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Genetic and Rare Diseases Information Center (GARD)

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Fibrocartilaginous embolism


Other Names for this Disease
  • Embolism, fibrocartilaginous
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Your Question

I had a spinal cord stroke this past summer. My neurologist thinks it may have been a fibrocartilaginous embolism. What might I expect? Will this happen to me again? What is the amount of recovery on average with this type of injury and what caused it?

Our Answer

We have identified the following information that we hope you find helpful. If you still have questions, please contact us.

What causes a fibrocartilaginous embolism?

Fibrocartilaginous embolism (FCE) is a rare cause of spinal cord infarction (stroke). It is thought that a sudden vertical disk herniation of the nucleus pulposus material can lead to spinal cord infarction by backward movement of the material, disrupting the vascular supply and causing embolization in the artery.[1] Conditions resulting in high internal pressure, such as a Valsalva maneuver or trauma, may permit the abnormal backwards flow.[2] Some individuals have reported lifting, physical exertion, minor trauma, or Valsalva maneuver before severe spinal cord infarction.[2]
Last updated: 3/24/2011

How is fibrocartilaginous embolism diagnosed?

Initially, all cases of fibrocartilaginous embolism (FCE) were discovered at autopsy. In 1991, the first diagnosis of FCE was made in a patient who survived. Although there are no formal diagnostic criteria for FCE in a living individual, a number of authors have suggested specific features that make the diagnosis likely. These include minor trauma before the event, absence of vascular risk factors, spinal cord imaging consistent with an evolving infarction, normal cerebrospinal fluid (CSF) analysis, and the exclusion of other possible causes.[2]
Last updated: 3/24/2011

How might fibrocartilaginous embolism be treated?

Unfortunately, there is no cure for the symptoms associated with this condition. Common treatments for fibrocartilaginous embolism (FCE) have included intravenous steroids, intravenous heparin, and plasma exchange. However, no treatment has had a recognized impact on symptoms. The possibility that these treatments may have prevented further worsening or recurrence may still be considered.[2]
Last updated: 3/24/2011

What is the general prognosis for an individual who has had a fibrocartilaginous embolism?

A review of available resources yields little information about the avergage length or extent of recovery for an individual who has had a fibrocartilaginous embolism (FCE). Current understanding of FCE is based on case reports, nearly all discovered at autopsy; therefore, the prognosis of FCE may seem overwhelmingly pessimistic.[2]

In a 2011 article in the European Journal of Neurology, the authors discuss the characteristics and outcome of nine individuals suspected of having a diagnosis of FCE. The onset of symptoms occurred within six hours of a recognized precipitating event most individuals (such as motor vehicle accident without recognized back injury, heavy lifting, physical exertion, and bending over), with the range being immediate onset of symptoms to 15 hours. The time from symptom onset to maximal weakness was 4 hours or less in eight individuals, and less than 12 hours in all of them. Back or neck pain was a common initial symptom in six individuals and was accompanied by radiating pain in three individuals.[2]

All but one of the individuals in this study received varying doses of intravenous (IV) steroids, all without any noticeable improvement of symptoms. Four individuals also received plasma exchange, also without meaningful improvement. Other treatments, including IV heparin, a 4-day course of daily IV immunoglobulin, and emergent anterior spinal decompressive surgery, were all similarly unsuccessful.[2]

In this study, the outcomes for the individuals varied from moderate to severe disability. None of the individuals in this study have died, nor have they had repeat events to the authors' knowledge.[2]
Last updated: 3/24/2011

References
  • Han JJ, Massagli TL, Jaffe KM.. Fibrocartilaginous embolism--an uncommon cause of spinal cord infarction: a case report and review of the literature. Archives of Physical Medincine and Rehabilitation. January 2004; 85(1):153-157. http://www.ncbi.nlm.nih.gov/pubmed/14970983. Accessed 3/23/2011.
  • F. J. Mateena,b, P. A. Monradb, A. N. Leep Hunderfundb, C. E. Robertsonb and E. J. Sorenson. Clinically suspected fibrocartilaginous embolism: clinical characteristics, treatments, and outcomes. European Journal of Neurology. 2011; 18:218-225.