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Neuropediatrics 2024; 55(03): 196-199
DOI: 10.1055/a-2090-5865
Short Communication

Anterior Spinal Artery Syndrome Due to Fibrocartilaginous Embolism—Case Report and Treatment Options

C. Menke
1   Clinic for Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
,
I. Wieland
2   Clinic for Pediatric Oncology and Hematology, Hannover Medical School, Hannover, Germany
,
E. Bueltmann
3   Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
,
S. Illsinger
1   Clinic for Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
,
H. Hartmann
1   Clinic for Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
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Abstract

Acute occlusion of the anterior spinal artery and subsequent spinal ischemic infarction leads to anterior spinal artery syndrome characterized by back pain and bilateral flaccid paresis with loss of protopathic sensibility. As a rare cause fibrocartilaginous embolism has been described and is associated with sports or unusual strain.

Following gymnastic exercise the day before symptom-onset, a 11 years old girl presented with neck pain, paresis of arms and legs, and impaired deep tendon reflexes. She was unable to lift her arms, grasp, stand, walk and had urinary incontinence. Magnetic resonance imaging revealed a longitudinal T2 hyperintense signal in the anterior spinal cord from C3 to C6 with accompanying bilateral diffusion restriction involving gray matter bilaterally at the level of C4 and C5 and unilaterally at the level of C3/4. The adjacent annulus fibrosus of the intervertebral disc showed a fissure without disc protrusion. Treatment with prednisolone and enoxaparin was started within 12 hours of symptom-onset and continued over 6 days and 8 weeks, respectively. After 2 months, her motor function gradually improved, spinal imaging showed persistent T2 signal hyperintense defects at the level of C4/5. After 5 months, there was only slight impairment affecting elevation and abduction of the right arm.

Following physical exercise, the patient suffered from acute anterior spinal cord ischemia with imaging findings in line with a presumed fibrocartilaginous embolism. Unlike most cases, our patient showed almost complete recovery following treatment with prednisolone and enoxaparin. We speculate that the positive outcome is related to rapid treatment initiation.

Keywords

anterior spinal artery syndrome - fibrocartilaginous embolism - minor trauma


Publikationsverlauf

Eingereicht: 09. Februar 2023

Angenommen: 05. Mai 2023

Accepted Manuscript online:
10. Mai 2023

Artikel online veröffentlicht:
17. Juni 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Pikija S, Mutzenbach JS, Kunz AB. et al. Delayed hospital presentation and neuroimaging in non-surgical spinal cord infarction. Front Neurol 2017; 8: 143 DOI: 10.3389/fneur.2017.00143. [doi]
    CrossrefPubMedGoogle Scholar
  • 2 Hakimi KN, Massagli TL. Anterior spinal artery syndrome in two children with genetic thrombotic disorders. J Spinal Cord Med 2005; 28 (01) 69-73
    CrossrefPubMedGoogle Scholar
  • 3 Raventhiranathan N, Petropoulou K, Sakonju A, Bakrukov D, Mirchia K. Pediatric fibrocartilaginous spine embolism induced by trauma. Radiol Case Rep 2021; 16 (08) 1951-1955
    CrossrefPubMedGoogle Scholar
  • 4 Cheshire WP, Santos CC, Massey EW, Howard Jr JF. Spinal cord infarction: etiology and outcome. Neurology 1996; 47 (02) 321-330
    CrossrefPubMedGoogle Scholar
  • 5 Fockaert N, De Temmerman G, Couvreur F. Spinal cord infarction due to fibrocartilaginous embolism. Acta Neurol Belg 2020; 120 (04) 1021-1023
    CrossrefPubMedGoogle Scholar
  • 6 Karlin A, Vossough A, Agarwal S, Jacobwitz MN, Virupakshaiah A, Beslow LA. Spinal cord infarct due to fibrocartilaginous embolism. Neuropediatrics 2021; 52 (03) 224-225
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 7 Ahluwalia R, Hayes L, Chandra T, Maugans TA. Pediatric fibrocartilaginous embolism inducing paralysis. Childs Nerv Syst 2020; 36 (02) 441-446
    CrossrefPubMedGoogle Scholar
  • 8 Feigin I, Popoff N, Adachi M. Fibrocartilaginous venous emboli to the spinal cord with necrotic myelopathy. J Neuropathol Exp Neurol 1965; 24: 63-74
    CrossrefPubMedGoogle Scholar
  • 9 Mikulis DJ, Ogilvy CS, McKee A, Davis KR, Ojeman RG. Spinal cord infarction and fibrocartilaginous emboli. AJNR Am J Neuroradiol 1992; 13 (01) 155-160
    PubMedGoogle Scholar
  • 10 AbdelRazek MA, Mowla A, Farooq S, Silvestri N, Sawyer R, Wolfe G. Fibrocartilaginous embolism: a comprehensive review of an under-studied cause of spinal cord infarction and proposed diagnostic criteria. J Spinal Cord Med 2016; 39 (02) 146-154
    CrossrefPubMedGoogle Scholar
  • 11 Al-Farsi SA, Al-Abri H, Al-Ajmi E, Al-Asmi A. Spinal cord infarct due to fibrocartilaginous embolism in an adolescent boy: a case report and literature review. Cureus 2023; 15 (04) e37319 DOI: 10.7759/cureus.37319.
    CrossrefPubMedGoogle Scholar
  • 12 Shah S, Bryant P. Fibrocartilaginous emboli in the pediatric population: the role of rehabilitation in facilitating functional recovery. J Pediatr Rehabil Med 2018; 11 (01) 53-56
    CrossrefPubMedGoogle Scholar