PURPOSE: A sudden elevation of the intervertebral disc pressure could result in injection of cartilaginous material into spinal small caliber vessels causing embolism of the underlying vessels is well documented but rarely occurs. CASE REPORT: Here we present a patient with sudden onset of weakness over left upper extremity several minutes after neck rotation exercise. The symptoms were progressive with quadra-paresis and urine incontinence without cranial nerve or sensory function deficit. The cervical spine MRI showed cervical spondylosis with degenerative osteophytes of lower cervical-spine with mild indentation of the thecal sac. There was also focal T2-high intensity edema of "H" gray matters of C3 spinal cord. According to the preliminary examination and clinical course, the symptoms of the patient can be explained by the ischemia of spinal cord secondary to fibrocartilaginous embolism(FCE) derived from intervertebral discs. After aspirin and IV dexamethasone treatment, the clinical condition of the patient improved significantly. CONCLUSION: Neck rotation exercise is common among all kinds of relaxation or physical rehabilitation activities. However, the potential unwanted effects of this exercise suggest that one should be aware of the potential adverse neurologic outcomes especially inappropriate non- professional method.
PURPOSE: A sudden elevation of the intervertebral disc pressure could result in injection of cartilaginous material into spinal small caliber vessels causing embolism of the underlying vessels is well documented but rarely occurs. CASE REPORT: Here we present a patient with sudden onset of weakness over left upper extremity several minutes after neck rotation exercise. The symptoms were progressive with quadra-paresis and urine incontinence without cranial nerve or sensory function deficit. The cervical spine MRI showed cervical spondylosis with degenerative osteophytes of lower cervical-spine with mild indentation of the thecal sac. There was also focal T2-high intensity edema of "H" gray matters of C3 spinal cord. According to the preliminary examination and clinical course, the symptoms of the patient can be explained by the ischemia of spinal cord secondary to fibrocartilaginous embolism(FCE) derived from intervertebral discs. After aspirin and IV dexamethasone treatment, the clinical condition of the patient improved significantly. CONCLUSION:Neck rotation exercise is common among all kinds of relaxation or physical rehabilitation activities. However, the potential unwanted effects of this exercise suggest that one should be aware of the potential adverse neurologic outcomes especially inappropriate non- professional method.