ACUTE ISCHEMIC STROKE FROM FIBROCARTILAGINOUS EMBOLISM TO THE MIDDLE CEREBRAL-ARTERY

Background and Purpose: Fibrocartilaginous embolism from the nucleus p ulposus. has been reported as a rare cause of spinal cord ischemia. We were unable to find previous reports of embolism from this source to cerebral arteries. Case Description: A previously healthy 17-year-old girl fell during a basketball game. Left hemiparesis and unresponsiven ess developed followed by signs of right uncal herniation and death ov er a 3 -day period. There was no evidence of neck, head, or spine trau ma, and cardiac evaluation was normal. Neuropathological examination s howed extensive ischemic infarction of the right middle cerebral arter y territory, brain edema, and herniation. Complete embolic occlusion o f the right middle cerebral artery by fibrocartilaginous material, con sistent with nucleus pulposus, was documented. Small, terminal coronar y artery branches also showed embolism by the same material and limite d areas of myocardial infarction. Conclusions: Acute cerebral embolism after minor trauma in a young patient may be rarely due to fibrocarti laginous embolism from the nucleus pulposus. The pathogenesis of this problem remains poorly understood, but systemic embolism appeared to h ave occurred in this case.