Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan; Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan.
Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan.
Pediatr Neurol. 2019 Oct;99:3-6. doi: 10.1016/j.pediatrneurol.2019.04.013. Epub 2019 Apr 26.
Fibrocartilaginous embolism is assumed to be caused by fibrocartilaginous nucleus pulposus component migration through retrograde embolization to the spinal cord artery. Fibrocartilaginous embolism is currently not well recognized among pediatricians because of its rarity. We describe a previously healthy 15-year-old soccer player who, after kicking a ball, developed progressive weakness in both legs and urinary retention the next day. Magnetic resonance imaging revealed T2 hyperintensity in the anterior horn of the spinal cord at the Th12/L1 level with Schmorl node at the level of L1/2. We also review the previous literature on fibrocartilaginous embolism of the spinal cord in children (less than18 years age); a total of 25 pediatric patients, including our patient, were identified. The median age was 14 years, and 64% of the reviewed patients were female. The most common trigger event was intense exercise or sports. The neurological symptoms started within one day in most cases, and the time to symptom peak varied from a few hours to two weeks. The most common initial neurological symptoms were weakness or plegia (100%), followed by paresthesia or numbness (48%). Affected areas of the spinal cord were distributed evenly from the cervical to thoracolumbar regions. Although steroids and anticoagulants were most commonly used, the prognosis was quite poor (mild to severe sequelae with three deaths). Although fibrocartilaginous embolism is a very rare condition, physicians should be aware of the characteristics and include fibrocartilaginous embolism of the spinal cord in their differential diagnosis, especially for physically active patients.
纤维软骨栓子形成被认为是由于纤维软骨核髓核成分通过逆行栓塞迁移到脊髓动脉引起的。纤维软骨栓子形成在儿科医生中尚未得到很好的认识，因为它比较罕见。我们描述了一位以前健康的 15 岁足球运动员，他在踢球后第二天出现双腿进行性无力和尿潴留。磁共振成像显示 T2 高信号在胸 12/腰 1 水平的脊髓前角，并有胸 1 水平的 Schmorl 结节/2。我们还回顾了以前关于儿童脊髓纤维软骨栓子形成的文献（年龄小于 18 岁）；总共确定了 25 名儿科患者，包括我们的患者。中位年龄为 14 岁，64%的患者为女性。最常见的诱发事件是剧烈运动或运动。大多数情况下，神经症状在一天内开始，症状高峰的时间从数小时到两周不等。最常见的初始神经症状是无力或瘫痪（100%），其次是感觉异常或麻木（48%）。脊髓受累区域从颈段到胸腰段均匀分布。尽管最常使用类固醇和抗凝剂，但预后相当差（有 3 例死亡，轻度至重度后遗症）。虽然纤维软骨栓子形成是一种非常罕见的情况，但医生应该意识到其特征，并将其纳入脊髓纤维软骨栓子形成的鉴别诊断中，特别是对于活动活跃的患者。
