title: Fibrocartilaginous embolism: a comprehensive review of an under-studied cause of spinal cord infarction and proposed diagnostic criteria.
abstract: BACKGROUND
  Most spinal cord infarctions are due to aortic pathologies and aortic surgeries. Fibrocartilaginous Embolism (FCE) has been reported to represent 5.5% of spinal cord infarctions. Some believe that FCE is more common than presumed and is rather under-diagnosed due to vagueness surrounding its clinical presentation.
  
  
  METHODS
  A literature search was conducted for case reports of FCE published before August 2014. PubMed, the Cochrane Central Register and Google Scholar were searched for different combinations of the key words "fibrocartilaginous, "nucleus pulposus", "embolism", "spinal cord", "inter-vertebral disc", "infarction", "stroke", "paraplegia", "quadriplegia", "myelopathy".
  
  
  RESULTS
  Fifty-five case articles were reviewed, ten of which were translated from foreign languages. A total of 67 cases of FCE were found, 41 tissue-confirmed and 26 clinically suspected. A comprehensive summary of the clinical anatomy, patho-physiologic mechanisms, epidemiology, diagnosis and treatment of FCE is described, along with the conflicting opinions on its incidence and relevance after reviewing all of the related literature. The 41 tissue proven cases are summarized and a schematic approach to the clinical diagnosis of FCE, deducted from their clinical findings, is presented.
  
  
  CONCLUSIONS
  FCE of the spinal cord, often mis-diagnosed as transverse myelitis, may be more common than presumed. Future research into FCE, including the development of a chondrolytic therapy that can be given empirically upon its clinical suspicion to acutely reverse its symptoms, may be of value.
authors.affiliation: a Department of Neurology , State University of NY at Buffalo , Buffalo , NY , USA.
authors.forename: Mahmoud A
authors.initials: MA
authors.lastname: AbdelRazek
authors.affiliation: a Department of Neurology , State University of NY at Buffalo , Buffalo , NY , USA.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Mowla
authors.affiliation: a Department of Neurology , State University of NY at Buffalo , Buffalo , NY , USA.
authors.forename: Salman
authors.initials: S
authors.lastname: Farooq
authors.affiliation: a Department of Neurology , State University of NY at Buffalo , Buffalo , NY , USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Silvestri
authors.affiliation: a Department of Neurology , State University of NY at Buffalo , Buffalo , NY , USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Sawyer
authors.affiliation: a Department of Neurology , State University of NY at Buffalo , Buffalo , NY , USA.
authors.forename: Gil
authors.initials: G
authors.lastname: Wolfe
mesh_terms: D002357:Cartilage Diseases / Q000175:diagnosis* / Q000453:epidemiology; D003937:Diagnosis, Differential; D004617:Embolism / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007238:Infarction / Q000175:diagnosis* / Q000453:epidemiology; D009187:Myelitis / Q000175:diagnosis*; D013116:Spinal Cord / Q000098:blood supply* / Q000473:pathology
keywords: Idiopathic myelopathy; Nucleus pulposus; Paraplegia; Stroke; Transverse myelitis
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