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Fibrocartilaginous embolism of the posterior spinal artery: A case report regarding the responsible intervertebral disc on magnetic resonance imaging

Spinal Cord Series and Cases volume 8, Article number: 10 (2022) Cite this article

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Abstract

Introduction

Fibrocartilaginous embolism (FCE) of the spinal cord is an ischemic myelopathy caused by rupture of the intervertebral disc and subsequent entrance of the nucleus polposus material into the nearby vasculature. However, responsible disc lesions frequently cannot be determined, which may cause diagnostic difficulty.

Case presentation

A 63-year-old man suddenly felt a strange sensation in the lower limbs and noticed that he could not walk. The patient was brought to our hospital, where he was hospitalized. On neurological examination, his proprioception and vibratory sense were disturbed in the lower limbs. Spine magnetic resonance imaging (MRI) revealed a hyperintense cord lesion located at the C4–5 vertebral level of the posterior spinal artery region on diffusion-weighted sequence. He was diagnosed as having spinal cord infarction and treated with antiplatelet medication. Follow-up MRI was performed 5 days later, which displayed a collapsed C3/4 disc and a defected C4 vertebral body that were not evident on earlier MRI. These findings suggested the disc lesion was active and responsible for the infarction, leading to the diagnosis of FCE. The patient gradually improved and had no gait difficulty at the time of discharge.

Discussion

In the presented case, MRI did not reveal the responsible disc lesion when the diagnosis of spinal cord infarction was made; however, it became evident 5 days later. Although such a disc signal change within several days has not been described as a clue suggesting FCE, follow-up MRI with a relatively short interval may elucidate the responsible lesion and correct diagnosis.

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Fig. 1: Midsagittal magnetic resonance imaging (MRI) findings.
Fig. 2: Magnetic resonance imaging (MRI) findings of the axial slice at the C4/5 intervertebral level (a, b) and midsagittal slice (c–e).

References

  1. Moore BJ, Batterson AM, Luetmer MT, Reeves RK. Fibrocartilaginous embolic myelopathy: Demographics, clinical presentation, and functional outcomes. Spinal Cord. 2018;56:1144–50.

    Article  Google Scholar 

  2. Mateen FJ, Monrad PA, Hunderfund AN, Robertson CE, Sorenson EJ. Clinically suspected fibrocartilaginous embolism: Clinical characteristics, treatments, and outcomes. Eur J Neurol. 2011;18:218–25.

    Article  CAS  Google Scholar 

  3. AbdelRazek MA, Mowla A, Farooq S, Silvestri N, Sawyer R, Wolfe G, et al. Fibrocartilaginous embolism: A comprehensive review of an under-studied cause of spinal cord infarction and proposed diagnostic criteria. J Spinal Cord Med. 2016;39:146–54.

    Article  Google Scholar 

  4. Tosi L, Rigoli G, Beltramello A. Fibrocartilaginous embolism of the spinal cord: A clinical and pathogenetic reconsideration. J Neurol Neurosurg Psychiatry. 1996;60:55–60.

    Article  CAS  Google Scholar 

  5. Davis GA, Klug GL. Acute-onset nontraumatic paraplegia in childhood: Fibrocartilaginous embolism or acute myelitis? Childs Nerv Syst. 2000;16:551–4.

    Article  CAS  Google Scholar 

  6. Raghavan A, Onikul E, Ryan MM, Prelog K, Taranath A, Chennapragada M, et al. Anterior spinal cord infarction owing to possible fibrocartilaginous embolism. Pediatr Radio. 2004;34:503–6.

    Article  Google Scholar 

  7. Duprez TP, Danvoye L, Hernalsteen D, Cosnard G, Sindic CJ, Godfraind C, et al. Fibrocartilaginous embolization to the spinal cord: Serial MR imaging monitoring and pathologic study. AJNR Am J Neuroradiol. 2005;26:496–501.

    PubMed  PubMed Central  Google Scholar 

  8. Bansal S, Brown W, Dayal A, Carpenter JL. Posterior spinal cord infarction due to fibrocartilaginous embolization in a 16-year-old athlete. Pediatrics. 2014;134:e289–92.

    Article  Google Scholar 

  9. Weidauer S, Nichtweiss M, Lanfermann H, Zanella FE. Spinal cord infarction: MR imaging and clinical features in 16 cases. Neuroradiology. 2002;44:851–7.

    Article  Google Scholar 

  10. Weidauer S, Nichtweiß M, Hattingen E, Berkefeld J. Spinal cord ischemia: Aaetiology, clinical syndromes and imaging features. Neuroradiology. 2015;57:241–57.

    Article  Google Scholar 

  11. Novy J, Carruzzo A, Maeder P, Bogousslavsky J. Spinal cord ischemia: Clinical and imaging patterns, pathogenesis, and outcomes in 27 patients. Arch Neurol. 2006;63:1113–20.

    Article  Google Scholar 

  12. Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. Classification of stroke subtypes. Cerebrovasc Dis. 2009;27:493–501.

    Article  CAS  Google Scholar 

  13. Zalewski NL, Rabinstein AA, Krecke KN, Brown RD Jr, Wijdicks EFM, Weinshenker BG, et al. Characteristics of spontaneous spinal cord infarction and proposed diagnostic criteria. JAMA Neurol. 2019;76:56–63.

    Article  Google Scholar 

  14. Kuek DKC, Chung SL, Zishan US, Papanikitas J, Yanny S, Meagher T, et al. Conus infarction after non-guided transcoccygeal ganglion impar block using particulate steroid for chronic coccydynia. Spinal Cord Ser Cases. 2019;5:92.

    Article  Google Scholar 

  15. Morshid A, Jadiry HA, Chaudhry U, Raghuram K. Pediatric spinal cord infarction following a minor trauma: A case report. Spinal Cord Ser Cases. 2020;6:95.

    Article  Google Scholar 

  16. Draganich C, Wenzel LR. Fibrocartilagenous embolism case series: Is it a zebra? Spinal Cord Ser Cases. 2021;7:28.

    Article  Google Scholar 

  17. Griffith JF, Guglielmi G. Vertebral fracture. Radio Clin North Am. 2010;48:519–29.

    Article  Google Scholar 

  18. Ozgen S, Pait TG, Cağlar YS. The V2 segment of the vertebral artery and its branches. J Neurosurg Spine. 2004;1:299–305.

    Article  Google Scholar 

Download references

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  1. Department of Neurology, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan

    Makoto Kobayashi

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Kobayashi, M. Fibrocartilaginous embolism of the posterior spinal artery: A case report regarding the responsible intervertebral disc on magnetic resonance imaging. Spinal Cord Ser Cases 8, 10 (2022). https://doi.org/10.1038/s41394-022-00477-y

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