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Fibrocartilaginous embolism (FCE) is an
uncommon cause of spinal cord infarction.We
present the case of a 38-year-old previously
healthy woman who reported acute severe
back pain after skiing and developed a
Brown-Séquard syndrome in the following
24 hours. Her clinical findings and neuroimaging
studies were consistent with a spinal
cord infarction in the territory of the anterior
spinal artery. The main clinical features include
sudden severe pain, a free interval of
neurological symptoms and progression in
time indicating a “spinal stroke in evolution”,
which often leads to severe para- or tetraparesis
with urinary and bowel incontinence.
In approximately one half of the cases possible
precipitating factors like minor traumas
have been postulated. The most likely hypothesis
is that nucleus pulposus material may
be exposed to the vertebral body vasculature
by forceful herniation into the vertebral body
and then enters the arterial system by arteriovenous
communications during simultaneous
excessive Valsalva, causing arterial embolisation
of the spinal cord. The occurrence of a
sudden painful myelopathy following minor
trauma and/or Valsalva manoeuvre has to include
FCE in the differential diagnosis when
other common causes of myelopathy are excluded.