Acute-onset nontraumatic paraplegia in childhood : fibrocartilaginous embolism or acute myelitis ?

Fibrocartilaginous embolus causing acute spinal cord infarction is a rare cause of acute-onset paraplegia or quadriplegia. Few cases of survivors have been reported in the neurosurgical literature, with most reports involving postmortem or biopsy findings. There is little information on MRI findings...

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Bibliographic Details
Published in:Child's nervous system 2000-09, Vol.16 (9), p.551-554
Main Authors: DAVIS, Gavin A, KLUG, Geoffrey L
Format: Article
Language:English
Subjects:
Acute Disease
Biological and medical sciences
Cartilage
Child
Diagnosis, Differential
Embolism - complications
Embolism - diagnosis
Female
Humans
Infarction - diagnosis
Infarction - etiology
Magnetic Resonance Imaging
Medical sciences
Myelitis - diagnosis
Neurology
Paraplegia - etiology
Spinal Cord - blood supply
Spinal Cord - pathology
Vascular diseases and vascular malformations of the nervous system
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Summary:Fibrocartilaginous embolus causing acute spinal cord infarction is a rare cause of acute-onset paraplegia or quadriplegia. Few cases of survivors have been reported in the neurosurgical literature, with most reports involving postmortem or biopsy findings. There is little information on MRI findings in such patients. We present the youngest patient ever reported, and discuss the important differences between fibrocartilaginous embolus and acute myelitis of childhood. A 6-year-old girl with a history of back pain presented with sudden-onset nontraumatic paraplegia, with a clinical anterior spinal artery syndrome. Initial MRI scan revealed intervertebral disc disease at L1-2 and an incidental thoracic syrinx, but no cause for her acute-onset paraplegia was identified. Cerebrospinal fluid and other investigations were all negative. Sequential MRI scans revealed development of spinal cord expansion from T10 to the conus medullaris, with increased cord signal in the anterior aspect of the spinal cord. The intervertebral disc disease was unchanged. The imaging and clinical findings were caused by fibrocartilaginous embolus, which meant there was no need for spinal cord biopsy. The report describes the clinical and imaging criteria for diagnosis of fibrocartilaginous embolus, highlighting the case for avoiding an unnecessary biopsy. The clinical pattern in the paediatric group is discussed, with features differentiating it from acute myelitis of childhood.
ISSN:0256-7040
1433-0350
DOI:10.1007/s003810000268