Enzo a 10 year old Boxer, was brought in with a severe neck pain and inability to get up. With the help of the Referral Vet we tried to stabilize him to prevent the progression of the neurological deficits.
Enzo could now get up and walk , but he was completely paralyzed by his right forelimb.
A neurology work up helped me to get a tentative diagnosis of a Cervical spine / Brachial plexus lesion.
An MRI then revealed the presence of an extradural mass at the level of C4-C5 leading to a cord compression.
Surgical option was turned down by the owners and asked for a non-surgical approach. So an integrative approach was implemented,he was stabilized medically and received Acupuncture for his neurological rehabilitation.
He was so relaxed that he dozed off in the middle of the Acupuncture session, unaware of whats going on around him.
Enzo received a total of 6 Acupuncture sessions , spaced over one & half month.
This is Enzo after his 6 th Acupuncture session.
Here is a video showing Enzo's Progress
What did the repeat MRI show?
ReplyDeleteCould it be pseudo paralysis due to pain ?Is it possible that the relaxation offered relived the pain?How this recovery can be explained neurologically?Need to study follow up MRI,with current neuro status.
ReplyDeleteHello Dr.Jyotsna,
DeletePseudo paralysis is a great differential diagnosis addition to the list, but if i am not wrong,most of the cases it is of an infectious origin in human kids. if associated with pain,condition is only restricted to one limb.
In Veterinary Practice we see the most common cases with apparent paralysis are those with partial/complete bicep tendon rupture issue or severe Arthritis,But these cases never show neurological deficits.
Unilateral neurological deficits are seen in cases with Suprascapular n. or radial nerve paralysis. But in all the above differential diagnosis list, neurlogical deficits are restricted to only the thoracic limbs.
Enzo had a full neurological exam work up, with grade II / V proprioception deficits in the left hindleg, Grade III/V GP deficits in right hind and absent GP in right forelimb. Postural reactions : hopping was not elicited. motor deficits seen in rt.fore.
Thus an Upper motor neuron disease was on top of my list and LMN ruled out.
MRI showed up a well defined mass at Cervical Spine.
Repeat MRI studies are an excellent tool in Human Medicine, but in Veterinary Practice involves an Anaesthetic risk and for Brachycephalic breeds like Boxers, the risk increases in multiples as we use injectable anaesthetics ,many owners decline even the 1st MRI, thus puts 2nd MRI out of question.
Recovery is thus based upon him regaining all the neurological deficits. Enzo regained his G.Proprioception in all the 4 limbs and regained motor reflexes in his rt.foreleg 3 weeks post therapy.
We had clearly mentioned to the owners, with a sitting Mass, there is a possiblilty of Recurrence. But they opted for a non surgical option.
I just did all I could, by rehabilitating him