Diagnosing Fibrocartilaginous Embolism: A Rare Cause of Acute Myelopathy (A Case Series)

Fibrocartilaginous embolism (FCE) is a rarely reported cause of myelopathy. Diagnosis of FCE has typically been made by post-mortem diagnosis. Ante-mortem reports of FCE are rare. Fibrocartilaginous ebmilosim is considered to result from a complication of elevated intervertebral disk pressure, causing a nucleus pulpulsus embolus into the vascular supply of the spinal cord resulting in motor, sensory and autonomic dysfunction. Presently, a definitive diagnosis of FCE requires histological confirmation. This requirement may result in under representation of the true number of cases. A clinical set of suggested criteria may broaden the clinical understanding and outcome of this disorder, which is presently considered fatal. Diagnostic criteria for FCE would provide early diagnosis and perhaps a therapeutic window during which patients would benefit most from treatment option.

In this retrospective review study, we will review cases of FCE proven by histology and published in the literature. From these reports and with knowledge of the pathophysiology of FCE, we will generate a set of clinical criteria that best describes this cohort of patients as well as distinctly separates them from other non inflamatory and compressive causes of myelopathy. We will then apply these criteria to cases of non-inflamatory and non-compressive myelopathy seen in the Johns Hopkins Transverse Myelitis Center to identify possible cases of FCE. From this identified cohort of patients, we will aim at describing a set of clinical and para-clinical characteristics of FCE based on our review of the literature and clinical experience. This will allow a broader understanding of different outcomes of FCE, and help standardize the guidelines for clinical suspicion and treatment.