Fibrocartilaginous embolization is a rare cause of spinal cord infarction. It can

occur with strenuous activities that increase intradiscal pressures. Patients typically present

with acute and rapidly progressive motor, sensory, and/or autonomic dysfunction.

Case: A 57-year-old male training for a triathlon presented with sudden onset and crushing

interscapular back pain. Within four hours, he progressively developed quadriparesis,

dysesthesias, constipation, and urinary retention. Patient was hemodynamically stable and

basic labs were unremarkable. MRI of the spine revealed T2 hyperintensity at C4-T1

concerning for inflammation or infarction as well as C5-C6 disc osteophyte complex with mild

spinal stenosis. Inflammatory causes were considered unlikely given the acuity of symptoms,

lack of contrast enhancement on MRI, normal CSF analysis, and minimal response to empiric

corticosteroids that were administered for presumed transverse myelitis. Other potential

etiologies including trauma, significant disc compression, infection, demyelinating diseases,

nutritional deficiencies, and paraneoplastic syndromes were eliminated with appropriate

testing; yielding spinal cord infarction as the diagnosis of exclusion. CTA abdomen and spinal

angiogram ruled out vascular causes of infarction including arteriosclerosis, aortic pathology,

and AVMs. Given this patient’s recent strenuous physical activity and underlying degenerative

disc disease, it was concluded that a fibrocartilaginous embolus led to the spinal cord infarction.

Fibrocartilaginous emboli are thought to arise from the nucleus pulposus of the intervertebral discs. In the presence of degenerative disc disease, activities that increase the intradiscal pressure, such as lifting or Valsalva, can propel a fibrocartilaginous embolus from the nucleus pulposus into the spinal circulation leading to spinal cord infarction. Spinal cord infarction due to fibrocartilaginous emboli is rare but likely underdiagnosed and possibly misdiagnosed as a demyelinating disease due to overlapping clinical presentation. Increasing awareness of this condition may spare unnecessarily prolonged immunosuppressive therapy and help establish the true incidence, proper diagnosis, and management plan.