Geoffrey R. II Smith, II, MD
Assistant Professors
Mayo Clinic Rochester
Rochester, Minnesota, United States
Tyler Bendrick, MD
Resident Physician/MD
Mayo Clinic Rochester
Rochester, Minnesota, United States
Posterior Spinal Cord Infarct and Spinal Cord Injury due to Cervical Fibromuscular Dysplasia
Case Description: A 77 y.o. woman with medical history of hyperlipidemia, hypertension, and type 2 diabetes was admitted to our facility due to acute, rapidly progressive ascending paresthesia of arms and legs with loss of proprioception, strength and sensation, causing inability to ambulate. She underwent extensive diagnostic workup, including analysis of CSF, inflammatory markers, antiphospholipid antibodies and vitamin levels, multiple MRIs and CTAs, cardiac monitoring, and EMG. Results were largely negative except for 1) serial MRIs showing an evolving posterior C6-T1 cord lesion with increased T2 hyperintensity and 2) head and neck CTA showing tortuous and irregular beaded appearance of cervical vessels suggesting fibromuscular dysplasia (FMD). Multidisciplinary (neurologic, neurosurgical, and neuroradiologic) evaluation of her case deemed her symptoms secondary to C6-T1 cord ischemia in the posterior spinal artery, secondary to fibromuscular dysplasia (FMD). She was started on aspirin and admitted to intensive inpatient rehab meeting criteria for C5 ASIA Impairment Scale D.
Discussions: As far as we know, there are no documented cases of posterior spinal cord infarct due to FMD. Likewise, the etiology, natural course, and complications of FMD are not well studied, and even in known vascular diseases of the spinal cord, FMD is not mentioned. However, it is known that in the rare case cerebrovascular fibromuscular dysplasia is present, it can affect the vertebral arteries, and that vertebral artery pathologies are a known cause of posterior cord infarct. Thus, this is the first documented case of posterior cord infarct by mechanism of cervical FMD, likely secondary to vertebral artery involvement.
Conclusions: This is a rare and novel case of posterior spinal cord infarction by mechanism of FMD affecting vertebral arteries, providing an exciting opportunity to report concomitant and likely interrelated findings of two very rare and understudied conditions.
