Abstract
We present what is to our knowledge the first reported case of thoracic disc herniation leading to venous congestive myelopathy (VCM), which was clinically and radiographically suggestive of Foix–Alajouanine syndrome (angiodysgenetic necrotizing myelopathy). In addition, we review current concepts in evaluating the etiology of VCM and discuss indications for surgery.
Highlights
Venous congestive myelopathy (VCM) (Matsuo et al 2008) is classically associated with spinal dural arteriovenous fistula (AVF) and formerly known as Foix– Alajouanine syndrome (FAS) (Foix and Alajouanine 1926)
We present what is to our knowledge the first reported case of thoracic disc herniation leading to VCM, which was clinically and radiographically suggestive of FAS
Scattered reports of venous infarction of the spinal cord have been associated with decompression sickness, gliosarcoma, orchiectomy, pulmonary emboli, furunculosis, leukemia, polycythemia, and thrombosis of leg veins (Srigley et al 1981; Clarke and Cumming 1987; Niino et al 1999)
Summary
Venous congestive myelopathy (VCM) (Matsuo et al 2008) is classically associated with spinal dural arteriovenous fistula (AVF) and formerly known as Foix– Alajouanine syndrome (FAS) (angiodysgenetic necrotizing myelopathy) (Foix and Alajouanine 1926). Electromyogram, nerve conduction study, and brain MR imaging were unrevealing He underwent laminectomy for biopsy; upon opening, a small engorged superficial vessel was encountered along the dorsal cord. Thoracic and lumbar spine MR imaging was repeated with a 3-tesla magnet and demonstrated severe cord edema versus a syrinx at and below T8, with questionable venous infarction (Fig. 1). Computed tomographic (CT) myelography confirmed cord compression and cord displacement/distortion at T7–8 (Fig. 2); the severe cord edema impressively terminated at the level of the disc herniation (Fig. 1). He was fully investigated by the neurology service and evaluated for other causes of myelopathy; all these results (including cerebrospinal fluid and blood analyses) were negative. At the 1-year follow-up office visit, he was ambulating well with the assistance of a walker
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