702 - Fibrocartilaginous Embolism, an Under Reported cause of Pediatric Spinal Cord Infarction: A Case Report

15-year-old female, previously healthy, participated in discus throwing. The next day had intense pain and subsequent paraplegia.  Admitted and initially diagnosed with idiopathic spinal cord injury (SCI) due to extensive spinal cord infarction.  After negative rheumatologic and neurologic workup, MRI showed pattern of injury consistent with fibrocartilaginous embolism. She was then transferred to intensive in-patient rehabilitation with return of sensation but not motor movement in her lower extremities.


Case Description:

We present the case of a previously healthy 15-year-old female initially admitted with idiopathic spinal cord injury. After MRI imaging was obtained, she was diagnosed with extensive spinal cord infarction due to fibrocartilaginous embolism.


Discussions:

Spinal cord infarction is a rare cause of pediatric spinal cord injury. Our case is like previously reported idiopathic spinal cord infarctions. The patient, previously healthy, participated in a stretching activity then shortly after experienced intense pain, paraplegia, and was subsequently diagnosed with idiopathic SCI. During hospitalization, an extensive workup including rheumatologic and neurological disorders was negative.

Unlike in many causes of idiopathic SCI, upon review of our patient’s MRI, radiologist reported the pattern of injury was consistent with spinal cord infarction secondary to fibrocartilaginous embolism.

In pediatric patients, spinal cord injury is most often attributed to trauma, congenital, or acquired disorders. Less than 6% of spinal cord infarctions are attributed to fibrocartilaginous embolism. However, there are a growing number of reports of spinal cord injury occurring in the setting of minor trauma. We propose that fibrocartilaginous embolism is an under recognized etiology of pediatric spinal cord injury.


Conclusions:

There is an increasing number of reported cases of pediatric spinal cord infarction that occurs in the setting minor trauma.  The differential diagnoses of these patients should include fibrocartilaginous embolism. Further study is needed to better understand this diagnosis, its pathophysiology and potential treatments.