Fibrocartilaginous Embolus/Emboli (FCE) in Cats

By Krista Williams, BSc, DVM, CCRP; Robin Downing, DVM, DAAPM, DACVSMR, CVPP, CRPP

My veterinarian diagnosed my cat with FCE. What is FCE?

FCE is an abbreviation for “fibrocartilaginous embolus/emboli” (“emboli” is the plural of embolus). Fibrocartilage is connective tissue found primarily in the joints. An embolus is material that travels through the circulation and blocks a blood vessel. Another term for FCE is “fibrocartilaginous embolic myelopathy,” with the word “myelopathy” describing a problem with the spinal cord. Accordingly, an FCE is the acute death of part of the spinal cord, caused by the embolus of fibrocartilaginous material. The material originates in an intervertebral disk or the marrow found within a vertebral body, then travels in the circulation where it blocks arteries or veins. The precise way the material gets into the blood vessels is unknown.

Spinal X-rays in affected cats are usually normal. The most common diagnostic test for FCE is MRI.

Is this condition more common in some cats than others? Does age have anything to do with FCE?

FCE is a rare condition in cats. Most patients are middle-aged or older.

My cat was not doing anything special. What is the usual sequence of events for these cats?

In dogs, it is most common for an FCE to occur following a mild trauma or during vigorous exercise. This condition is so rare in cats that this has not been reported consistently. FCE occurs very suddenly, and affected cats typically cry out in pain. Most often the pain subsides within a few minutes, and signs of weakness and/or paralysis develop fairly quickly as well. These cats are generally stable within 12 to 24 hours.

My cat’s pain seemed to be gone, but her right rear leg was useless to her when I took her to her veterinarian. Is it common for only one leg to be affected? What other symptoms do these cats exhibit?

It is common for the cat with FCE to be relatively comfortable within a short time. In general, nervous system deficits are localized to one side of the body, and the other side of the body is either mildly affected or completely normal. Occasionally, the embolic lesion is positioned in such a way that both sides of the cat’s body are affected. The level of the cat’s dysfunction depends upon what level of the spinal cord is damaged, and the signs may be as simple as incoordination or as serious as paralysis of the affected limbs.

How is FCE treated?

Most cats who experience FCE are hospitalized in the acute phases, in order to perform diagnostic tests that look for and rule out other causes for acute-onset weakness or paralysis. If the cat is incapable of walking, then intensive nursing care is needed, including keeping the cat on a padded surface and turning them frequently to prevent pressure sores. It is important to encourage these cats to move and walk as soon as it is possible for them to do so.

"There is no specific medical treatment for FCE."

There is no specific medical treatment for FCE. Instead, the emphasis is to provide good supportive care and physical assistance. Using assistive devices, like a lightweight fabric harness, can facilitate both healing and early restoration of mobility. Physical rehabilitation, including assisted exercises, muscle stimulation, and hydrotherapy in an underwater treadmill or land treadmill, can also help these cats regain strength. Yes, cats can learn to walk in an underwater treadmill!

Once other causes of weakness or paralysis are ruled out, activity should be encouraged to prevent, or at least minimize, muscle atrophy. Most improvement for these cats occurs a few days to weeks , but every cat is different.

Do I need to worry about this happening again? Are there any other potential complications?

FCE is unlikely to recur. Depending upon the lesion, a cat may have difficulty emptying her bladder, requiring assistance and vigilance to prevent urinary tract infections. Also depending upon the lesion, the cat may have stool incontinence.

If the clinical signs of FCE progress during the initial phases of the disease, this indicates progressive destruction of the spinal cord that is not reversible and, unfortunately, euthanasia may be indicated.

Recovery from the weakness or paralysis caused by FCE is slow and gradual and often reaches a plateau. Some cats appear to make a complete recovery. In any event, your veterinary health care team can assist with guidance and support following FCE.

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