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Discussion on Abrupt weakness and ataxia... EPM relapse 10 yrs. later?
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New Member:
abe731
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Posted on Friday, Jan 13, 2012 - 8:57 pm:
I need to know if anyone has seen anything like this before. The horse is a 14 yr. old Friesian/Arab cross. He had EPM at the age of 4 and was treated successfully with Marquis. He recovered quite well, although he had permanantly lost some muscle tone in his hind end. Nonetheless, he's done dressage, hunter paces, and some foxhunting. This past summer I thought he seemed a bit stiff, and I gave him a course of Adequan, which seemed to work wonders. He seemed more comfortable than he's been in years.
Now the problem... I went to lead him out of the field yesterday and he was very weak in his hind end, and it seemed oddly twisted... his hind feet were pointing to the right, and it appeared he was falling to the left. I called the vet out right away. No pain response to anything and he was bright eyed and alert. No signs of fever, dullness, or anything else to indicate Herpes or any other disease. No sign that he'd suffered any trauma. We also noticed that his front feet seemed to be pointed to the left.
As an aside here, he did fall after trying to jump a hay rack about a week and a half ago, and caught a hind hoof... he struggled, got it free, and seemed fine. Trotted out fine, I rode him briefly at the walk and trot, again seemed fine. No problems after that.
I took photos of him a couple days ago, and in reviewing them, noticed that he appears to be leaning the same way. He was moving fine, though, and I didn't notice it at the time. I'll include some of the photos.
The vet gave him DMSO I.V. last night and today, and drew blood to test for various things. The standard blood profile should be back tomorrow morning. The tests for Lymes and EPM won't go out 'til Monday. From what I've read, an EPM relapse usually occurrs within a few months... I haven't found anything about it happening 10 yrs. later. Any ideas?  
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Member:
vickiann
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Posted on Saturday, Jan 14, 2012 - 9:48 am:
Lovely horse.
Given that he took a fall I would have to suspect that he injured something.
Can't help but wonder about the sacro joint or perhaps a ligament tear back there between the hips.
Diagnosing that type of injury can be pretty tricky from what some Vets who have done extra study about this area have told me.
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New Member:
abe731
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Posted on Saturday, Jan 14, 2012 - 10:51 am:
Blood work is back... his white blood cell count and red blood cell counts are both a little bit low. The vet said that is sometimes seen in horses with ulcers (which I think he has, although he's never been scoped... due to that I also ordered UlcerGard on the vet's recommendation).
His liver and kidneys are fine, and his lung enzyme is a little elevated, but the vet said that's to be expected given the extra exertion for him to balance himself.
The rest of his blood work goes out on Monday. The plan is to continue to treat him with Banamine and start him on Marquis (which I ordered yesterday). I'm almost thinking an EPM relapse might be the best case scenario, because at least then we know what it is and how to treat him. I just really question the chances of it lying dormant for so long. I know it's possible, it just seems very unlikely.
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Moderator:
DrO
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Posted on Saturday, Jan 14, 2012 - 12:13 pm:
Welcome Anna,
I am sorry to hear about your horse. The signs you describe sound like ataxia of all four limbs and since you do not describe signs of cranial nerve deficits, depression, or cerebellar deficits the lesion is most likely in the cervical (neck) spinal cord. However this does not tell us what might be wrong. This sort of wide spread problem would be atypical for EPM though it does not rule it out. Trauma or possibly Equine Herpes Virus 1 can look this way. There may not be external signs of trauma and rarely EHV-1 can come on without fever or other symptoms. Radiography of the cervical spine and titer for EHV-1 would be possible diagnostic steps.
Good nursing care and possibly antiinflammatories for trauma would be good first steps and I would not council against EPM treatment.
DrO
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New Member:
abe731
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Posted on Monday, Jan 16, 2012 - 5:34 pm:
Thanks Dr. O for your advice. He is about the same today as he's been the past 4 days. I'm also wondering about any tick-borne illnesses... I found a tick on him Thursday, and we have a lot around here. But it seems like most diseases would come with a fever or other signs of sickness, which has me stumped. I should have the other tests back by the end of the week. Also, from what I've read about EHV-1, once the horse shows neurological signs, don't they usually quickly deteriorate? Or is that not always the case?
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Moderator:
DrO
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Posted on Thursday, Jan 19, 2012 - 8:05 am:
There are forms of tick related neuromuscular disease that presents as a ascending weakness or ataxia without fever. Tick paralysis is the only tick-borne disease that is not caused by an infectious organism. The illness is caused by a neurotoxin produced in the tick's salivary gland. Removing the tick is curative.
EHV-1 presentation is variable and you can read more about this at HorseAdvice.com » Diseases of Horses » Nervous System » Incoordination, Weakness, Spasticity, Tremors » Equine Herpes Encephalopathy.
DrO
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New Member:
annab264
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Posted on Monday, Apr 9, 2012 - 12:29 pm:
Hello, this is the original poster again (I rejoined with a new user name). Maybe this discussion should be moved... all blood tests were negative for any abnormalities, the test for EHV-1 was negative as well. I treated him with a course of Marquis just in case it was EPM, but saw no real improvement. He's marginally better now than he was, but not great.
I'm thinking more and more that this is an injury related to his fall over the jump. I don't know why it wouldn't have shown up immediately, but it seems more clear now that it's his right hind bothering him. He often stands with that leg turned out (toe pointing outward). The other odd thing is that he didn't exhibit any heat / swelling or obvious pain. However, the way he fell and caught his hoof, then struggled before pulling it free makes me think he may have strained or torn something. Here's a picture so you get a better idea of what I'm talking about:  The picture of the jump is just to represent how his hoof was caught; it was a very heavy hay feeder, so it didn't budge as he struggled with it.
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Member:
stek
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Posted on Tuesday, Apr 10, 2012 - 12:45 pm:
Hi Anna, sorry to hear about your horse. Did your vet do a complete physical neurological exam, and if so what were the results?
We had a horse present with similar symptoms (ataxia of all 4 limbs) a few years ago. No outward evidence of trauma aside from an odd patch of dirt on his head. It was diagnosed as a cervical spinal lesion due to unknown trauma. His condition degenerated pretty rapidly though so I am hoping that is not what you're dealing with.
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New Member:
annab264
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Posted on Tuesday, Apr 10, 2012 - 3:03 pm:
Hello, Shannon. Yes, the vet originally did a full neurological exam, but the neurological signs have since improved greatly. Besides which, she said that it would have to be something in the cervical spine to affect the hind end like that, and he had no tenderness or pain at all when she palpated all around his neck.
I still think the neurological signs could have been because he had EPM when he was younger and had some residual permanent nerve damage, so he may have been more uncoordinated when trying to compensate for that leg. The really odd thing was when the vet did flexion tests on his hind legs, he trotted off just fine. He's improved slightly since January, so at least (so far) he's not getting worse. I'm just worried that if it's a ligament or something it might not heal without surgery (which isn't an option).
I could also add that he does occasionally canter and buck on his own in the pasture. It doesn't seem to hurt him, but his canter is a bit short-strided... sort of like he has to pick his hind end up higher to swing his rear leg forward more easily. He also lays down and rolls regularly, then gets up with no problem, so none of that seems to cause him pain.
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Moderator:
DrO
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Posted on Thursday, Apr 12, 2012 - 7:38 am:
Welcome back Anna,
Thank you for the update. Falls like you describe above could cause injury to the stifle or possibly to the reciprocal apparatus (ruptured peroneus tertius). Check out HorseAdvice.com » Diseases of Horses » Lameness » Diseases of the Upper Rear Limb Where we have sections on both of these topics.
DrO
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