Acute asymmetrical spinal infarct secondary to fibrocartilaginous embolism

Rengarajan, Balaji; Venkateswaran, Sunita; McMillan, Hugh J.

doi:10.1007/s00381-014-2562-9

Cited by 17 publications

(15 citation statements)

References 14 publications

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“…Patients usually experience sudden back pain with subsequent onset of rapid neurologic deterioration. 18 FCE most often affects the anterior spinal artery territory. Typically, MRI demonstrates T2 hyperintense area that is linear or pencillike and extending multiple spinal levels.…”

Section: Discussionmentioning

confidence: 99%

Presumed Arterial Gas Embolism After Breath-Hold Diving in Shallow Water

Harmsen¹,

Schramm²,

Karenfort³

et al. 2015

Pediatrics

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Dive-related injuries are relatively common, but almost exclusively occur in recreational or scuba diving. We report 2 children with acute central nervous system complications after breath-hold diving. A 12-year-old boy presented with unilateral leg weakness and paresthesia after diving beneath the water surface for a distance of ∼25 m. After ascent, he suddenly felt extreme thoracic pain that resolved spontaneously. Neurologic examination revealed right leg weakness and sensory deficits with a sensory level at T5. Spinal MRI revealed a nonenhancing T2-hyperintense lesion in the central cord at the level of T1/T2 suggesting a spinal cord edema. A few weeks later, a 13-year-old girl was admitted with acute dizziness, personality changes, confusion, and headache. Thirty minutes before, she had practiced diving beneath the water surface for a distance of ∼25 m. After stepping out, she felt sudden severe thoracic pain and lost consciousness. Shortly later she reported headache and vertigo, and numbness of the complete left side of her body. Neurologic examination revealed reduced sensibility to all modalities, a positive Romberg test, and vertigo. Cerebral MRI revealed no pathologic findings. Both children experienced a strikingly similar clinical course. The chronology of events strongly suggests that both patients were suffering from arterial gas embolism. This condition has been reported for the first time to occur in children after breath-hold diving beneath the water surface without glossopharyngeal insufflation.Dive-related injuries are relatively common and mostly occur in recreational or scuba diving. Decompression illness (DCI) is a term used to describe illness resulting from a reduction in the ambient pressure surrounding the body. DCI encompasses decompression sickness (DCS) and arterial gas embolism (AGE). 1 When severe diving injury occurs, the nervous system is frequently involved. 2 We report 2 children with central nervous system complications after breath-hold diving in shallow water. CASE REPORTS Patient 1A previously healthy 12-year-old boy presented with unilateral leg weakness and paresthesia. Two days earlier, he had practiced repeated diving beneath the water surface for a distance of 25 m. He reports that, after ascent, he suddenly felt extreme thoracic pain that resolved spontaneously. During the following hours, he subsequently experienced progressive sensory changes affecting his right side. This was followed by acute right leg weakness later the same day. A cerebral and lumbar spinal MRI that was ordered by the community neurologist on the next day was reported normal and he was discharged from the hospital. Two days later, the patient was referred to our hospital with persistent right leg weakness and paresthesia and an inability to walk. Neurologic examination revealed right leg weakness and sensory deficits with

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Section: Discussionmentioning

confidence: 99%

Presumed Arterial Gas Embolism After Breath-Hold Diving in Shallow Water

Harmsen¹,

Schramm²,

Karenfort³

et al. 2015

Pediatrics

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“…years of age, including our case, were reviewed [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] .…”

Section: Case Descriptionmentioning

confidence: 99%

Fibrocartilaginous Embolism of the Spinal Cord in Children: A Case Report and Review of Literature

Yamaguchi

Nagase

Nishiyama

et al. 2019

Pediatric Neurology

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Fibrocartilaginous embolism (FCE) is assumed to be caused by the migration of fibrocartilaginous nucleus pulposus components through retrograde embolization to the spinal cord artery. FCE is currently not well recognized among pediatricians due to its rarity. We present the case of a previously healthy 15-year-old soccer player who, after kicking a ball, developed progressive weakness in both legs and ischuria the next day. Magnetic resonance imaging revealed T2 hyperintensity in the anterior horn of the spinal cord at the Th12/L1 level with Schmorl's node at the level of L1/2. We also reviewed previous literature of FCE of the spinal cord in children (<18 years of age), and a total of 25 pediatric patients, including our case, were reviewed. The median age was 14 years and 64% of the reviewed patients were female. The most common trigger event was intense exercise or sports (52%). The neurological symptoms started within 1 day in most cases and time to symptom peak varied from a few hours to 2 weeks. The most common initial neurologic symptoms were weakness or plegia (100%), followed by paresthesia or numbness (44%). Affected areas of the spinal cord were distributed evenly from the cervical to thoracolumbar regions. Although steroids and anticoagulants were most commonly used, the prognosis was quite poor (mostly mild to severe sequelae and 3 patients died). Although FCE is a very rare condition, pediatricians should be aware of the characteristics and include FCE of the spinal cord in their differential diagnosis, especially for physically active patients.

