Spinal cord infarction following minor trauma in children: fibrocartilaginous embolism as a putative cause

Abstract

<jats:p>Spinal cord infarctions following seemingly innocuous trauma in children are rare, devastating events. In the majority of these cases, the pathophysiology is enigmatic. The authors present 3 cases of pediatric spinal cord infarction that followed minor trauma. An analysis of the clinical, radiographic, and laboratory features of these cases suggests that thromboembolism of the nucleus pulposus into the spinal cord microcirculation is the likely mechanism. A review of the human and veterinary literature supports this notion. To the authors' knowledge, this is the largest pediatric series of myelopathy due to thromboembolism of the nucleus pulposus reported to date, and it is the first report of this condition occurring in an infant.</jats:p>

Posterior Spinal Cord Infarction Due to Fibrocartilaginous Embolization in a 16-Year-Old Athlete

“…10 In pediatrics, it is most often reported in teenagers, 7,10-12 but notable cases of presumed FCE in young children include a 6-year-old gymnast 13 and an 8-month-old infant who fell from a changing table. 14 Postmortem biopsies have showed fibrocartilaginous material in spinal cord vasculature (arterioles and venules); however, the exact mechanism through which emboli enter remains unclear. Several mechanisms have been proposed.…”

Fibrocartilaginous embolism: a comprehensive review of an under-studied cause of spinal cord infarction and proposed diagnostic criteria

“…48,49 MRI of the cord in spinal cord infarctions typically show T2 hyper-intense lesions in a vascular distribution, and unlike those of an inflammatory cord lesion, they typically do not enhance with gadolinium and also can be delayed for 12-48 hours from symptom onset. 50 They can also be pathognomonicaly associated with similar radiologic changes in the posterior aspect of the opposing vertebral body, 51 due to a common blood supply. In FCE, these spinal cord MRI findings are often times opposite a Schmorl's node or a disc protrusion (Figure 2).…”

Spinal Cord Ischemia: Practical Imaging Tips, Pearls, and Pitfalls

“…In children, minor trauma is a cause of ischemia related to fibrocartilage emboli 18 and also spasm. Other origins include complications of cardiac surgery or traction for scoliosis after orthopedic surgery, 19 sickle cell anemia, and umbilical artery catheter in the neonate.…”