815 - Embolism with a Twist: A Rare Case of Spinal Cord Infarct Caused by Fibrocartilaginous Emboli in a Teenage Athlete

A teenage girl is diagnosed with spinal cord infarction from fibrocartilaginous emboli (FCE)

Case Description: A 14-year-old previously healthy female track runner presented to acute care with back pain and bilateral lower extremity paresthesia that progressed to paralysis following lumbar twisting exercises. MRI spine revealed restricted diffusion in the central and anterior gray matter area from T8 to conus, concerning for spinal cord infarction. Autoimmune workup was unremarkable, and screening for myelin oligodendrocyte glycoprotein, neuromyelitis optica, and vasculitis was negative. Although IVIG was administered empirically, neuroradiology confirmed spinal cord infarction secondary to FCE in the setting of physical exertion and trauma. Initial ISNCSCI one week following injury demonstrated T7 AIS B.

Discussions: At time of admission to acute inpatient rehabilitation, functional level for bed mobility was partial/mod, toilet transfer and toileting were substantial/max, lower body dressing was partial/mod, and wheelchair mobility was supervision/touch. Prior to discharge after a two-month intensive therapy program, bed mobility, toilet transfer, toileting, and lower body dressing were independent, and walking 800 feet with KAFO and walker was supervision/touch. She adopted and managed a self-directed bowel and bladder program. She developed hypertonia that progressed, requiring multimodal management. On discharge 14 weeks post-injury, ISNCSCI improved to T10 AIS C. Two weeks later at an intensive outpatient therapy program, her 6-minute walk test with KAFO and walker was 209 feet.

Conclusions: FCE is a rare cause of acute myelopathy due to spinal cord infarction, with no available incidence rates in the medical literature. It is a diagnosis of exclusion and should be especially considered in young, physically active individuals. In this case of a sensory-incomplete spinal cord injury, both motor and sensory function improved during acute rehabilitation. A spinal cord injury rehabilitation program can support this patient population in promoting neurological recovery and improving functional independence.