Desperate to identify this neuro problem - please help

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Booboos

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Apologies for the length of this post, I have posted about Rusky before but things are getting desperate now and I really need to identify what is going on.

R is a 16.2hh, 14yo WB gelding I have owned for 9-10 years and do dressage with. In a typical week he might be schooled 2-3 times and lunged twice in an Equiami. He used to work at Ad Med level but not with any great pressure, our progress has been glacial!

More than a year ago he started doing an odd thing with his hind leg (one at a time, but either leg). In a surface, in walk he would place the leg down and it would give way as if unable to support his weight. The hoofprint in the sand would be a lot deeper than any of his other ones but with no evidence of slipping. At first he was doing this maybe once every two months so I wasn't 100% sure it was happening.

Over time his symptoms have been:
- collapsing of the back leg (either leg but one at a time), ridden, on the lunge or in hand, ranging from mild to almost 'sitting down'.

- gradually more and more similar collapsing of the front legs. He has almost fallen on his knees ridden and we've seen him fall over in the field.

- impressive loss of muscle from top line and abdominals.

- unwillingness to engage, move forwards or collect.

- intermittently unwilling to have his feet picked up and will lift his hinds up really high after his hooves have been done (the only evidence of stringhalt type behaviour so far). He also collapsed fully in the stable while being shod. He had all 4 feet on the ground, he seemed to fall sideways onto the partition, pull back and end up forwards on his knees.

- he is a bit fussy about his back legs, lifting them when doing up rugs.

In the summer he saw the local vet twice who said it was a soft tissue problem and did two osteo treatments - he still got worse.

We then went to a specialist and saw two different vets with his notes being sent to a specialist radio and a specialist neuro in the US. He seems to have:

- x-ray evidence of kissing spines. This was first treated with steroid injections and along with the bar shoes below he was better for a couple of months, then regressed. A month ago he had Tildren IV but he does not seem significantly better this time although he is less reactive to pain in the saddle/behind the saddle area. There is no point thinking about a KS op if we don't get to the bottom of the neuro problems - vets all in agreement that the neuro issue is not typical of KS and needs to be accounted for.

- on the second visit he presented with 2/5ths lameness on left front when lunged on the hard and the hoof was reactive. He was fitted with bar shoes and was sound at the next two visits. Still has the bars on.

- fine at neuro exam performed twice (e.g. small circles, small figures of 8, backing up, walking with head in air, up and down bank, walking while vet pulls his tail).

- x-rays and ultrasound of neck and back show no evidence of arthritis or spinal nerve impingement, HOWEVER the US neuro specialist says that what I describe sounds neurological and the impingement may be occuring when his head/neck are in a particular position. He certainly seems worse after lateral work and lately after being on the lunge. To diagnose this kind of issue we would need to do a myelogram under GA and then the only possible treatment is an op to fuse the vertebrae with long box rest so the vet and I think this is too much to put him through.

For the past 3 weeks I have had him on an EMPS diet but there is no improvement so far.

Here is a video of him from yesterday. Sod's law he's never done the impressive collapses on video, there is a little one around 5.40 and maybe at 6.15 but overall you can see that he is moving very poorly behind:

http://www.youtube.com/watch?v=TfaQl9xQJZ4&feature=youtu.be

Any ideas anyone?
 
He is sound trotting up at the vets, sound after flexion and sound lunging in a deep, inclined pen - would the suspensories have shown under such circumstances? He has had 5 lameness workups by 3 different vets.
 
My horse who had kissing spine and hind suspensory issues never showed lame, not even in the flexion tests. Only diagnosed following scans. I hope you get him sorted.
Ours also would not go forward or do any collected work.
 
Ps. Just watched your vid. He looks un level behind . When you push him forward on the lunge does he prefer to canter than move forward in trot?
 
Lately, especially on the left rein he prefers to canter. He is very unlevel on both hinds by the end. I felt awful pushing him but I needed to get the vid. When he presents to the vet he presents sound. The more work he does the worse he gets and the rate at which he deteriorates has really accellerated. As recently as December he could still work well long and low, do some working trot/canter level work but relapsed after lateral work. Now he looks terrible after 5 minutes on the lunge.
 
Same as our boy. He would always skip into canter when asked to trot forward on the lunge. He got worse as well. He would also look like he was swinging his hind leg rather than pushing through with it. My vets could never really see it as it was a strange action from both hind legs rather than a obvious lateness.
 
What about wobblers syndrome? Sounds a bit like one I saw with this.. Obviously difficult to tell without seeing the horse but have the vets had a think about it? Hope you get to the bottom of it, and fingers crossed that it is fixable.
 
charlie76: many thanks I will mention it to the vet and see if they can do some nerve blocks

kit279: essentially it is wobblers syndrom if that covers spinal compression due to a variety of causes. We just can't identify the compression without the myelogram and we don't know the cause.
 
