Fibrocartilaginous Embolism (FCE) occurs when nucleus pulposus material from an intervertebral disc embolizes into the vasculature of the spinal cord, leading to infarction. FCE accounts for approximately 5.5% of spinal cord infarctions. This rare diagnosis is typically considered in patients with recent minor trauma, no vascular risk factors, imaging findings consistent with evolving spinal cord infarction, normal cerebrospinal fluid (CSF) analysis, and after ruling out other causes.

Case Report

A 56-year-old right-handed male with a history of hyperlipidemia and venous insufficiency presented with sudden, severe left upper and lower extremity weakness, along with sensory deficits, after experiencing a sharp pain and an audible “pop” while lifting his 40-pound daughter. On examination, he exhibited 0/5 strength in the left upper and lower extremities, diminished sensation to cold and pinprick on the right below the T4 level and decreased vibratory sensation on the left below the same level.

Initial imaging with contrast-enhanced cervical spine MRI revealed an ovoid T2 hyperintense lesion spanning the C3-C4 levels.  An MRI of the brain was unremarkable, and CSF analysis did not show any abnormalities. He was started on high-dose IV Methylprednisolone for management of transverse myelitis, however given the bland CSF, a repeat MRI C spine was performed and demonstrated restricted diffusivity suggestive of acute spinal cord infarct primarily affecting the left C3-C4 region. Steroids were discontinued and he was started on Aspirin and Atorvastatin for secondary prevention.

FCE-related spinal cord infarction is challenging to differentiate from inflammatory or demyelinating cord lesions. In patients with progressive limb weakness and a history of minor trauma accompanied by acute neck, shoulder, or back pain, FCE should be considered as a potential cause of spinal cord infarction. Early identification is essential to guide appropriate management.