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“…Uncommon posttraumatic intramedullary disorders include ischemic myelopathy from arterial compromise or venous hypertension from fibrocartilagenous embolus. 19 Patients with anterior spinal artery occlusion present with deficits localized to the territory of the anterior two-thirds of the cord.…”

Section: Differential Diagnosis and Evaluationmentioning

confidence: 99%

Pediatric transverse myelitis

et al. 2016

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Pediatric acute transverse myelitis (ATM) is an immune-mediated CNS disorder and contributes to 20% of children experiencing a first acquired demyelinating syndrome (ADS). ATM must be differentiated from other presentations of myelopathy and may be the first presentation of relapsing ADS such as neuromyelitis optica (NMO) or multiple sclerosis (MS). The tenets of the diagnostic criteria for ATM established by the Transverse Myelitis Consortium Working Group can generally be applied in children; however, a clear sensory level may not be evident in some. MRI lesions are often centrally located with high T2 signal intensity involving gray and neighboring white matter. Longitudinally extensive ATM occurs in the majority. Asymptomatic lesions on brain MRI are seen in more than one-third and predict MS or NMO. The role of antibodies such as myelin oligodendrocyte glycoprotein in monophasic and relapsing ATM and their significance in therapeutic approaches remain unclear. ATM is a potentially devastating condition with variable outcome and presents significant cumulative demands on health and social care resources. Children generally have a better outcome than adults, with one-half making a complete recovery by 2 years. There is need for standardization of clinical assessment and investigation protocols to enable international collaborative studies to delineate prognostic factors for disability and relapse. There are no robust controlled trials in children or adults to inform optimal treatment of ATM, with one study currently open to recruitment. This review provides an overview of current knowledge of clinical features, investigative workup, pathogenesis, and management of ATM and suggests future directions. Neurology ® 2016;87 (Suppl 2):S46-S52 GLOSSARY ADS 5 acquired demyelinating syndrome; AFM 5 acute flaccid myelitis; AQP4 5 aquaporin-4; ASIA 5 American Spinal Injury Association; ATM 5 acute transverse myelitis; GBS 5 Guillain-Barré syndrome; IL 5 interleukin; IVIg 5 IV immunoglobulin; LETM 5 longitudinally extensive TM; MOG 5 myelin oligodendrocyte glycoprotein; MS 5 multiple sclerosis; NMO 5 neuromyelitis optica; PLEX 5 plasmapheresis; SLE 5 systemic lupus erythematosus; TMCWG 5 Transverse Myelitis Consortium Working Group.Pediatric acute transverse myelitis (ATM) is an immune-mediated CNS disorder classically described as demyelinating. ATM comprises a subgroup of the noncompressive transverse myelopathies.1,2 It is a potentially devastating condition with variable outcome. 3 ATM must be differentiated from other, rarer presentations of noncompressive myelopathy.4,5 ATM may be the first presentation of relapsing acquired demyelinating syndromes (ADS) such as neuromyelitis optica (NMO) or multiple sclerosis (MS). A PubMed search using the terms "pediatric or paediatric transverse myelitis" revealed that more than 200 articles have been published in English on the topic between 1976 and 2015. In this article we discuss current knowledge on clinical features, pathogenesis, and investigative and management ...

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Acute asymmetrical spinal infarct secondary to fibrocartilaginous embolism

Abstract: We outline the key clinical and radiographic features that enable spinal cord infarction to be differentiated from transverse myelitis. Prognosis depends on many factors such as extent and type of injury, level of the cord affected, and age at the time of spinal cord infarction.

Cited by 17 publications

References 14 publications

Presumed Arterial Gas Embolism After Breath-Hold Diving in Shallow Water

Presumed Arterial Gas Embolism After Breath-Hold Diving in Shallow Water

Fibrocartilaginous Embolism of the Spinal Cord in Children: A Case Report and Review of Literature

Pediatric transverse myelitis

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