Spinal Cord Infarction Due to Fibrocartilaginous Embolization: The Role of Diffusion Weighted Imaging and Short-Tau Inversion Recovery Sequences

Fibrocartilaginous embolization is a rare cause of ischemic myelopathy caused by embolization of intersomatic disk nucleus pulposus into spinal vasculature during Valsalva-like maneuvers. Diagnostic criteria are based on patient’s clinical history, magnetic resonance evidence of T2-hyperintense spin...

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Bibliographic Details
Published in:Journal of child neurology 2010-08, Vol.25 (8), p.1024-1028
Main Authors: Manara, Renzo, Calderone, Milena, Severino, Maria Savina, Citton, Valentina, Toldo, Irene, Laverda, Anna Maria, Sartori, Stefano
Format: Article
Language:English
Subjects:
Adolescent
Child
Diffusion Magnetic Resonance Imaging - methods
Embolism - etiology
Embolism - pathology
Embolism - physiopathology
Female
Fibrocartilage - pathology
Fibrocartilage - physiopathology
Humans
Intervertebral Disc - pathology
Intervertebral Disc - physiopathology
Male
Neural Pathways - blood supply
Neural Pathways - pathology
Neural Pathways - physiopathology
Predictive Value of Tests
Prognosis
Spinal Cord - blood supply
Spinal Cord - pathology
Spinal Cord - physiopathology
Spinal Cord Ischemia - etiology
Spinal Cord Ischemia - pathology
Spinal Cord Ischemia - physiopathology
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Summary:Fibrocartilaginous embolization is a rare cause of ischemic myelopathy caused by embolization of intersomatic disk nucleus pulposus into spinal vasculature during Valsalva-like maneuvers. Diagnostic criteria are based on patient’s clinical history, magnetic resonance evidence of T2-hyperintense spinal cord lesion, and exclusion of other causes of ischemic myelopathy. These criteria do not take into account the development of magnetic resonance techniques able to enhance signal abnormalities within the neighboring intersomatic disc or vertebral body and to early characterize central nervous system lesions according to the presence of cytotoxic edema. We present 2 pediatric cases of progressive paraplegia attributed to fibrocartilaginous embolization in which short-tau inversion recovery and diffusion-weighted imaging sequences played a pivotal role showing the ischemic nature of spinal cord lesions. Due to its specificity, diffusion-weighted imaging should be included in the magnetic resonance criteria of fibrocartilaginous embolization and in standard magnetic resonance analysis when dealing with acute transverse myelopathy.
ISSN:0883-0738
1708-8283
DOI:10.1177/0883073809355822