Foix-Alajouanine Syndrome: A Case Report

Foix-Alajouanine syndrome is a rare form of presentation of an arteriovenous malformation of the spinal cord that causes myelopathy in the thoracic and lumbar medullary segments. We present the case of a 46-year-old female who suffered from weakness in the lower limbs with sensation loss, low back pain, urinary incontinence, and constipation. The magnetic resonance image T2 sequence of the thoracic spine from T6 to T11 revealed abnormally hypointense signals in the posterior epidural region caused by larger arteries. A spinal digital subtraction angiography was useful to diagnose a right perimedullary fistula with venous drainage, which was satisfactorily embolized. The key to suspecting this diagnosis is the presence of dilated vessels in the posterior epidural space, which are evident in T2 and short tau inversion recovery (STIR)-weighted sequences. Physicians often misdiagnose Foix-Alajouanine syndrome, resulting in potential delays in care. Neurosurgeons can use surgery or endovascular embolization to treat this condition.