Compressive myelopathy caused by epidural haematoma associated with fibrocartilaginous embolism in a horse

Abstract

Compressive myelopathy caused by an epidural haematoma associated with fibrocartilage embolism was diagnosed in a 2.5-year-old Hanoverian gelding. The patient showed severe ataxia with no improvement following medical therapy and a poor prognosis after myelography. An epidural mass located dorsal to the intervertebral disc between C4 and C5 was compressing the spinal cord dorsally to approximately onethird of its normal height. The epidural tissue was characterised histologically as an organised thrombus, and its major components were fibrin and macrophages with intracytoplasmic brown, iron-rich granules. Positive Alcian blue stain confirmed the presence of cartilage within the thrombus.

Acute non‐ambulatory tetraparesis in a 6‐month‐old Standardbred weanling caused by a cervical vertebral epidural haematoma

“…Cervical vertebral spinal haematomas are rarely found in horses with only four case reports accounting for 10 clinical cases described in the literature (von Oberregierungsrat and von Gehimrat 1966; Gold et al 2008; Cunha dos Santos et al 2014; Dörner et al 2015). Of these cases, five horses survived of which four had a presumptive diagnosis based merely on history, clinical signs and the exclusion of other aetiologies (von Oberregierungsrat et al 1966; Gold et al 2008).…”

“…One additional horse survived to 4 weeks but ultimately was euthanised due to a lack of response to treatment and worsening of neurological signs (Cunha dos Santos et al 2014). All five cases that did not survive had evidence of compressive lesions caused by cervical epidural haematomas on necropsy (Gold et al 2008; Cunha dos Santos et al 2014; Dörner et al 2015). The location of these lesions was at C6‐C7 with the exception of one horse where spinal cord compression was located at C4‐5 (Gold et al 2008; Cunha dos Santos et al 2014; Dörner et al 2015).…”

“…Although myelography can be used to diagnose compressive lesions in the cervical vertebrae, most cases of epidural haematomas in the horse are confirmed during necropsy (Gold et al 2008; Cunha dos Santos et al 2014; Dörner et al 2015). Medical management in the horse has been attempted through administration of anti‐inflammatory medication, intravenous fluids, dimethyl sulphoxide and vitamin E, although only one horse of the six treated horses recovered using conservative management (Gold et al 2008; Cunha dos Santos et al 2014; Dörner et al 2015). Surgical intervention via laminectomy for the treatment of an epidural haematoma in the horse has not been reported in the literature, likely due to the challenging aspect of their cervical spine anatomy.…”

“…Ataxia in horses is generally due to deficits originating from vestibular disease, cerebellar disease or disorders of general proprioception (Alcott 2017). Spinal cord injury and dysfunction manifest as general proprioceptive deficits and can be the result of cervical vertebral stenotic myelopathy or malformation, equine protozoal myeloencephalitis, equine degenerative myeloencephalopathy, neuroaxonal dystrophy, equine herpes virus myeloencephalopathy, vertebral fracture‐luxation, fibrocartilaginous embolism, osteomyelitis, discospondylitis, neoplasia, trauma and cervical vertebral haematomas (Gold et al 2008; Cunha dos Santos et al 2014; Dörner et al 2015; Alcott 2017).…”

Imaging of the Equine Neck With a Focus on Vertebral Variation and the Intervertebral Disc

“…There are several case reports on cervical vertebral epidural hematomas. They are considered of traumatic origin and manifest with acute neurological signs such as severe spinal ataxia [67][68][69]. In one of these cases fibrocartilaginous tissue was found in the epidural thrombus, focally occluding the ventral vertebral plexus and believed to derive from the cartilaginous tissue of the vertebral body growth plate [69].…”