Fibrocartilaginous embolism: a rare cause leading to spinal cord infarction?

Purpose Fibrocartilaginous nucleus pulposus components herniation and embolism rarely causes acute ischaemic events involving the spinal cord. Few reports have suggested this as a mechanism leading to anterior spinal artery syndrome. The purpose of this study was to evaluate the topography and patte...

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Bibliographic Details
Published in:	Neurological sciences Vol. 44; no. 1; pp. 263 - 271
Main Authors:	Ciceri, Elisa Francesca, Opancina, Valentina, Pellegrino, Carlo, Scarabelli, Alice, Botturi, Andrea G., Bersano, Anna, D’arrigo, Stefano, Erbetta, Alessandra, Chiapparini, Luisa
Format:	Journal Article
Language:	English
Published:	Cham Springer International Publishing 2023 Springer Nature B.V
Subjects:	Adult Central nervous system diseases Child Differential diagnosis Embolism Embolism - complications Embolism - diagnostic imaging Embolisms Female Humans Infarction Infarction - diagnostic imaging Infarction - etiology Intervertebral discs Ischemia Magnetic Resonance Imaging Male Medicine Medicine & Public Health Neurology Neuroradiology Neurosciences Neurosurgery Nucleus pulposus Original Article Paresis Psychiatry Retrospective Studies Risk factors Spinal cord Spinal Cord - blood supply Spinal Cord - diagnostic imaging Spinal Cord Diseases - complications Spinal Cord Diseases - diagnostic imaging Thorax Fibrocartilaginous embolism Anterior spinal artery syndrome Magnetic resonance imaging Spinal cord ischaemia
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Summary:	Purpose Fibrocartilaginous nucleus pulposus components herniation and embolism rarely causes acute ischaemic events involving the spinal cord. Few reports have suggested this as a mechanism leading to anterior spinal artery syndrome. The purpose of this study was to evaluate the topography and pattern of this rare myelopathy by MRI. Methods A retrospective observational case series of patients, admitted to our Institute between 2008 and 2021, with a diagnosis of fibrocartilaginous embolism based on typical clinical and radiological features. Results Five patients were identified (2 men and 3 women; range 13–38 years). No one had pre-existing vascular risk factors. All referred potential precipitating event in the 24 h prior to symptom onset. MRI findings showed increased signal intensity of the spinal cord on T2-weighted images in all cases and degenerative disc changes opposite to it in four of them. The outcome was poor: three showed only partial sensitivity and motor improvement (mRs 4, 3, and 2, respectively); one completely recovered except for isolated hand paresis (mRs 1); and one remained severely neurologically affected (mRs 5). Conclusions Fibrocartilaginous embolism must be a differential diagnosis in case of otherwise unexplained spinal cord infarction in adult and paediatric low risk population. Neuroradiological findings such as abnormal spinal cord signal intensity and degenerative disc changes can aid in early diagnosis of this rare myelopathy. The prevalent myelopathy location was thoracic. All signal alterations were detected in the anterior region of the spinal cord in the territories of the anterior spinal artery.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1590-1874 1590-3478
DOI:	10.1007/s10072-022-06398-w