Severe spinal cord ischemia subsequent to fibrocartilaginous embolism

Fibrocartilaginous embolism is a rare cause of spinal cord ischemia. Here we report the case of a young previously healthy man who noted sudden thoracic spinal belt-like pain after intensive physical effort. Following a free interval he developed paraplegia, complete sensory loss below Th(4) and inability to voluntarily purge bladder and bowel. Neuroimaging exposed an intramedullary longitudinal hyperintense signal from C(6) down to the conus in T2-weighted images, intersomatic disc collapses and vertebral body infarctions (C(5-7)/Th(8-10)). Other plausible diagnosis, e.g. spinal contusion, cord compression or acute onset transverse myelitis were excluded. Altogether, clinical presentation, neuroimaging and lack of evidence of other plausible diagnosis suggest fibrocartilaginous embolism as the most probable diagnosis.