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A previously healthy 17-year-old girl fell during a basketball game.Left hemiparesis and unresponsiveness developed followed by signs of right uncal herniation and death over a 3-day period.There was no evidence of neck,head,or spine trauma,and cardiac evaluation was normal. Neuropathological examination showed extensive ischemic infarction of the right middle cerebral artery territory,brain edema,and herniation.Complete embolic occlusion of the right middle cerebral artery by fibrocartilaginous material,consistent with nucleus pulposus,was documented.Small,terminal coronary artery branches also showed embolism by the same material and limited areas of myocardial infarction.Acute cerebral embolism after minor trauma in a young patient may be rarely due to fibrocartilaginous embolism from the nucleus pulposus.The pathogenesis of this problem remains poorly understood,but systemic embolism appeared to have occurred in this case. |
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cerebral embolism
cerebrovascular accident
cerebrovascular accident,posttraumatic
cerebrovascular accident,young adult
embolism
embolism,nucleus pulposus
middle cerebral artery,emboli to
mortality
trauma
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