History
Patients present with increasing unilateral and/or bilateral weakness, dysesthesias, and numbness or tingling in the lower extremities, which may be symmetrical or asymmetrical. [6] Early problems with bowel, bladder, and sexual function are common. [7]
After brief exertion, symptoms begin as a heavy feeling in the legs that generally improves with rest. The symptoms gradually worsen over months, and the patient may have difficulty standing for long periods. Frequent falls can be a problem. Urinary and fecal incontinence eventually occur.
Complaints of nonradiating lower back pain in the lumbosacral or coccygeal regions are common. This may initially be interpreted as sciatica. Weakness or numbness eventually can progress to the upper extremities.
In most patients, Foix-Alajouanine syndrome follows a protracted course over a few years before a diagnosis is made. [5] In a minority of patients, however, an acute onset of symptoms is reported.
Physical Examination
A physical examination can reveal the following:
-
Neurologic examination - Reveals an alert patient with normal mentation
-
Mental status, speech, language, and cranial nerve function - Generally are normal
-
Unsteadiness of gait - Common; may be halting in nature but on a narrow base
-
Spastic or flaccid paraparesis and a sensory level below the lesion
-
Deep tendon reflexes - May be normal or increased
-
Bilateral Babinski signs - May be present, as may clonus; upper motor neuron and lower motor neuron signs may be seen simultaneously [5]
-
Vibration and joint position senses - Usually are preserved
-
Rectal sphincter tone - Frequently is diminished
-
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).
