Acute cervical myelopathy due to presumed Fibrocartilaginous embolism a case report and systematic review of the literature

Juan P. Cuello, Santiago Ortega-Gutierrez, Guillermo Linares, Sachin Agarwal, Alyson Cunningham, P. Mohr, Stephan A. Mayer, Randolph S. Marshall, Jan Claassen, Neeraj Badjatia, Mitchel S.V. Elkind, Kiwon Lee

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Introduction: Fibrocartilaginous embolism (FCE) is an uncommon cause of myelopathy that should be considered after more common causes have been ruled out.

Objective: This article presents a case report of a 50-year-old man with acute myelopathy attributed to FCE and summarizes the clinical features of the disease by analyzing all of the published evidence.

Data Sources and Extraction: Two computerized literature searches (MEDLINE-Pubmed, EMBASE, the Cochrane Library) were performed. The search term used was "Fibrocartilaginous embolism." No language restrictions were applied. All articles were evaluated and key data were extracted according to predefined criteria: patient's age, year of publication, localization of the embolism and type of vascular syndrome, clinical outcome, and time to death in the fatal cases.

Results: Fifty-two cases (39 biopsy proven and 13 clinically diagnosed) were found in the literature. Median age at presentation was 37 years (interquartile range, 19-53) and 56% were women. Median progression of symptoms was 6 hours (interquartile range, 5-60 h), predominantly affecting the cervical spine (48%) by an arterial embolic source (56%).

Conclusions: FCE is an unusual cause of spinal cord and cerebral ischemia with unknown incidence. Implementation of diagnostic imaging techniques and initial management of acute spinal disorders care in intensive care units might increase the incidence of disease antemortem. FCE should be considered in the differential diagnosis of ischemic spinal cord injury when no other causes can be identified and especially when the onset is progressive over several hours.

Original languageEnglish
Pages (from-to)E276-E281
JournalJournal of Spinal Disorders and Techniques
Volume27
Issue number8
DOIs
StatePublished - 8 Dec 2014
Externally publishedYes

Keywords

  • Embolism
  • Fibrocartilaginous
  • Myelopathy
  • Spinal stroke

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