to be from the body. She's also giving a tiny bit of resistance on her right leg when I'm doing her physio. The back leg stretches happen on and off, even when not doing the physio and I've also seen her splay the toes on her right foot (only once, so far).

We're using an electronic tooth brush to stimulate her feet as a physio suggested, and she is definitely aware on the right and a toe twitch although the left is still fairly dead at the moment.

So a great week for us in all. She has a re-exam with the specialist on 28th Jan, so I hope we can make a little more progress before then. She's have short physio session 4 or 5 times a day now and we stand her to eat and do her assisted standing exercises three times a day.

She's such a determined girl and we're so proud of her xx

[CarolC]

That seems like a lot of progress in a very short time, really good. It's hard work, but when you are seeing progress, you're so elated you don't care. I can't remember if I've heard of using an electric toothbrush before, what a good idea!

[TanMorris]

The toothbrush works a treat. We have a definite tickle on both paws now, although the left is much weaker. No waking movement as yet, but when we stand her she can now hold her body weight for around 10 seconds before her legs buckle. Over the last few days her standing strength has slowly been increasing. This is much more than we expected in 18 days. We see the specialist in a couple of weeks, so once she has the sign off, we're really looking forward to getting her into a pool and wheels and start patterning her legs. Just hope she will continue little improvements xx

[critters]

The toothbrush really IS a good idea!!