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[Acute paraplegia due to embolism from nucleus pulposus tissue (author's transl)]
Abstract:
Typical anterior spinal artery syndrome with initially severe pain and paraplegia with sensory disturbances occurred after a fall in a 36-year-old man with a history of lumbago. Multiple emboli of fibrocartilaginous material with nucleus pulposus cells were found in the foci of myelomalacia. The embolism of nucleus pulposus tissue originating from Schmorl's nodules was probably carried via the blood vessels of the neighbouring vertebral bodies with retrograde flow through the perispinal venous plexus into spinal cord veins and hence into the arteries of the spinal cord via veno-arterial anastomoses. A transitory increase in intra-abdominal pressure was probably the cause of the inversion of venous flow.
Insights
A fall caused spinal artery syndrome in a man, leading to severe pain and paraplegia. Nucleus pulposus emboli from Schmorl's nodules likely caused the spinal cord damage.
Area of Science:
- Neurology
- Spinal Cord Medicine
- Vascular Surgery
Background:
- Anterior spinal artery syndrome (ASAS) can result from various causes, including emboli.
- Schmorl's nodules are common findings, but their role in spinal cord infarction is rarely described.
Observation:
- A 36-year-old man with a history of lumbago experienced acute paraplegia and severe pain after a fall.
- Imaging revealed multiple emboli of fibrocartilaginous material containing nucleus pulposus cells within areas of myelomalacia in the spinal cord.
Findings:
- The study identified nucleus pulposus tissue emboli, likely originating from Schmorl's nodules, as the cause of spinal cord infarction.
- A retrograde flow mechanism through vertebral body vessels, perispinal venous plexus, and veno-arterial anastomoses was proposed for the embolism.
- Transient increases in intra-abdominal pressure following the fall were hypothesized to induce venous flow inversion, facilitating embolism.
Implications:
- This case highlights a rare but potential cause of spinal cord infarction.
- Understanding this mechanism can aid in diagnosing and managing similar neurological emergencies.
- The findings emphasize the importance of considering less common embolic sources in spinal cord injury.