2369 Young spinal stroke – ? Fibrocartilaginous embolism

Objectives Fibrocartilaginous embolism is a rarely reported cause of spinal cord infarction.¹ The embolism arises from cartilaginous nucleus pulposus material entering the spinal cord vasculature usually after a Valsalva manoeuvre.²

Case A 36-year-old woman presented with sudden onset bilateral arm paraesthesia and chest pain soon after cleaning her fish tank without heavy lifting. 24 hours later, she developed bilateral upper and lower limb weakness with diminished deep tendon reflexes, and sensory loss to pinprick in the right C4/C5 distribution but with no sensory level. Vibration and position sense were normal. After a brief resolution of symptoms, she deteriorated to tetraparesis, with some retained distal movement.

Results MRI of brain and whole spine 48 hours after symptom onset showed central T2-hyperintensity in the cervical cord extending from C4/C5 to T1, with possible restricted diffusion, associated central and left paracentral disc protrusion at C6/C7 and a mild central posterior disc protrusion at C5/C6 with preserved CSF space surrounding the cord. Vasculitic, thrombophilia and cardiac investigations were unremarkable. CSF oligoclonal bands and aquaporin-4 antibodies were negative. Repeat MRI confirmed true restricted diffusion and aspirin was commenced. A disc protrusion at the level of cord infarction was in keeping with fibrocartilaginous embolism as the primary cause, alternative causes having been excluded.

Conclusions This case illustrates a rare but potentially underreported cause of spinal cord infarct. It should be considered when a patient with few vascular risk factors presents with an acute cord syndrome.

References

1. AbdelRazek MA, Mowla A, Farooq S, Silvestri N, Sawyer R, Wolfe G. Fibrocartilaginous embolism: a comprehensive review of an under-studied cause of spinal cord infarction and proposed diagnostic criteria. J Spinal Cord Med. 2016;39(2):146–54.

2. Kepes JJ, Reynard JD. Infarction of spinal cord and medulla oblongata caused by fibrocartilaginous emboli. Virchows Archiv A. 1973;361(3):185–93.