Fibrocartilaginous embolism: a comprehensive review of an under-studied cause of spinal cord infarction and proposed diagnostic criteria

INTRODUCTION: Spinal cord infarction (SCI) in children is rare and difficult to diagnose. Fibrocartilaginous embolism (FCE) is probably the underlying cause for some unexplained cases of spinal cord infarcts. Abrupt back pain followed by a progressive syndrome of myelopathy appears to be the typical presentation, with a close temporal relationship between the onset of symptoms and preceding minor trauma. Supportive care and rehabilitation are essential in the treatment of children with SCI. CASE REPORT: A previously healthy 12-year-old girl who practiced acrobatic gymnastics was admitted to a rehabilitation centre 14 days after being diagnosed with an acute anterior SCI with no identified cause. Sensory modality of pin prick and light touch were impaired, with the former more significantly affected. She was not able to run and had difficulty on monopodal standing and performing motor sequencing. Additionally, she mentioned ineffective cough along with flatus incontinence and normal bladder function. After a 4-week multidisciplinary rehabilitation program her neurologic deficits improved. DISCUSSION: Given the patient’s age and clinical presentation, a literature review led to the consideration of FCE as the most likely definitive diagnosis. It should be recognized as a cause of SCI especially in those involved in sport activities, even if previous trauma is denied.

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Anterior spinal cord infarction caused by fibrocartilaginous embolism

Neuropathology ◽

10.1111/j.1440-1789.2008.00938.x ◽

2009 ◽

Vol 29 (2) ◽

pp. 172-175 ◽

Cited By ~ 12

Author(s):

Yue-Shan Piao ◽

De-Hong Lu ◽

Ying-Ying Su ◽

Xiao-Ping Yang

Keyword(s):

Spinal Cord ◽

Spinal Cord Infarction ◽

Fibrocartilaginous Embolism

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Spinal Cord Infarction due to Fibrocartilaginous Embolism: A Report of 3 Cases

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2019.03.012 ◽

2019 ◽

Vol 28 (6) ◽

pp. e66-e67 ◽

Cited By ~ 2

Author(s):

Jeffrey N. Quinn ◽

Hannah Breit ◽

Rima M. Dafer

Keyword(s):

Spinal Cord ◽

Spinal Cord Infarction ◽

Fibrocartilaginous Embolism

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Spinal cord infarction following minor trauma in children: fibrocartilaginous embolism as a putative cause

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.1.peds12382 ◽

2013 ◽

Vol 11 (4) ◽

pp. 445-450 ◽

Cited By ~ 21

Author(s):

Andrew Reisner ◽

Matthew F. Gary ◽

Joshua J. Chern ◽

J. Damien Grattan-Smith

Keyword(s):

Spinal Cord ◽

Nucleus Pulposus ◽

Spinal Cord Infarction ◽

Minor Trauma ◽

First Report ◽

Fibrocartilaginous Embolism ◽

Laboratory Features

Spinal cord infarctions following seemingly innocuous trauma in children are rare, devastating events. In the majority of these cases, the pathophysiology is enigmatic. The authors present 3 cases of pediatric spinal cord infarction that followed minor trauma. An analysis of the clinical, radiographic, and laboratory features of these cases suggests that thromboembolism of the nucleus pulposus into the spinal cord microcirculation is the likely mechanism. A review of the human and veterinary literature supports this notion. To the authors' knowledge, this is the largest pediatric series of myelopathy due to thromboembolism of the nucleus pulposus reported to date, and it is the first report of this condition occurring in an infant.

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