title: Acute cervical myelopathy due to presumed fibrocartilaginous embolism: a case report and systematic review of the literature.
abstract: BACKGROUND
  Fibrocartilaginous embolism (FCE) is an uncommon cause of myelopathy that should be considered after more common causes have been ruled out.
  
  
  OBJECTIVE
  This article presents a case report of a 50-year-old man with acute myelopathy attributed to FCE and summarizes the clinical features of the disease by analyzing all of the published evidence.
  
  
  METHODS
  Two computerized literature searches (MEDLINE-Pubmed, EMBASE, the Cochrane Library) were performed. The search term used was "Fibrocartilaginous embolism." No language restrictions were applied. All articles were evaluated and key data were extracted according to predefined criteria: patient's age, year of publication, localization of the embolism and type of vascular syndrome, clinical outcome, and time to death in the fatal cases.
  
  
  RESULTS
  Fifty-two cases (39 biopsy proven and 13 clinically diagnosed) were found in the literature. Median age at presentation was 37 years (interquartile range, 19-53) and 56% were women. Median progression of symptoms was 6 hours (interquartile range, 5-60 h), predominantly affecting the cervical spine (48%) by an arterial embolic source (56%).
  
  
  CONCLUSIONS
  FCE is an unusual cause of spinal cord and cerebral ischemia with unknown incidence. Implementation of diagnostic imaging techniques and initial management of acute spinal disorders care in intensive care units might increase the incidence of disease antemortem. FCE should be considered in the differential diagnosis of ischemic spinal cord injury when no other causes can be identified and especially when the onset is progressive over several hours.
authors.affiliation: *Department of Neurology, Division of Neurocritical Care †Division of Stroke, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Cuello
authors.forename: Santiago
authors.initials: S
authors.lastname: Ortega-Gutierrez
authors.forename: Guillermo
authors.initials: G
authors.lastname: Linares
authors.forename: Sachin
authors.initials: S
authors.lastname: Agarwal
authors.forename: Alyson
authors.initials: A
authors.lastname: Cunningham
authors.forename: Jay P
authors.initials: JP
authors.lastname: Mohr
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
authors.forename: Randolph S
authors.initials: RS
authors.lastname: Marshall
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.forename: Neeraj
authors.initials: N
authors.lastname: Badjatia
authors.forename: Mitchel S V
authors.initials: MS
authors.lastname: Elkind
authors.forename: Kiwon
authors.initials: K
authors.lastname: Lee
mesh_terms: D001706:Biopsy; D002357:Cartilage Diseases / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D002574:Cervical Vertebrae; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D018450:Disease Progression; D004617:Embolism / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013116:Spinal Cord / Q000473:pathology; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology