A 10-year-old boy fell while playing in a basement, then developed neck pain followed by quadriparesis and bladder and bowel incontinence within a few hours. A spinal magnetic resonance image showed edema in cervical segments 3 through 8. He was administered treatment with intravenous steroids, with a presumptive diagnosis of acute transverse myelitis. At discharge from the rehabilitation hospital, he was ambulatory with limitation of hand functions and intermittent urinary symptoms. Motor examination 3.5 years after the event showed intrinsic hand-muscle wasting and fasciculations, which were greater in the right hand. There was mild proximal and marked distal weakness in the right upper limb with moderate left-distal weakness. There was also mild right lower-limb weakness. Deep tendon reflexes (right > left) were brisk with bilateral extensor plantar. Sensory examination results were normal. Repeat spine magnetic resonance imaging conducted 1.5 years after the event showed features consistent with fibrocartilaginous embolism (Figure, A, B, and C).
Figure. Cervical spine magnetic resonance image. A, Hyperintense signals of the bilateral anterior horn cells (owl's eye appearance; arrowhead) in axial T2-weighted image. B, Hyperintense signal (arrow) and Schmorl nodes (arrowheads) on sagittal T2-weighted image. C, Atrophy of anterior cervical cord (arrow). CS indicates cervical segment.
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