Acute paraparesis: do not miss Foix-Alajouanine syndrome

Paraparesia crural aguda: a síndrome de Foix-Alajouanine não deve ser desconsiderada

A 71-year-old male patient presented with sudden loss of strength and hypoesthesia in the lower limbs. A spinal cord magnetic resonance imaging (MRI) scan revealed a vascular tangle in the spinal canal region with hypersignal on T1 in the spinal cord at the T8–T9 level, corresponding with the clinical presentation of the patient (Figure 1). Arteriography was performed to study the patient's anatomy and plan further treatment. Dural arteriovenous fistula (DAVF) was confirmed (Figure 2).

Figure 1
Magnetic resonance imaging (MRI) scans of the thoracic spine: T2-weighted axial (A) and sagittal (B) images showing centromedullary edema (arrow) and prominent serpiginous intradural extramedullary flow voids (arrow); And T1-weighted sagittal postcontrast image (C) depicting enhancement of these vessels (arrow).

Figure 2
Spinal angiography showing the site of the spinal dural arteriovenous fistula (arrow). Through a super-selective microcatheterization of the neurodural branch of T11, we found that the same vessel that supplies the dural arteriovenous fistula also gives rise to the anterior spinal artery.

Foix-Alajouanine syndrome (FAS) is a chronic myelopathy with an ischemic lesion in the spinal cord.¹ The classic clinical picture is of a progressive paraparesis; however, acute lower-limb paraparesis could be the initial clinical presentation.²

References

• ¹
  Sadighi N, Tajmalzai A, Salahshour F. Spinal arteriovenous malformations causing Foix-Alajouanine syndrome, a case report and review of the literature. Radiol Case Rep 2021;16(08):2187–2191. Doi:10.1016/j.radcr.2021.05.048PMID:34178190;PMCID:PMC8213980
  » https://doi.org/10.1016/j.radcr.2021.05.048
• ²
  Del Pino-Camposeco J, Villanueva-Castro E, Ponce-Gómez JA, Ramírez-Aragón S, Hernández-Hernández A, Arriada-Mendicoa JN. Foix-Alajouanine Syndrome: A Case Report. Cureus 2023;15(03):e36696. Doi:10.7759/cureus.36696PMID:37113340;PMCID:PMC10128097
  » https://doi.org/10.7759/cureus.36696

Edited by

Editor-in-Chief:

Hélio A. G. Teive.

Associate Editor:

João Brainer Clares Andrade.

Publication Dates

• Publication in this collection
  16 Aug 2024
• Date of issue
  2024

History

• Received
  14 Feb 2024
• Reviewed
  04 Apr 2024
• Accepted
  15 Apr 2024