Successful management of spinal cord ischemia in a pediatric patient with fibrocartilaginous embolism: illustrative case

Augustinas Fedaravičius, Yael Feinstein, Isaac Lazar, Micky Gidon, Ilan Shelef, Elad Avraham, Arimantas Tamašauskas, Israel Melamed

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

BACKGROUND Fibrocartilaginous embolism (FCE) is a rare cause of ischemic myelopathy that occurs when the material of the nucleus pulposus migrates into vessels supplying the spinal cord. The authors presented a case of pediatric FCE that was successfully managed by adapting evidence-based recommendations used for spinal cord neuroprotection in aortic surgery. OBSERVATIONS A 7-year-old boy presented to the emergency department with acute quadriplegia and hemodynamic instability that quickly progressed to cardiac arrest. After stabilization, the patient regained consciousness but remained in a locked-in state with no spontaneous breathing. The patient presented a diagnostic challenge. Traumatic, inflammatory, infectious, and ischemic etiologies were considered. Eventually, the clinical and radiological findings led to the presumed diagnosis of FCE. Treatment with continuous cerebrospinal fluid drainage (CSFD), pulse steroids, and mean arterial pressure augmentation was applied, with subsequent considerable and consistent neurological improvement. LESSONS The authors proposed consideration of the adaptation of spinal cord neuroprotection principles used routinely in aortic surgery for the management of traumatic spinal cord ischemia (FCE-related in particular), namely, permissive arterial hypertension and CSFD. This is hypothesizedto allow for the maintenance of sufficient spinal cord perfusion until adequate physiological blood perfusion is reestablished (remodeling of the collateral arterial network and/or clearing/absorption of the emboli).

Original languageEnglish
Article numberCASE21380
JournalJournal of Neurosurgery: Case Lessons
Volume2
Issue number11
DOIs
StatePublished - 1 Sep 2021
Externally publishedYes

Keywords

  • fibrocartilaginous embolism
  • spinal cord ischemia
  • spinal cord perfusion pressure

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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