Spinal Cord Infarct Due to Fibrocartilaginous Embolism

An 8-year-old healthy girl had sudden-onset neck pain while performing a backbend. She rapidly developed bilateral arm weakness followed by difficulty ambulating. Initial examination showed symmetric quadriparesis (preserved antigravity hip/knee flexion), and decreased temperature sensation with preserved vibration. Magnetic resonance imaging (MRI) spine showed a small annular tear of the C4-C5 disc ([Fig. 1A]), restricted diffusion within central gray matter extending from the cervicomedullary junction through C6 ([Fig. 1B]), and abnormal T2 signal on MRI 1 day later ([Fig. 1C]).

Fig. 1 (A) Sagittal T2-weighted MRI on the day of presentation demonstrates an annular tear in the posterior aspect of the C4–5 intervertebral disc (white arrow). (B) Axial diffusion-weighted image shows restricted diffusion in the spinal cord, roughly corresponding to the gray matter. ADC maps not shown. (C) Axial T2-weighted image performed 1 day after the initial event demonstrates abnormal T2 hyperintensity of the gray matter of the spinal cord. MRI, magnetic resonance imaging.

Leg strength improved soon after presentation. At discharge, she remained unable to raise her arms past 60 degrees and had full lower extremity strength. Temperature sensation normalized.

Spinal cord infarction is a rare cause of myelopathy, typically in a healthy child. The proposed mechanism is increased intradisc or intravertebral body pressure by axial loading forces applied to the spine that propels the fibrocartilaginous nucleus pulposus into the spinal vasculature.[1] [2] [3] Diagnostic clues include acute bilateral weakness after minor trauma (spine hyperextension or flexion) and dissociation of temperature/pain from proprioception/vibration. Diagnosis is made radiographically by spine diffusion-weighted and T2-weighted MRI, which demonstrate signal change within the anterior spinal artery territory and can show evidence of disc injury.[4] [5]

Financial Disclosure

The authors have no financial relationships relevant to this article to disclose.

Publication History

Received: 20 August 2020

Accepted: 28 August 2020

Article published online:
27 October 2020

• References

• 1 Ahluwalia R, Hayes L, Chandra T, Maugans TA. Pediatric fibrocartilaginous embolism inducing paralysis. Childs Nerv Syst 2020; 36 (02) 441-446
• 2 Quinn JN, Breit H, Dafer RM. Spinal cord infarction due to fibrocartilaginous embolism: a report of 3 cases. J Stroke Cerebrovasc Dis 2019; 28 (06) e66-e67
• 3 Yamaguchi H, Nagase H, Nishiyama M. et al. Fibrocartilaginous embolism of the spinal cord in children: a case report and review of literature. Pediatr Neurol 2019; 99: 3-6
• 4 Beslow LA, Ichord RN, Zimmerman RA, Smith SE, Licht DJ. Role of diffusion MRI in diagnosis of spinal cord infarction in children. Neuropediatrics 2008; 39 (03) 188-191
• 5 Kelly TG, Mathews VP, Khalil ST, Palasis S. Magnetic resonance imaging patterns in nontraumatic pediatric spinal cord myelopathy. Neurographics 2019; 9: 185-200