scholarly journals Successful management of spinal cord ischemia in a pediatric patient with fibrocartilaginous embolism: illustrative case

2021 ◽  
Vol 2 (11) ◽  
Author(s):  
Augustinas Fedaravičius ◽  
Yael Feinstein ◽  
Isaac Lazar ◽  
Micky Gidon ◽  
Ilan Shelef ◽  
...  

BACKGROUND Fibrocartilaginous embolism (FCE) is a rare cause of ischemic myelopathy that occurs when the material of the nucleus pulposus migrates into vessels supplying the spinal cord. The authors presented a case of pediatric FCE that was successfully managed by adapting evidence-based recommendations used for spinal cord neuroprotection in aortic surgery. OBSERVATIONS A 7-year-old boy presented to the emergency department with acute quadriplegia and hemodynamic instability that quickly progressed to cardiac arrest. After stabilization, the patient regained consciousness but remained in a locked-in state with no spontaneous breathing. The patient presented a diagnostic challenge. Traumatic, inflammatory, infectious, and ischemic etiologies were considered. Eventually, the clinical and radiological findings led to the presumed diagnosis of FCE. Treatment with continuous cerebrospinal fluid drainage (CSFD), pulse steroids, and mean arterial pressure augmentation was applied, with subsequent considerable and consistent neurological improvement. LESSONS The authors proposed consideration of the adaptation of spinal cord neuroprotection principles used routinely in aortic surgery for the management of traumatic spinal cord ischemia (FCE-related in particular), namely, permissive arterial hypertension and CSFD. This is hypothesized to allow for the maintenance of sufficient spinal cord perfusion until adequate physiological blood perfusion is reestablished (remodeling of the collateral arterial network and/or clearing/absorption of the emboli).

Author(s):  
Jennifer C. Chung ◽  
Carly L. Lodewyks ◽  
Thomas L. Forbes ◽  
Michael W.A. Chu ◽  
Mark D. Peterson ◽  
...  

2019 ◽  
Vol 35 (10) ◽  
pp. S163-S164
Author(s):  
J. Chung ◽  
C. Lodewyks ◽  
T. Forbes ◽  
M. Chu ◽  
M. Peterson ◽  
...  

1995 ◽  
Vol 3 ◽  
pp. 56-56 ◽  
Author(s):  
K KAMIYA ◽  
O SUZUKI ◽  
K IYORI ◽  
M KOBAYASHI ◽  
T ISHIMOTO ◽  
...  

2013 ◽  
Vol 47 (2) ◽  
pp. 85-91 ◽  
Author(s):  
Brant W. Ullery ◽  
Grace J. Wang ◽  
Edward Y. Woo ◽  
Albert T. Cheung ◽  
Michael L. McGarvey ◽  
...  

2007 ◽  
Vol 263 (1-2) ◽  
pp. 211-213 ◽  
Author(s):  
Jan Thöne ◽  
Andreas Hohaus ◽  
Andreas Bickel ◽  
Frank Erbguth

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