Davis G A, Klug G L
Department of Neurosurgery, Royal Children's Hospital, Victoria, Australia.
Childs Nerv Syst. 2000 Sep;16(9):551-4. doi: 10.1007/s003810000268.
Fibrocartilaginous embolus causing acute spinal cord infarction is a rare cause of acute-onset paraplegia or quadriplegia. Few cases of survivors have been reported in the neurosurgical literature, with most reports involving postmortem or biopsy findings. There is little information on MRI findings in such patients. We present the youngest patient ever reported, and discuss the important differences between fibrocartilaginous embolus and acute myelitis of childhood. A 6-year-old girl with a history of back pain presented with sudden-onset nontraumatic paraplegia, with a clinical anterior spinal artery syndrome. Initial MRI scan revealed intervertebral disc disease at L1-2 and an incidental thoracic syrinx, but no cause for her acute-onset paraplegia was identified. Cerebrospinal fluid and other investigations were all negative. Sequential MRI scans revealed development of spinal cord expansion from T10 to the conus medullaris, with increased cord signal in the anterior aspect of the spinal cord. The intervertebral disc disease was unchanged. The imaging and clinical findings were caused by fibrocartilaginous embolus, which meant there was no need for spinal cord biopsy. The report describes the clinical and imaging criteria for diagnosis of fibrocartilaginous embolus, highlighting the case for avoiding an unnecessary biopsy. The clinical pattern in the paediatric group is discussed, with features differentiating it from acute myelitis of childhood.
纤维软骨栓子导致急性脊髓梗死是急性发作性截瘫或四肢瘫的罕见原因。神经外科文献中报道的幸存者病例很少，大多数报道涉及尸检或活检结果。关于此类患者的MRI表现的信息很少。我们报告了有史以来最年轻的患者，并讨论了纤维软骨栓子与儿童急性脊髓炎之间的重要差异。一名有背痛病史的6岁女孩出现突发非创伤性截瘫，临床诊断为脊髓前动脉综合征。最初的MRI扫描显示L1-2椎间盘疾病和一个偶然发现的胸段脊髓空洞症，但未发现其急性发作性截瘫的病因。脑脊液和其他检查均为阴性。连续的MRI扫描显示脊髓从T10到圆锥部扩张，脊髓前部信号增强。椎间盘疾病无变化。影像学和临床发现是由纤维软骨栓子引起的，这意味着无需进行脊髓活检。该报告描述了纤维软骨栓子诊断的临床和影像学标准，强调了避免不必要活检的情况。讨论了儿科组的临床模式，以及将其与儿童急性脊髓炎区分开来的特征。
