Last modified: 2014-04-03
Abstract
Introduction: Fibrocartilaginous embolism is a rare cause of spinal cord infarction, caused by an acute vertical disk herniation of the nucleus pulposus material followed by a retrograde embolization to the central artery. Objective: Describe a case of spinal cord infarction after fibrocartilaginous embolism in a teenager admitted in Hospital das Clínicas, SP. Case Description: We present a previously healthy 11-year-old girl with sudden onset of back pain and progressive paraparesis within 24 hours after a fall on her coccyx during roller skating. The patient presented with flaccid paraplegia with anesthesia below T12 level, associated with urinary retention and bowel disfunction, with fecal incontinence. Admission laboratory investigation, cranial TC and cerebrospinal fluid analyses were normal. Spinal magnetic ressonance showed a low medular lesion, between T11 level and the medular cone, with features suggesting ischemic injure. There were also signs of degeneration of the nucleous pulposus between T7-8 and T8-9 and Schmorl's nodes in T12 level, suggesting the etiology of fibrocartilaginous embolism. The patient was discharged after investigation to rehabilitation, maintaining the same neurologic exam. Discussion/Conclusion: The accurate diagnosis of fibrocartilaginous embolic spinal cord infarct is ussually post-mortem. The clinical presentation after an inoccuous trauma, associated with laboratorial exams and neuroimaging are consistent with spinal cord infarct. The increased axial load during trauma with concomitant Schmorl's nodes may embolize to the vascular supply of the spinal cord causing infarction. In cases of paraparesis with no other evidence than trauma, pediatricians should consider the clinical diagnosis of fibrocartilaginous spinal cord infarction.
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References
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