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Foix-Alajouanine Syndrome Differential Diagnoses

  • Author: Cheryl Ann Palmer, MD; Chief Editor: Helmi L Lutsep, MD  more...
 
Updated: Aug 09, 2016
 
 

Diagnostic Considerations

In its early stages, Foix-Alajouanine syndrome may mimic a polyradiculopathy or anterior horn cell disorder. By the time upper motor neurons or sacral segments are involved, making it obvious that Foix-Alajouanine syndrome is present, a patient may already have substantial neurologic deficits.[5] Patients sometimes undergo unsuccessful lumbar disk prolapse surgery.[5] An incorrect diagnosis of spinal cord tumor may result from patient presentation and imaging examinations.

Conditions to consider in the differential diagnosis of Foix-Alajouanine syndrome include the following:

  • Lumbosacral disk syndromes
  • Cervical disk syndromes
  • Lumbosacral spondylosis
  • Polyradiculopathy
  • Primary or metastatic neoplastic disease
  • Spinal arachnoiditis
  • Spinal artery thrombosis
  • Spinal injury
  • Hereditary spastic paraplegias
  • HIV infection
  • HTLV-1 infection
  • Lyme disease (late disseminated infection)
  • Syphilis

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Cheryl Ann Palmer, MD Professor of Pathology, Director of Neuropathology, Director of Pathology Residency Program, Department of Pathology, Huntsman Cancer Institute, University of Utah School of Medicine

Cheryl Ann Palmer, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuropathologists, Society for Neuro-Oncology, International Society of Neuropathology

Disclosure: Nothing to disclose.

Coauthor(s)

Meghan J Driscoll, MD Resident Physician, Department of Pathology, University of Utah School of Medicine

Meghan J Driscoll, MD is a member of the following medical societies: College of American Pathologists, Academy of Clinical Laboratory Physicians and Scientists, Society for Pediatric Pathology, Wyoming Public Health Association

Disclosure: Nothing to disclose.

Chief Editor

Helmi L Lutsep, MD Professor and Vice Chair, Department of Neurology, Oregon Health and Science University School of Medicine; Associate Director, OHSU Stroke Center

Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology, American Stroke Association

Disclosure: Medscape Neurology Editorial Advisory Board for: Stroke Adjudication Committee, CREST2.

Acknowledgements

Howard S Kirshner, MD Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center

Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neurorehabilitation, National Stroke Association, Phi Beta Kappa, and Tennessee Medical Association

Disclosure: BMS/Sanofi Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

Richard M Zweifler, MD Chief of Neurology, Sentara Healthcare, Norfolk, VA; Professor of Neurology, Eastern Virginia Medical School, Norfolk, VA

Richard M Zweifler, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Medical Association, American Stroke Association, Royal Society of Medicine, and Stroke Council of the American Heart Association

Disclosure: Nothing to disclose.

References
  1. Krishnan P, Banerjee TK, Saha M. Congestive myelopathy (Foix-Alajouanine Syndrome) due to intradural arteriovenous fistula of the filum terminale fed by anterior spinal artery: Case report and review of literature. Ann Indian Acad Neurol. 2013 Jul. 16(3):432-6. [Medline]. [Full Text].

  2. Mishra R, Kaw R. Foix-Alajouanine syndrome: an uncommon cause of myelopathy from an anatomic variant circulation. South Med J. 2005 May. 98(5):567-9. [Medline].

  3. Foix CH, Alajouanine T. La myelite necrotique subaigue. Rev Neurol. 1926. 46:1-42.

  4. Rodriguez FJ, Crum BA, Krauss WE, Scheithauer BW, Giannini C. Venous congestive myelopathy: a mimic of neoplasia. Mod Pathol. 2005 May. 18(5):710-8. [Medline].

  5. Jellema K, Tijssen CC, van Gijn J. Spinal dural arteriovenous fistulas: a congestive myelopathy that initially mimics a peripheral nerve disorder. Brain. 2006 Dec. 129:3150-64. [Medline].

  6. Iovtchev I, Hiller N, Ofran Y, Schwartz I, Cohen J, Rubin SA, et al. Late diagnosis of spinal dural arteriovenous fistulas resulting in severe lower-extremity weakness: a case series. Spine J. 2013 Oct 2. [Medline].

  7. Sivakumar W, Zada G, Yashar P, Giannotta SL, Teitelbaum G, Larsen DW. Endovascular management of spinal dural arteriovenous fistulas. A review. Neurosurg Focus. 2009 May. 26(5):E15. [Medline].

  8. Andres RH, Barth A, Guzman R, et al. Endovascular and surgical treatment of spinal dural arteriovenous fistulas. Neuroradiology. 2008 Oct. 50(10):869-76. [Medline].

  9. Zhao LB, Shim JH, Lee DG, Suh DC. Two microcatheter technique for embolization of arteriovenous fistula with liquid embolic agent. Neurointervention. 2014 Feb. 9(1):32-8. [Medline].

  10. Hessler C, Regelsberger J, Grzyska U, Illies T, Zeumer H, Westphal M. Therapeutic clues in spinal dural arteriovenous fistulas - a 30 year experience of 156 cases. Cen Eur Neurosurg. 2010 Feb. 71(1):8-12. [Medline].

  11. Krause F. Chirurgie des Gehirns und Ruckenmarks nach eigenen Erfarungen. Berlin: Urban & Schwarzenberg; 1911.

  12. Thorn, A. Spinale durale arteriovenöse Fisteln. Der Radiologe. November 2001. 41:955-960.

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Gross photograph of the dorsal surface of the spinal cord showing dilated and tortuous vessels.
Photomicrograph of the cervical spinal cord region showing a thickened subarachnoid vein with a thrombotic occlusion (hematoxylin and eosin stain).
Photograph of the cervical spinal cord illustrating dilated, abundant subarachnoid veins (hematoxylin and eosin stain).
Photomicrograph of the cervical spinal cord region demonstrating several dilated, hyalinized intraparenchymal vessels (hematoxylin and eosin stain).
Photomicrograph of the cervical spinal cord depicting ischemic necrosis of the parenchyma (hematoxylin and eosin stain).
 
 
 
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