Spinal Cord Arteriovenous Malformations
Related Subjects:
|Vitamin B12 deficiency
|Myelopathy
|Spinal Cord Arteriovenous Malformations
🧠 Foix-Alajouanine syndrome is a severe form of spinal dural AV fistula (AVF).
It occurs in a minority of patients and presents with rapidly progressive myelopathy due to venous thrombosis from spinal venous stasis. ⚡
ℹ️ About
- Spinal AVMs (arteriovenous malformations) can cause acute, subacute, or chronic myelopathy.
- They often resemble AV fistulas, where high-pressure arterial blood enters the venous system, causing venous hypertension → spinal cord ischaemia and dysfunction.
⚠️ Aetiology & Classification
- Type 1: Dural AVMs (≈85%)
- Most common form, usually in middle-aged men 👨.
- Venous hypertension → expansion of lesion → spinal cord compression.
- Affects corticospinal and posterior columns.
- Management: Spinal angiography & obliteration of fistula.
- Type 2: Intradural AVMs (Glomus AVMs)
- Arterial-pressure bleeding into subarachnoid space → myelopathy.
- Seen in younger patients 👩🦱; fluctuating course with acute deterioration from haemorrhage.
- Type 3: Juvenile AVMs
- Large, high-flow AVMs, sometimes with an audible bruit 🔊.
- Clinical features resemble Type 2 but more extensive.
- Type 4: Perimedullary AV Fistulas
- Rare; complex venous hypertension pattern.
🩺 Clinical Features
- Painful radiculopathy, especially in Type 1.
- Symptoms of spinal cord compression: gradual weakness, sensory loss.
- Bladder and bowel dysfunction 🚽 in advanced disease.
- Sudden haemorrhage → severe back pain + abrupt weakness.
- Intradural lesions may cause subarachnoid haemorrhage with excruciating back pain (“coup de poignard” — dagger-like pain) 🗡️.
🔬 Investigations
- MRI/MRA: First-line to identify AVMs and cord changes.
- Spinal arteriography: Gold standard for diagnosis and treatment planning 🎯.
💊 Management
- Endovascular therapy (interventional neuroradiology): Embolization of fistula or nidus using occlusive agents.
- Surgical removal: Considered for accessible lesions.
- Stereotactic radiosurgery: Causes gradual occlusion by scarring the AVM with focused radiation.
