However, no previous comparative review has discussed similarities and differences in clinical presentations, imaging and pathological findings, outcomes, and prognostic factors of these conditions.
Studies and case reports have been published on the clinical and diagnostic features of these conditions and a few studies have also investigated outcome and prognostic factors ( 1– 37).
Prognostic factors include degree of neurological dysfunction (particularly loss of nociception) and disease-specific MRI variables.įibrocartilaginous embolic myelopathy (FCEM) and peracute intervertebral disk extrusions (IVDEs) that are not resulting in extradural spinal cord compression have been increasingly recognized since the use of magnetic resonance imaging (MRI) has become widespread in veterinary neurology. Dogs reported with IIVDE have been managed either conservatively or surgically. Treatment of FCEM and ANNPE is conservative.
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Identification of a linear tract (predominantly hyperintense on T2-weighted images, iso to hypointense on T1-weighted images and hypointense on T2*-weighted gradient recall echo images) extending from the intervertebral disk into the spinal cord parenchyma is highly suggestive of IIVDE. In dogs with ANNPE signal changes associated with the extruded nucleus pulposus and epidural fat disruption can be identified in the epidural space dorsal to the affected intervertebral disk. In animals with ANNPE and IIVDE, the affected intervertebral disk space is often narrowed and the focal area of intramedullary hyperintensity on T2-weighted images is located above the affected intervertebral disk space. Optimal MRI definition and experience in neuroimaging can help identify the findings that allow differentiation between FCEM, ANNPE, and IIVDE. Data on cats with ANNPE and IIVDE are limited. In cats, FCEM occurs more frequently in the cervical spinal cord than in other locations. In dogs, ANNPE and IIVDE most commonly occur in the intervertebral disk spaces between T12 and L2, whereas FCEM has not such site predilection. FCEM can occur in both adult and immature animals, whereas ANNPE or IIVDE have been reported only in animals older than 1 year. Differentiating between these conditions can be challenging, however, certain clinical and imaging findings can help.
FCEM, ANNPE, and IIVDE have a similar clinical presentation characterized by peracute onset of neurological dysfunction that is generally non-progressive after the initial 24–48 h. This review discusses terminology, pathological, clinical, and magnetic resonance imaging (MRI) findings, treatment, outcome, and prognostic factors of fibrocartilaginous embolic myelopathy (FCEM), acute non-compressive nucleus pulposus extrusion (ANNPE), and intradural/intramedullary intervertebral disk extrusion (IIVDE).