Just throwing ideas around here, but I think that's what you want so here goes.

Serious instability of the sacroiliac joint? In mine an SI injury presented as front leg lameness on the days that it showed at all. It never showed in flexions.

The puzzling thing is the deterioration as you work him. Bone injuries tend to stay the same. Soft tissue injuries tend to get better or stay the same. I wouldn't expect a brain tumour problem to do that either. I can understand exactly why you are treating him for EPSM (by the way, I found the cheapest way to get the Vit E was from simplysupplements.com and cut the gel capsules up into the feed).

Would a gamma ray scintigraph maybe help pinpoint a problem, assuming you are either insured or flush for cash?

I hope you get the answer soon.
 
Yes that's exactly it cptrayes, I am hoping someone may have an idea the vets have missed. Someone on a French forum mentioned a toxic plant that cases hind limb ataxia but we can't find the stupid plant anywhere on our grounds!

A scintigraphy would be at the very least intersting. It could rule in KS or uncover something new although it wouldn't decide the neuro question...there are only two equine scintigraphies in France, one in Paris and one in Normandy both about 7-8 hours away. I am looking into another option in Barcelone (3 hours away) but I am in two minds over whether I am torturing him needlessly with more exams and it will be a waste of time for the neuro aspect or whether I am missing something that could sort him out!

The vet does not think it's SI or a brain tumour.

digitalangel thank you very much for taking the time to look at it all! It may well be that one hind is worse than the other. He is stiffer in the neck on the right rein (which may be coming from somewhere else) and more likely to break into canter on the left rein.
 
Sorry to hear about this, sounds similar to a horse we had who suddenly and rapidly developed wobblers, began with little give-ways or misplacements of the hind legs, he was reluctant to go forwards but he deteriorated rapidly within the space of 6 weeks. He was PTS as he became very unstable.
Hope your boy is ok x
 
My wobbler was similar to yours Worried, but I also had clear xrays of serious neck problems.

I assume they've tested for EHV have they Booboos, that can cause ataxia and mine was tested for it?

I can't see your video on this tablet, does the whole leg collapse with the foot flat to the floor, or does he knuckle over? Mine knuckled over, and that was his first sign of a problem.
 
Just to add neck X-ray was initially ok but the left shoulder was abnormal and was impinging and later X-rays showed pinching.
 
Ah Worried1 that is such a quick deterioration, what a shame for your boy and such a shock for you.

cptrayes: they haven't tested for EHV not sure why not. They dismissed it when I brought it up but I will insist they do it, it's not a very invasive test. The foot is always flat on the floor he's never knuckled over.
 
The overall picture looks a lot like my last horse who had a few different issues. Not suggesting yours has the exact same thing but since you're after ideas I thought it might at least help.

The collapsing of the hind legs I can't comment on but snatching it up after farrier, struggling to pick up hinds etc sounds like mine who was a shiverer. I had him for about 5 years and it didn't progress quickly, but he did slowly get worse while I had him. When I first got him, he shivered in his right hind only and he struggled to pick it up, could be tricky for the farrier on that side. Eventually it began to progress into his left hind too. I discussed it with my vet who said he thought the shivers had contributed to some muscle wastage, mainly on the right side (HQs). My physio always told me he had a tendency to get sore around his SI area which she felt was due to the shivers. Before he finally retired, the shivers did make him short behind, particularly on the right side and he also struggled to take his weight properly on that leg when schooling... cantering and lateral work were hard because he couldn't fully use it to push through.

To compound that... he also had bilateral hock spavins. And ringbone (articular and non-articular, high and low!!) in his left fore, and sidebone in both front feet. Later he also developed sesamoiditis (sp?).

My vet and physio's opinions were basically that the back end was crocked so he'd tended to put more weight on the front end, which had aggravated the niggly/developing problems there. He did do the slight collapsing thing in front, only ever on the left fore. His movement on that leg was a little odd - he would dish ever so slightly and occasionally just seemed to roll too far over and collapse. I've known him to lose his front legs occasionally out hacking, almost as though he just didn't quite pick his foot up quickly enough and fell over himself (but not in a gangly baby horse kind of way). Later on my vet & physio also identified some damage to the supraspinous ligament, possibly a precursour to KS. I did do, on physio recommendation, an intensive 8 week lunging prog to strengthen him which helped enormously but if I backed off the lunging, he would lose that new muscle very quickly. Feeding Equitop Myoplast helped but at £80 a tub, feeding a tub every 2-3 weeks, that wasn't economically sustainable. The physio summed it up by saying the back end was broken, the front end had then broken so eventually, the middle bit (his back) was always going to go.

