Diagnostic Procedures - MRI

MRI for disc problem in Pekingese

Question: Hi Doctor

I have a Pekingese, Ricky, he will be nine years old this December. In 1994, I took him outside for a walk one day, on a leash, because I was still staying in a townhouse. He ran in front of me as usual and jumped onto a pavement. When he landed, he slipped a disc and started crying profusely.

The rest of this sad tale is history. I took him to an emergency clinic where he stayed for a week before I discovered a brilliant small animal surgeon specialist here in South Africa who did a mylogram first and then operated on Ricky. I took him home and because he was so young, his recovery period was quick. After being paralyzed for about 3 weeks, he started to walk again, with a sway in his backside.

In 1997, the same problem re-occurred, but being alert from the first time, I recognized his symptoms quick enough to get him to Doctor B again. His symptoms were an uncomfortable look on the face, growling when I tried to pick him up, especially when I touched him stomach, lack of wanting to move around freely and of course his abnormal breathing from the pain in the back.

This time I caught it in time and after another mylogram and another operation, the recovery took over two months before he showed any signs of wanting to walk on his own again. His hair took over a year to start growing back and eventually is covered all the scarring.

Now 3 years later, the same symptoms. He is in the hospital as I type and this time his back legs started collapsing. Especially his right leg. It almost looked to me like he had something stuck under his foot, because he couldn't use it, but the specialist (Dr. B) told me that another disc giving problem, he definitely has invertebral disc disease and that he suggests doing an MRI to see exactly where all the problems are.

I informed him to continue conservative treatment and since Ricky is showing signs of improvement, I will take him home this Saturday and keep him still for a while. The problem is that I have another Peke as well as a Toy French Poodle, both very active. I have to try and keep them apart, if only for a while. The doctor also told me that he would hate to operate on the same dog a third time.

I have spend many hundreds of dollars (thousands of Rands over here) on this dog and he is one of my children. I do not believe in euthanasia, unless the dog is permanently in pain and I will only do it in consultation with my specialist.

Do you think an MRI would be the way to go? Is it possible for my vet to fix all the problems at once if the MRI shows more disc problems?

Thank you very much Mario

Answer: Mario-

It usually is helpful to have an MRI examination in these cases because it does help to identify which discs are affected and if it is possible to operate on all of them at the same time because dogs that have a recurrence of disc disease after the first disc problem are likely to have multiple episodes of disc disease.

Conservative therapy sometimes allows recovery to occur but weakness is a serious prognostic sign and usually is a good indication to consider surgery.

Ricky is lucky that he is living with you since you have been persistent in finding good care and have been willing to work through these problems more than one time. I hope that he has been improving with the conservative approach to this problem this time, but if not, surgery probably is going to be necessary again.

In a review of 260 cases of disc disease by Knapp, et al (Sept/Oct 1990 Journal of the American Animal Hospital Association) Pekingese dogs and dachshunds were the dog breeds most likely to have disc problems.

Mike Richards, DVM 8/29/2000

Update

Hi Doctor

Please refer to MRI for disc problem in Pekingese, to which you responded 8/29/2000.

Ricky went for the MRI. It revealed what looked like a tumor. The specialist operated again, but luckily the 'tumor' turned out to be old disc material and bone that caused an infection and 'grew' round the spine, thereby causing some pressure on the nerves. It took Dr. Buffa 2 hours to remove the growth. Ricky is back at home. He is already walking again and is back to about 85% of his previous mobility. I have lots of hope, since I thought this to be the last operation ever to be done on him and that he wouldn't make it because of his age (9 yrs). The specialist told me he reckons this is probably the last one, becuase Ricky has so many scarring from the previous ops, he simply cannot find anywhere to cut on him again.

Regards Mario

MRI for assessing disc problems and degenerative myelopathy

Q: Hello Dr.Mike,

I am a Vetinfo Digest new subscriber. I have a 14-year old German Shepherd dog.For his age, Bruno is really in a very good condition. He was always well taken care of and never really got sick. During the last 3 years, he started having minor problems with his back legs and, of course, I was pshycologically prepared for that since I knew that these were signs of him getting old and that this problem appears especially in GSD's. Since last year the problem with his back legs became stronger and after many discussions I had with vets and after reading a couple of your answers , I now suppose that Bruno has signs of Degenerative Myelopathy.

