Acute Spinal Cord Infarct Secondary to Fibrocartilaginous Embolism Treated With Tenecteplase

Fibrocartilaginous embolism is a rare cause of spinal cord infarction. It can affect young healthy adults during physical exertion or the Valsalva maneuver. There is little evidence behind a fibrocartilaginous embolism causing spinal cord infarctions. The efficacy of thrombolytic therapy in spinal cord infarction is not well established.

A 56-year-old male with hypertension presented with acute onset left arm and leg weakness after a Valsalva maneuver. The exam was remarkable for dense flaccid paralysis of the left arm and leg. Patient received thrombolytic therapy for suspicion of stroke. MRI C-spine revealed a nonenhancing lesion from C2 to C5 with diffusion restriction on DWI, suggesting a spinal infarct. He received 5 days of high-dose steroids with mild improvement of left lower extremity weakness. Labs were unremarkable for underlying inflammatory or demyelinating causes of myelopathy. We ruled out aortic dissection and cardioembolic causes. Upon further evaluation, the patient endorsed lifting heavy weights and had cervical spondylosis on imaging, which led to the diagnosis of fibrocartilaginous embolism. On 1-year follow-up, he is walking without support with some motor improvement in the distal left upper extremity.

It is important to have a wide differential diagnosis in acute cases of myelopathy. In our patient's case, his diagnosis was one of exclusion. This case highlights a rare cause of spinal cord infarction in a middle-aged man. The efficacy of thrombolytic therapy in such cases needs further investigation.