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Fibrocartilagenous embolism case series: is it a zebra?
Christina Draganich1, Lisa R Wenzel2,3
1Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA. Christina.Draganich@cuanschutz.edu.
Introduction:
There have been 30 clinically suspected cases and 41 histopathologically confirmed cases of fibrocartilaginous embolism (FCE) reported in the literature. FCE often has a poor prognosis and is estimated to represent 5.5% of spinal cord infarctions, but may be more common than initially presumed given underdiagnosis due to its vague clinical presentation.
Case Presentation:
We report two cases, a 15-year-old male and a 15-year-old female, whose clinical history, examination, and imaging findings were consistent with spinal cord infarction secondary to FCE.
Discussion:
These cases were unique given our patients' neurologic improvement; however, the commonly held assumption of poor prognosis may in part be fueled by the preferential case ascertainment via biopsy on autopsy. These cases highlight the importance of recognizing rare causes of spinal cord pathology and considering FCE in the differential diagnosis of acute myelopathy.
Insights
Fibrocartilaginous embolism (FCE) can cause spinal cord infarction, often with poor outcomes. However, this report details two unique cases of adolescent FCE with significant neurologic improvement, challenging assumptions about prognosis.
Area of Science:
- Neurology
- Pathology
Background:
- Fibrocartilaginous embolism (FCE) is a rare cause of spinal cord infarction.
- FCE is often associated with a poor prognosis and may be underdiagnosed due to its nonspecific clinical presentation.
Observation:
- This report presents two cases of adolescent spinal cord infarction secondary to FCE.
- The patients, a 15-year-old male and a 15-year-old female, exhibited clinical, examination, and imaging findings consistent with FCE.
Findings:
- Unlike the typical poor prognosis associated with FCE, both patients demonstrated significant neurologic improvement.
- This suggests that the assumption of universally poor outcomes may be influenced by ascertainment bias, with cases diagnosed post-mortem potentially skewing the perceived prognosis.
Implications:
- These cases underscore the importance of considering FCE in the differential diagnosis of acute myelopathy, even in young patients.
- Recognizing FCE as a potential cause of spinal cord infarction is crucial for appropriate management and highlights the possibility of recovery.
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