The medication that Bruno had first was METACAM, a steroid-free, antiinflammatory, analgesic medicine that contains 1,5mg meloxicam per ml (0.1 mg meloxicam per drop). This made him feel a little better. Then a week after Metacam was finished , he got Vibramycin for 8 days because suddenly he had high temperature, bad breathing, loss of appetite and wet eyes. I am not sure if I can attribute the above situation to any side effects that Metacam had on Bruno or it was just a cold or some other type of internal infection . As long as he was under Vibramycin , he was fine. Two days after Vibramycin was finished, a very strong problem with his back legs appeared. He couldn't walk straight and when he turned his back legs were completely beyond his control. He was also very afraid and unsure of himself when moving inside a room or in limited space in general than outside in the yard. After that incident, a vet advised me to give Bruno a medicine called ROMEFEN 10mg, which contains ketoprofen and is similar to Metacam but even stronger. Today ,is the third day of Romefen, and Bruno acts normally again.

That is the situation up to now. I feel that I am in a dead end. I believe that this medication temporarily solves the effects of the problem and not the cause of it. Perhaps, nothing can be done to attack the cause of such a problem.

Dr.Mike, I would greatly appreciate any information on degenerative myelopathy, its symptoms, and ideas on medication that can help my dog.

Many thanks

Natasha

A: Natasha-

The first step, if possible, is to accurately identify the disease process that is leading to Bruno's problems with his rear legs.

With the increased availability of magnetic resonance imaging for pets in the United States, there seems to be a change in the opinion of neurologists concerning prevalence of degenerative myelopathy. MRI scans show disc damage and spinal tumors much more clearly than any other available imaging method. Due to this, many older dogs who previously were thought to have degenerative myelopathy or other degenerative spinal disorders are now recognized as having disc herniation that could not be diagnosed using X-rays or even myelography (dye studies of the spinal area). If it is possible for you to arrange to have an MRI scan done on Bruno, that would be helpful. I realize that for many people this is not an available option but it is the best diagnostic test where it can be done.

When herniated discs are present and are causing neurologic signs, surgery to relieve the pressure is the best option. Because multiple discs are often involved and because degenerative myelopathy may actually get worse if it is present and if surgery is attempted, it probably is not a good idea to consider surgery without some way of confirming that disc disease is present.

The clinical signs of herniated discs often include pain in addition to the weakness and loss of ability to correctly place the legs for support. The cases we have seen of degenerative myelopathy have not seemed to have pain as a clinical sign. It would also be surprising if there was a response to the meloxicam or ketoprofen if degenerative myelopathy were the cause of the neurologic signs. A spinal tumor may produce signs similar to disc herniation or degenerative myelopathy, may or may not be painful and may or may not respond to medications to reduce inflammation, so there isn't a good way to rule that possibility out without the availability of advanced imaging techniques.

I suspect that Bruno may have had an ulcer after the use of meloxicam, since this is a potential side effect of non-steroidal anti-inflammatory (NSAID) medications. It is supposed to be less frequent with meloxicam than with other NSAIDS but an ulcer would explain the fever and other signs seen. The same problem could occur with ketoprofen, or any other NSAID. When the non-steroidal anti-inflammatories work to relieve the pain and clinical signs they are preferable to the use of corticosteroids, if it is possible to use them. Sometimes it is possible to use misoprostol or other medications that protect the stomach lining, in addition to the NSAID, in order to lessen the probability of an ulcer. It is definitely possible that something else entirely caused the fever, but it seems like a good idea to keep an eye out for ulcers.

If an MRI and surgery, if a disc herniation is identified, are not options that are available to you, then the use of a non-steroid anti-inflammatory medication to slow the decline in function associated with disc disease may be the best option. In a dog in Bruno's age range, I would consider use of corticosteroids, if NSAIDs stop working and there are no other diagnostic or surgical options. At that point, there isn't much to lose. This is also a condition for which accupuncture may have beneficial effects, based on the reports of veterinary practitioners who accupuncture in their practices.

