Acute-onset nontraumatic paraplegia in childhood: fibrocartilaginous embolism or acute myelitis?

Fibrocartilaginous embolus causing acute spinal cord infarction is a rare c ause of acute-onset paraplegia or quadriplegia. Few cases of survivors have been reported in the neurosurgical literature, with most reports involving postmortem or biopsy findings. There is little information on MRI findings in such patients. We present the youngest patient ever reported, and discu ss the important differences between fibrocartilaginous embolus and acute m yelitis of childhood. A 6-year-old girl with a history of back pain present ed with sudden-onset nontraumatic paraplegia, with a clinical anterior spin al artery syndrome. Initial MRI scan revealed intervertebral disc disease a t L1-2 and an incidental thoracic syrinx, but no cause for her acute-onset paraplegia was identified. Cerebrospinal fluid and other investigations wer e all negative. Sequential MRI scans revealed development of spinal cord ex pansion from T10 to the conus medullaris, with increased cord signal in the anterior aspect of the spinal cord. The intervertebral disc disease was un changed. The imaging and clinical findings were caused by fibrocartilaginou s embolus, which meant there was no need for spinal cord biopsy. The report describes the clinical and imaging criteria for diagnosis of fibrocartilag inous embolus, highlighting the case for avoiding an unnecessary biopsy. Th e clinical pattern in the paediatric group is discussed, with features diff erentiating it from acute myelitis of childhood.