1111 - Fibrocartilaginous Embolism Causing Cervical Spinal Cord Infarction with Favorable Recovery After High-Dose Corticosteroid Therapy

Case Diagnosis: Fibrocartilaginous embolism (FCE) leading to cervical spinal cord infarction.

Case Description: A fit 54-year-old male with well-controlled hyperlipidemia reported acute-onset upper back pain and bilateral upper extremity paresthesias after lifting a bag awkwardly. His exam demonstrated left-sided upper and lower extremity weakness. Initial stroke evaluation, CT/CTA head and neck, and MRI brain were unremarkable. MRI of the cervical spine demonstrated a posterior disc osteophyte complex causing a mild C5–C6 stenosis. Overnight his weakness progressed and he developed urinary retention. Repeat MRI revealed a focal C4–C5 intramedullary lesion with restricted diffusion, consistent with spinal cord ischemia. A thorough workup was negative and the presumed diagnosis was FCE.  High-dose IV corticosteroids were given and the patient quickly demonstrated clinical improvement; left upper and lower extremity strength grossly improved from 0/5 to 4–5/5 within two weeks of presentation.

Discussions: FCE represents a rare but increasingly recognized etiology of spinal cord infarction, typically resulting from extrusion of nucleus pulposus material into spinal vasculature. It should be considered in patients presenting with acute non-compressive myelopathy, especially when onset follows exertion or minor trauma. The diagnostic framework relies on sudden symptom onset, characteristic MRI findings of spinal cord infarction, negative vascular imaging, and exclusion of other causes such as inflammation, infection, or compressive lesions. Although FCE is often associated with a guarded prognosis, our patient experienced substantial recovery after early high-dose IV corticosteroid therapy. The contribution of IV steroids to his recovery remains uncertain and need to be studied further.

Conclusions: This case highlights FCE as an important diagnostic consideration in acute non-compressive myelopathy. Further research is needed to clarify prognostic factors and therapeutic strategies in FCE-related spinal cord infarction.