Despite all of the above, the horse did actually still enjoy work (! honestly!). He just hated schooling and lunging, although good for his back, made him more lame in front and behind. With mine it was no one thing that caused all his issues, he had a lot of things going on. Is this maybe the case with your horse? Have you x-rayed his feet and hocks too? My horse's issues began as one problem that alone was manageable but as a result he developed many others.
 
chesnut cob thank you for sharing your story. I suspect that Rusky, similarly to your boy, may have more than one problems that compound each other. What a nightmare! His feet were x-rayed, not the hocks.

ReggieP: thank you for the link. I have asked the vet if we can look into infectuous and parasitic causes although I think the really long onset of symptoms (16 months plus now) may rule out some things).
 
Having watched the video, he looks virtually identical to the WB here who was also working at advanced medium before the onset of his symptoms. He would occasionally seem to lose one of his hinds, show the same weakness pushing into the trot as your boy, and the same swishing of the tail etc. To me, your boy looks lame behind, especially on the right hind when on the left rein. This would indicate a suspensory problem on that hind to my eyes, but I also think he has sacroilliac and back issues (the latter which you are aware of). What is his canter like? The gelding I refer to above would hop into trot in a similar way to your horse, and also would start to change leads behind, especially on the left rein. He was found to have arthritis of the neck, mild KS, sacro illiac dysfunction and right hind suspensory desmitis. Do you have any facilities near you for scintigraphy or thermal imaging?
 
Before his symptoms started had he had any injections, treatments? Our neighbours horse had ataxia such as that caused by the French plant. Only thing is that we are in the UK and the plant was nowhere. UK vet stumped, it went to France for treatment in the end, took 2 jabs to cure.
 
Thank you Wagtail, it would have to be Barcelona for a scintigraphy but it may be worth it if there are no other answers. I just don't feel ready to retire him with no diagnosis as I keep thinking there may be something I am missing that could be helped. If he does have multiple problems perhaps there is no other option but it's difficult to make the decision without knowing.

Rebels: mmmm, let me think. We moved to France September 2010. That autumn/winter he had a UTI and a mildly infected leg from a cut on separate occassions - he got antibiotics for both. Other than that normal vaccinations and sedation for getting his teeth done every 6 months. He has only left the yard once in June 2012 for a show (very mild symptoms were already showing at that stage), other than the specialist vet visits which started in November 2012. I get all of mine tested for worms, he was positive last autumn but vet had forgotten what kinds of worms she had seen (!!!) so I gave him Equimax, then he was clear in the next few tests, but everyone had small and large encrysted redworms this spring so they just had Equest Pramox. I can't think of anything else out of the ordinary.
 
Wagtail: sorry forgot to say re the canter. He does not change behind, but he lacks engagement and the canter can be four beat.

Here he is trying to do a test (for comparison purposes) towards the end of March. It was so bad I gave up but nowhere near as bad as last week:

http://www.youtube.com/watch?v=tJe0NEf6HEA&list=HL1364554050&feature=mh_lolz

Literally seconds after we stopped filming he did he hind leg collapse, I got off and he collapsed three times in front just trying to walk to the stables.

Amos: not a stupid question at all, one I asked myself! The vet couldn't see a reason to do them but yesterday we took a sample anyway. It may be pointless but it's a simple thing to check so why not do it.
 
Just something else, he looks quite porky, is his weight consistent? Is he better or worse when leaner? I know things like sciatica can be exacerbated by weight.
 
Always best to cover all bases! I have one who's brain is not connected to his back legs. Blood tests were very interesting. May well not be connected but as hes a complete mystery who knows! I wish you the best of luck.
 
Wagtail.. Ours too has kissing spine, sacroiliac issues and suspensory issues. He has similar symptoms and always looks lamer with the lame leg on the outside
 
charlie76 said:
Wagtail.. Ours too has kissing spine, sacroiliac issues and suspensory issues. He has similar symptoms and always looks lamer with the lame leg on the outside
Click to expand...

Interesting. Though devastating at the same time. Always seems to be the best ones. I knew that suspensories and kissing spine have been linked, but it seems that SI too is often involved.

Booboos, in your second video I can see more evidence of possible neurological problems than in the first video. In the first video he loos in pain (more tail swishing etc). In the second video, he looks completely unconcerned in his head carriage and expression, and is trot is nice and big, though you can clearly see the weakness behind. The gelding I refoerred to earlier, also has the most amazing big trot. I think it covered up a lot of his problems for a long time.
 
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