Objective:

To present a rare case of spinal cord infarction secondary to fibrocartilaginous embolism who received Tenecteplase.

Background:

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

Design/Methods:

NA. This research was supported in whole or in part by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the authors and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities

Results:

A 56-year-old male with hypertension presented with acute onset left arm and leg weakness after a Valsalva maneuver. Exam was remarkable for dense flaccid paralysis of left arm and leg. Patient received thrombolytic therapy for suspicion of stroke. MRI C-spine revealed non-enhancing lesion from C2-C5 with diffusion restriction on DWI suggesting spinal infarct. He received five 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, patient endorsed lifting heavy weights and had cervical spondylosis on imaging which led to the diagnosis of fibrocartilaginous embolism. On one-year follow-up, he is walking without support with some motor improvement in distal left upper extremity.

Conclusions:

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. Efficacy of thrombolytic therapy in such cases needs further investigation.