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; Jay P Mohr; Stephan A Mayer; Randolph S Marshall; Jan Claassen; Neeraj Badjatia; Mitchel S V Elkind; Kiwon Lee

doi:10.1097/BSD.0000000000000115

Journal article

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, Jay P Mohr, Stephan A Mayer, Randolph S Marshall, Jan Claassen, Neeraj Badjatia, …

Journal of spinal disorders & techniques, Vol.27(8), pp.E276-E281

12/2014

DOI: 10.1097/BSD.0000000000000115

PMID: 24901879

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Abstract

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.

Magnetic Resonance Imaging

Spinal Cord Diseases - diagnosis

Cervical Vertebrae

Diagnosis, Differential

Embolism - complications

Embolism - diagnosis

Humans

Middle Aged

Embolism - pathology

Male

Cartilage Diseases - pathology

Disease Progression

Spinal Cord Diseases - etiology

Biopsy

Spinal Cord - pathology

Diffusion Magnetic Resonance Imaging

Female

Spinal Cord Diseases - pathology

Cartilage Diseases - diagnosis

Cartilage Diseases - complications

Details

Title: Subtitle: Acute cervical myelopathy due to presumed fibrocartilaginous embolism: a case report and systematic review of the literature
Creators: Juan P Cuello - Department of Neurology, Division of Neurocritical Care †Division of Stroke, Columbia University College of Physicians and Surgeons, New York, NY
Santiago Ortega-Gutierrez
Guillermo Linares
Sachin Agarwal
Alyson Cunningham
Jay P Mohr
Stephan A Mayer
Randolph S Marshall
Jan Claassen
Neeraj Badjatia
Mitchel S V Elkind
Kiwon Lee
Resource Type: Journal article
Publication Details: Journal of spinal disorders & techniques, Vol.27(8), pp.E276-E281
DOI: 10.1097/BSD.0000000000000115
PMID: 24901879
NLM abbreviation: J Spinal Disord Tech
ISSN: 1536-0652
eISSN: 1539-2465
Publisher: United States
Language: English
Date published: 12/2014
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984020505802771

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