Classic location, classic diagnosis....

Feline Medicine and Surgery, 2014

Feline Ischaemic Myelopathy with a Predilection for the Cranial Cervical Spinal Cord in Older Cats

Katherine M. Simpson, Luisa De Risio, Anita Theobald, Laurent Garosi, and Mark Lowrie

Background
Ischaemic myelopathy (IM) in cats results from vascular occlusion leading to spinal cord infarction. This study aimed to describe a novel subtype of feline cervical IM affecting the ventral spinal artery (VSA) and to characterize its clinical, imaging, and long-term follow-up findings. Prior studies reported feline IM as an acute, non-recurrent condition, but this study observed chronic relapsing cases.

Methods
A retrospective review of medical databases from two UK veterinary hospitals identified cases meeting the following criteria: acute onset of C1–T2 myelopathy, MRI evidence of IM in the VSA territory, comprehensive medical records, and a minimum of six months of follow-up. MRI findings included ventrally located, symmetrical, well-demarcated, hyperintense lesions on T2-weighted images without contrast enhancement. Cases with trauma or intervertebral disc disease were excluded.

Results
Eight cats (four males, four females) with a mean age of 14 years and 2 months were included. Neurological severity ranged from ambulatory tetraparesis to tetraplegia, with six cats displaying cervical ventroflexion. All cats had at least one concurrent medical condition, including hypertension (n=6), hypertrophic cardiomyopathy (n=2), and chronic kidney disease (n=2). MRI revealed characteristic lesions at C2 or C3. The median time to ambulation was 5.7 days. Five cats had no recurrence of signs, but three experienced chronic relapsing disease. One cat had a suspected intracranial infarction and was euthanized after recurrent episodes.

Limitations
The study was retrospective with a small sample size. Lack of post-mortem examinations limited confirmation of thromboembolic disease. Variability in treatment protocols and absence of follow-up MRIs in recurrent cases were additional limitations.

Conclusions
This study describes a novel subtype of feline cervical IM, distinct from fibrocartilaginous embolic myelopathy, with a predisposition for VSA embolization at C2–C3. Older cats with concurrent medical conditions, particularly hypertension, appear at higher risk. While initial prognosis for neurological recovery is favorable, some cases may experience recurrent ischemic events. MRI findings provide a distinctive diagnostic pattern, and comprehensive ancillary testing is recommended in affected cats.

T2-weighted sagittal and transverse images of the cervical spinal cord of cats 1 (a,b) and 2 (c,d). A ventral hyperintense lesion is seen at the level of C2 on the sagittal images (a,c). An analogous ventral hyperintense elliptical lesion is seen in the transverse images (b,d) corresponding to the territory of the ventral spinal artery at C2

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