Fibrocartilaginous embolism—an uncommon cause of spinal cord infarction: a case report and review of the literature

• Published in: Archives of physical medicine and rehabilitation Vol. 85; no. 1; pp. 153 - 157
• Main Authors: Han, Jay J, Massagli, Teresa L, Jaffe, Kenneth M
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2004; Elsevier
• Subjects: Adolescent; Biological and medical sciences; Cartilage; Case report; Cerebrospinal fluid. Meninges. Spinal cord; Diseases of the osteoarticular system; Embolism; Embolism - complications; Embolism - etiology; Embolism - physiopathology; Fibrocartilage; Humans; Infarction - etiology; Magnetic Resonance Imaging; Male; Medical sciences; Myelopathy; Nervous system (semeiology, syndromes); Neurology; Prolapse; Rehabilitation; Spinal Cord - blood supply; Spinal Cord - pathology; Spinal Cord Diseases - etiology; Spinal cord injuries; Traumas. Diseases due to physical agents; Vascular diseases and vascular malformations of the nervous system; Myelopathy; Case report; Spinal cord injuries; Rehabilitation; Embolism; Fibrocartilage; Nervous system diseases; Cardiovascular disease; Review; Traumatology; Cerebral disorder; Vascular disease; Case study; Reeducation; Orthopedics; Central nervous system disease; Spinal cord infarction; Spinal cord disease; Cerebrovascular disease; Bibliographic review; Spinal cord traumatism
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/S0003-9993(03)00289-2

Han JJ, Massagli TL, Jaffe KM. Fibrocartilaginous embolism—an uncommon cause of spinal cord infarction: a case report and review of the literature. Arch Phys Med Rehabil 2004;85:153-7. Fibrocartilaginous embolism is a rare cause of spinal cord infarction. It is postulated that an acute vertical disk herniation of the nucleus pulposus material can lead to spinal cord infarction by a retrograde embolization to the central artery. An increased intradiskal pressure resulting from axial loading of the vertebral column with a concomitant Valsalva maneuver is thought to be the initiating event for the embolus. We present a previously healthy 16-year-old boy with sudden onset of back pain and progressive paraparesis within 36 hours after lifting exercises in a squat position. His clinical presentation and neuroimaging studies were consistent with spinal cord infarction resulting from a central artery embolus at the T8 spinal cord level. Laboratory investigation showed no evidence of infectious, autoimmune, inflammatory, or neoplastic causes. Although no histologic confirmation was obtained, lack of evidence for other plausible diagnoses in the setting of his clinical presentation and in the magnetic resonance imaging findings made fibrocartilaginous embolism myelopathy the most likely diagnosis. We postulated that some cases of transverse myelitis might actually be fibrocartilaginous embolism, making it a more prevalent cause of an acute myelopathy than commonly recognized. Relevant literature and current theories regarding the pathogenesis of fibrocartilaginous embolism myelopathy are reviewed.