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

Report of 3 cases

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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.

Abbreviations used in this paper:ASIA = American Spinal Injury Association; DWI = diffusion-weighted imaging; FCE = fibrocartilaginous embolism.

Article Information

Address correspondence to: Andrew Reisner, M.D., 5455 Meridian Mark Road NE, Suite 540, Atlanta, Georgia 30342. email: andrew.reisner@choa.org.

Please include this information when citing this paper: published online February 15, 2013; DOI: 10.3171/2013.1.PEDS12382.

© AANS, except where prohibited by US copyright law.



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    Case 1. A and B: Sagittal (A) and axial (B) T2-weighted MR images obtained at admission. There is C2–T1 central cord hyperintensity localized to the central gray matter. There is diminished signal in the C3–4 disc space. C and D: One-year follow-up sagittal (C) and axial (D) T2-weighted MR images of the cervicothoracic spine revealing cord atrophy and cystic myelomalacia of the spinal cord.

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    Case 2. A and B: Sagittal (A) and axial (B) T2-weighted MR images obtained at admission, revealing spinal cord swelling and hyperintensity from C-1 to T-1. Note the hyperintensity involving the entire cord on axial images. There are diminished signals in multiple disc spaces (C2–3, C4–5, C5–6, and C6–7 spaces). C and D: Follow-up sagittal (C) and axial (D) T2-weighted MR images of the cervicothoracic spine revealing cord atrophy and cystic myelomalacia of the spinal cord.

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    Case 3. A and B: Sagittal (A) and axial (B) T2-weighted MR images obtained at admission, revealing C1–4 spinal cord swelling and hyperintensity involving the anterior and central spinal cord. There is mild kyphosis and diminished signal in the C3–4 disc space. C: Diffusion-weighted image indicating restricted diffusion and infarction. D: Apparent diffusion coefficient map demonstrating restricted diffusion in the cervical cord.



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