Mike Richards, DVM 8/12/99

MRI

Q: Doctor Mike, I'm not quite sure I can provide all the details, in a brief email message. In a day or so we are to have an MRI at the local veterinary teaching hospital and we're not sure if it should be performed. Our 12 year old male poodle had a tumor removed behind his left eye, the eye specialist vet was able to save the eye, but the bad news was that it was cancer. Although I can't repeat the type of tumor it was (I couldn't pronounce it, let alone spell it) but they did comment that its a slow react type of cancer, and would probability be awhile for it to grow back again (dogs age an all) to be a concern. This operation took place about 3 months ago. Just within the past couple of weeks he went into a seizure(?). He couldn't stand up, kept falling to the right, and was disorientate & confused. At first I though he also went blind, because when I would call his name, he would turn his head, but it seemed like he couldn focus in on me. I rush him to the vet emergency hospital. By the time I arrived he was ok. This seizure took about 15 minutes and he never lost conciousness. (Another episode happen a week earlier, a relative was dog sitting, they indicated that he spun around, fell over a few times then defecated, but was ok after that.) A complete blood work up was done with normal results. A neurology consultative exam was done at the ER room, & their finding was no outward evidence of neurologic disease. It was recommended to return for a MRI test. This is in consideration to the recent eye operation. They advised that this is the only procedure to identify if a tumor or something else, in or near the brain is causing the seizures. And if an operation is even possible. I want to go ahead with the MRI, but my family would rather not. Its their opinion that if we don't want to proceed with brain surgery, then what's the point of the MRI test. His recovery after the eye operation had the whole family upset and concern, and we feel that a brain operation at his age will be too much suffering for the little guy. And there is no guarantee he'll be the same dog. Am I jumping the gun on proceeding with the MRI? Could there be other procedures/tests that should be done first to rule out another possible causes? If he continues to experence more seizures, could they cause permanent damage? Last but not least, is there any medication that can be administered to lessen the chance or severity of seizures? Thank you for your prompt reply. Marlene

A: I am sorry that I could not get to your email until now. In general I agree with your family -- unless a client is pretty sure they will try surgery, radiation therapy or chemotherapy depending on what is found, I am reluctant to advise spending the amount of money an MRI costs to find out what is going on. Some people simply can not handle not knowing what is going on, though. If it will help you get through a difficult situation to know the prognosis and to be able to reassure yourself that nothing else is being missed and money is not a problem then I would have a really hard time arguing against an MRI. This is an intensely personal decision and it is tough when family members disagree. I sincerely hope that you were able to resolve the situation in such a way that everyone felt OK with the outcome.

Mike Richards, DVM

Pug puppy with seizures - MRI

Q: HI MIKE ,DO YOU KNOW WHY A MALE PUG PUPPY (ABOUT 2MONTHS-3MONTHS OLD) WOULD HAVE SEIZURES? HE HAD A "COLD" ABOUT 2 WEEKS AGO.

THANKS, MARY

A: In a puppy this young, particularly a pug, the number one rule out would be hydrocephalus (water on the brain). It is necessary to do an MRI or CT scan to diagnose this definitively. Due to the cost (about $850) most people won't do this for a puppy. Sometimes there are physical signs that make it more likely, like open fontanelles, strabismus (one eye looking in a different direction from the other one) and lethargy or dullness. Sometimes seizures are the only sign.

Other causes of seizuring in puppies this young include meningitis/encephalitis problems (like distemper virus infection), liver disorders (especially liver shunts -- circulatory problems with neonatal circulation), intestinal parasites, hypoglycemia and trauma. Birth may be traumatic enough in the short nosed breeds to lead to seizures even if it seemed to go OK.

A good physical exam and labwork to rule out sytemic or organ disease and intestinal parasites should be done in puppy this young with seizures. If the lab work checks out normally it may be necessary to treat the seizures without firmly establishing the cause.

Hope this helps. Mike Richards, DVM

MRI

Q: Do you have any background or know where I can get more information if our vet has tentatively recommended that our 12-year doxie needs a MIR to determine the cause of seizures? We had heard the mortality rate was something we should consider before proceeding. For example,there was a one in ten chance that our dog could die during the procedure. Is this correct? Too high? Thanks!!!

A: I think you are asking about magnetic resonance imaging (MRI, NMR). This is a way to get very good images of the brain (or other tissue). It is possible that it would take an MRI to diagnose seizure activity if it was related to brain tumors or other brain disease that might show on an NMR image. Usually, it is necessary to refer a pet to a facility that has this equipment and most of them have veterinary neurologists as well. This is good because the neurologist may be able to diagnose the problem in another manner.

The only cause of death I can think of from magnetic resonance imaging is anesthetic death. I may not know of some other complication since we have only had this procedure done on one or two of our patients, though. The risk of anesthetic death are probably not 1 in 10 but there is a small risk associated with anesthesia.

If I am way off base on what your vet is considering (if there is something else referred to as MRI, for instance), please let me know. Mike Richards, DVM