A 16-year-old DSH presented with a rapid onset over 12 hours of non-ambulatory tetraparesis, neck ventroflexion, reduced postural reactions on all four limbs, and intact segmental spinal reflexes with increased extensor tone in all four limbs.

The MR study shows a symmetric intramedullary T2W hyperintensity affecting the ventral part of spinal cord at the level of C1-C2 and confined to the vascular territory of the ventral spinal artery. This lesion is T1W isointense and shows faint contrast enhancement in its cranial part.

The imaging findings at C1-C2 were considered highly suggestive of ischaemic myelopathy in the vascular territory of the ventral spinal artery. Similar findings have been reported in older cats with a characteristic appearance on MRI distinct from previous reports of fibrocartilaginous embolic myelopathy (FCEM) and ischemic myelopathy seen in younger cats.

This type of finding in older cats has been reported to be associated with hyaline degeneration of the ventral spinal artery, basilar artery, or associated branches, resulting in aneurysmal dilation and thrombosis of these vessels.

Cats diagnosed with this type of imaging findings have been diagnosed with concurrent medical conditions including chronic kidney diseases, hypertrophic cardiomyopathy and hypertension. The latter has been associated with arteriolar hyalinosis which in turn may be a predisposing factor to the thrombotic events. Compared to FCEM, cats with this type of pathology tend to experience a chronic relapsing disease course and ventroflexion of the neck is common.

Courtesy of Dr. Anna Tauro

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