Session Time: 11:15am-12:45pm
Location: Research Hub - Kiosk 4
Disclosures: Javier A. Santana, MD: Nothing to disclose
Case Description: The patient woke up suddenly one morning with severe neck pain. Within one day, he lost all left hemi body motor strength and developed weakness in his right upper extremity. He was treated for suspected transverse myelitis with steroids. Two weeks later, he did not show any improvement and an extensive workup was performed. CSF analysis showed that his presentation was not consistent with an inflammatory process as seen in demyelinating diseases.
Setting: Inpatient rehabilitation facility.
Patient: A previously healthy 58-year-old male.
Assessment/Results: Magnetic resonance imaging of and angiogram of the spine showed a spinal cord infarct with a hyper intense signal revealing the presence of fibrocartilaginous emboli in left and central upper cervical spine. He began a comprehensive inpatient rehabilitation program, showed moderate gains in motor strength, and was discharged home modified independent.
Discussion: Infarcts of the spinal cord caused by fibrocartilaginous embolisms (FCE) from a herniated nucleus pulposus remain a rare cause of stroke. It is often underdiagnosed or simply misdiagnosed as transverse myelitis, as reported in this case. Important distinctions should be noted, such as the fact that demyelinating diseases will cause weakness that will progress over days to months, as opposed to FCE which presents with weakness within hours to days. Although a clear pathophysiology has not been established, it is generally agreed that vertebral disk herniation can cause the nucleus pulposus to embolize and travel along the vessels of the cord, which may lead to infarcts. Prognosis is poor and no specific pharmacological treatment exists; however, more research with chondrolytic therapy has yet to be done. Rehabilitation remains a key component in the recovery of patients.
Conclusion: Physiatrists should be familiar with this pathology in order to assign the proper diagnosis, avoid unnecessary treatments and possibly be a part of research looking into safe medical interventions.
Level of Evidence: Level V
To cite this abstract in AMA style:Santana JA, Lacerte M, Dalal K. Fibrocartilaginous Embolism: The Case of a Male with Sudden Onset of Severe Neck Pain and Left-sided Weakness [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/fibrocartilaginous-embolism-the-case-of-a-male-with-sudden-onset-of-severe-neck-pain-and-left-sided-weakness/. Accessed February 26, 2024.
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