Makindo Medical Notes.com

About

• subacute necrotizing myelopathy due to spinal dural arteriovenous fistula (SDAVF)

Aetiology

• Extreme form of spinal dural AVF that affects a minority of patients.

Clinical

• Progressive weakness: Gradual onset of weakness, often starting in the lower extremities and progressing upward.
• Sensory disturbances: Numbness, tingling, or loss of sensation, particularly in the legs and lower body.
• Gait disturbances: Difficulty walking, unsteady gait, or dragging of one or both feet.
• Back pain: Chronic pain in the lower back, often radiating to the legs.
• Bowel and bladder dysfunction: Loss of control over urination and defecation due to the involvement of the lower spinal cord.
• Spasticity: Increased muscle tone leading to stiffness and spasms, particularly in the legs.

Investigations

Diagnosing Foix-Alajouanine syndrome involves a combination of clinical evaluation, imaging studies, and sometimes invasive procedures. The process typically includes:

• Magnetic Resonance Imaging (MRI): MRI is the preferred imaging modality. Shows spinal cord oedema, venous congestion, and other characteristic signs of spinal cord involvement.
• Magnetic Resonance Angiography (MRA) : visualize the arteriovenous fistula and confirm the diagnosis.
• Spinal tap (lumbar puncture): elevated protein levels in the CSF is nonspecific.

Management

Treatment of Foix-Alajouanine syndrome focuses on addressing the underlying vascular malformation to prevent further damage to the spinal cord. The primary treatment options include:

• Surgical ligation: surgically closing the arteriovenous fistula to restore normal blood flow and reduce venous congestion.
• Endovascular embolization: blood vessels are blocked using coils, glue, or other embolic agents delivered through a catheter.
• Supportive care: PT, pain management, and rehabilitation to improve functional outcomes and manage symptoms.