Fibrocartilagenous Embolism (FCE)

What is FCE?

FCE is a stroke-like event within the spinal cord: signs (symptoms) are very sudden in onset and vary with the location of the FCE. Small particles of fibrocartilage believed to come from the discs between the vertebrae (bones of the spine) block blood vessels within the spinal cord. FCE is NOT related to disc herniations (slipped discs).

What type of dog is affected by FCE?

The typical patient affected by FCE is a young adult or middle-aged dog of a medium to large breed, such as a Labrador Retriever or Border Collie. However, any dog of any age can be affected, even toy breeds. FCE has been reported very rarely in cats and horses.

What are the signs (symptoms) of FCE?

FCE commonly occurs while dogs are active (e.g., playing, running) but occasionally occurs when they are quiet (even during sleep). The onset is usually very painful and the dog will cry out and may fall down: owners often think that the dog has broken its leg or even its back. Pain is present initially, although not usually very severe after the onset, and tends to resolve within minutes to hours. Rarely, some pain seems to persist for as long as 24 hours. After 24 hours FCE is NOT painful: continuation of any spinal pain indicates that a different condition must be present. Weakness or paralysis may occur in a single limb, both hindlimbs, or all four limbs. Signs are frequently much more severe on one side than the other, but they can be symmetrical. The severity of signs can vary from mild weakness to complete paralysis.

What causes FCE?

Unfortunately, this is a question that we cannot answer. No dietary, environmental, or inherited factors, nor any underlying diseases have been identified that predispose to FCE in the majority of dogs. Miniature schnauzers with hyperlipidemia (an inherited tendency to develop high blood fat) and Shetland sheepdogs with hypothyroidism do seem to be predisposed to FCE; these dogs may have a slightly different condition from regular FCE.

How can FCE be diagnosed?

Diagnosis depends on the history and clinical signs, and on ruling out other diseases that can cause similar signs (e.g., disc herniations, spinal fractures). Studies that allow us to image the spinal cord can be helpful: CT scan and myelography can help to rule out other problems; MRI may reveal areas of fluid swelling (edema) within the spinal cord in the first few hours after FCE occurs. Spontaneous recovery (see below) also can increase the suspicion of FCE rather than other spinal cord diseases.

How is FCE treated?

No treatment has been proven to help recovery from FCE. In the very early stages after onset (within 8 hours of onset) there may be some justification for the use of corticosteroids, but there is no information available that fully supports their use. Corticosteroids have side effects that can be harmful, so they should not be used lightly. Fortunately, most dogs with FCE will recover spontaneously (see prognosis, below). Physical therapy (e.g., underwater treadmill) can be helpful to facilitate recovery and build strength. Patience is needed while recovery is occurring.

What is the prognosis for FCE?

Prognosis depends on the severity of the signs and, to some extent, the location of the FCE within the spinal cord. Most dogs with FCE will begin to show improvement within 24-48 hours. Full recovery may take many weeks to months. A number of dogs may have some permanent disability, but this is usually manageable and in most cases won’t severely impact quality of life. Animals that have FCE in the spinal cord at the sites of origin of the nerves to the limbs (lower neck and lower back) are more likely to have permanent and significant deficits. Neurological examination helps the veterinarian determine the location of the FCE. In a minority of animals the deficits after FCE will have a major negative impact on quality of life. FCE almost never recurs.

Additional information

There are several sites on the Internet that contain information about FCE. Just beware that many of these are quite pessimistic about prognosis. Our experience with FCE (based on over 20 years of combined experience) is that most dogs recover to normal quality of life.