Fibrocartilaginous Venous and Arterial Emboli from the <i>Nucleus pulposus </i>in the Anterior Spinal System

Abstract

The authors describe the case of an elderly woman exhibiting the clinical signs of occlusion of the anterior spinal artery at the cervical level. Pathological findings indicate that the material occluding not only this vessel but also the satellite veins is fibrocartilage. The authors review the literature concerning this unusual situation and discuss the mechanism by which the fibrocartilaginous emboli, in their case, are both arterial and venous. Large arteriovenous shunts within and around the spinal cord are likely to explain such a disturbing pathologic finding.

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

“…15,17,24,36,38,39 • Despite the rarity of the overall reported cases in the literature, there are several incidents where multiple tissue confirmed cases are reported by the same team. 10,[16][17][18]27,28,32 This supports the theory suggesting that when a clinical familiarity with the diagnosis of FCE is present, it is more commonly and accurately diagnosed. • There have been reports of incidentally found FCE in the spinal cord vasculature on autopsy.…”

Fatal embolism of the anterior spinal artery after local cervical analgetic infiltration

“…The causes for occlusion of the anterior spinal artery are analogous to those leading to occlusions of blood vessels in other anatomical regions (coagulatory disorders, cardiac embolic events, trauma of blood vessels, degeneration of blood vessels) [2]. Moreover, a number of cases have been described in the past [1,2,[4][5][6][7][8][9] in which fibrocartilaginous material was discovered post-mortally in the anterior spinal artery, leading to obstruction or occlusion of this vessel. However, no morphological mechanism could be proven as being responsible for the deposit of fibrocartilaginous material in the lumen of the artery in any of these cases.…”

Spinal cord infarction secondary to nucleus pulposus embolization in pregnancy

“…The clinical history preceding the onset of symptoms was variable in the reported cases, including falls, symptoms on awakening from sleep, and in some cases the onset is sudden with no identifiable antecedant. 2,[6][7][8][9][10][11][12] How the disc material enters into the vascular system is not clear, and many theories have been proposed. The blood supply to the spinal cord is characterized by an extensive network of epidural arteriovenous anastomoses, as demonstrated by postmortem intravascular injection of gelatinated ink.…”