title: Clinically suspected fibrocartilaginous embolism: clinical characteristics, treatments, and outcomes.
abstract: OBJECTIVE
  To study the frequency, demographics, clinical characteristics, and outcomes of patients with an antemortem diagnosis of fibrocartilaginous embolism (FCE), a rare cause of spinal cord and cerebral infarction because of the presumed embolization of nucleus pulposus material into the vascular circulation.
  
  
  METHODS
  We retrospectively reviewed the institutional experience of patients who received an antemortem diagnosis of FCE by their treating physician at the Mayo Clinic (Rochester, MN, USA) from 1997 to 2009. All patients underwent laboratory, radiological, and clinical exclusion of other possible and related diagnoses.
  
  
  RESULTS
  Of 164 patients with acute spinal cord infarction seen during the study timeframe, 9 (5.5%; 95% CI 2.5, 10.2%) met inclusion criteria for high likelihood of FCE (6 men, 3 women; median age 46 years old, range 21-64). All patients were severely affected (median modified Rankin Scale 4, median Barthel index 45; mean time to evaluation 57 days). One patient (1/9) experienced concomitant cerebral infarction. No patients had noticeable improvement from steroid treatment.
  
  
  CONCLUSIONS
  The diagnosis of FCE in life is common at this referral center, accounting for 5.5% of all cases of acute spinal cord infarction seen. Although FCE is a postmortem diagnosis, we propose clinical criteria for FCE in life to better characterize the relatively high number of patients with unexplained ischaemic myelopathy.
authors.affiliation: The Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.|Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors.forename: F J
authors.initials: FJ
authors.lastname: Mateen
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors.forename: P A
authors.initials: PA
authors.lastname: Monrad
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors.forename: A N
authors.initials: AN
authors.lastname: Leep Hunderfund
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Robertson
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Sorenson
mesh_terms: D000328:Adult; D002357:Cartilage Diseases / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D004617:Embolism / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020760:Spinal Cord Ischemia / Q000175:diagnosis* / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult
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