Fibrocartilaginous embolism

What causes fibrocartilaginous embolism?

Fibrocartilaginous embolism (FCE) occurs when materials that are usually found within the vertebral disc of the spine migrate into the nearby vascular system (veins and arteries) and block one of the spinal cord vessels. The exact cause of this migration is unclear, but symptoms often occur after a minor trauma.

FCE seems to occur most frequently in people who are in their late teens to their 20s and again in people who are in their 60s, but symptoms can begin anytime during adolescence or adulthood. This is thought to be because the vasculature in the spinal cord regresses as individuals enter young adulthood, and the vasculature increases again as people enter their 60s. Therefore, FCE is more likely to occur when there are more blood vessels located in and around the spinal cord. Some causes of FCE are thought to include aging, people who have fibrocartilaginous material (Schmorl nodes) built up in the vertebrae, or people who have spinal cord vasculature that is present throughout adulthood.

Risk factors for FCE include osteoporosis and a previous injury to the spinal cord such as a motor vehicle accident. FCE seems to be more common in women, which may be due to the increased likelihood for women to develop osteoporosis.

Last updated on 05-01-20

How is fibrocartilaginous embolism diagnosed?

A diagnosis of fibrocartilaginous embolism (FCE) is generally suspected based on the presence of characteristic signs and symptoms. Other conditions that cause similar features can be ruled out using the following tests:

Unfortunately, FCE is generally only confirmed with a biopsy, often performed at the time of autopsy. It is thought that FCE may be underdiagnosed and that it may be more common than originally thought.

Last updated on 05-01-20

Is fibrocartilaginous embolism inherited?

Fibrocartilaginous embolism (FCE) is not known to run in families. Most cases occur sporadically in people with no family history of disease. However, it is possible for people in the same family to share risk factors that increase the likelihood for developing FCE.

Last updated on 05-01-20

What is the long-term outlook for people affected by fibrocartilaginous embolism?

The long-term outlook (prognosis) for people affected by fibrocartilaginous embolism (FCE) was once thought to be extremely poor with little hope for improvement of symptoms. However, more recent research has challenged this assumption. Many researchers now believe that there is a much wider spectrum of the severity and recovery associated with FCE. Researchers also suspect that the length and degree of recovery depends on many factors including:

  • The location of FCE along the spinal cord
  • The extent of spinal cord ischemia (restriction of blood supply to organs or tissues)

Last updated on 05-01-20

How might fibrocartilaginous embolism be treated?

There is, unfortunately, no specific treatment for fibrocartilaginous embolism (FCE). Management is generally focused on preventing possible complications and improving quality of life with medications and physical therapy.

Treatments reported in the literature include surgery, steroid therapy, heparin administration, and/or blood pressure control. However, the benefits of these treatment options are not well-defined.

Last updated on 05-01-20

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Jones DD, Watson RE, Heaton HA. Presentation and Medical Management of Fibrocartilaginous Embolism in the Emergency Department J Emerg Med. September 2016; 51(3). 315-318. Reference Link AbdelRazek MA, Mowla A, Farooq S, Silvestri N, Sawyer R, Wolfe G. Fibrocartilaginous embolism: a comprehensive review of an under-studied cause of spinal cord infarction and proposed diagnostic criteria J Spinal Cord Med. 2016; 39(2). 146-154. Reference Link Han JJ, Massagli TL, and Jaffe KM. Fibrocartilaginous embolism--an uncommon cause of spinal cord infarction: a case report and review of the literature Archives of Physical Medincine and Rehabilitation. January 2004; 85(1). 153-157. Reference Link Mateen FJ, Monrad PA, Hunderfund AN, Robertson CE, and Sorenson EJ. Clinically suspected fibrocartilaginous embolism: clinical characteristics, treatments, and outcomes European Journal of Neurology. February 2011; 18(2). 218-225. Reference Link Alkhachroum AM, Weiss D, Lerner A, and De Georgia MA. Spinal cord infarct caused from suspected fibrocartilaginous embolism Spinal Cord Series and Cases. May 18, 2017; Reference Link

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