PMC7871706_01
PMC7871706_02
PMC7871706_03
(A) Case 1, sagittal T2 MRI demonstrating intramedullary hyperintensity to T2. (B) Case1, post-SDAVF resection sagittal T2 MRI demonstrating regression of hyperintensity to T6. (C) Case 1, spinal DSA demonstrating left L3 SDAVF. (D) Case 2, sagittal T2 MRI demonstrating intramedullary hyperintensity to T5. (E) Case 2, postembolisation sagittal T2 MRI demonstrating regression of intramedullary hyperintensity. (F) Case 2, spinal DSA demonstrating left L3 SDAVF. (G) Case 3, sagittal T2 MRI demonstrating intramedullary hyperintensity to T5. (H) Case 3, postembolisation sagittal T2 MRI demonstrating regression of intramedullary hyperintensity. (I) Case 3, spinal DSA demonstrating right L1 SDAVF. (J) Case 4, sagittal T2 MRI demonstrating intramedullary hyperintensity to T6. (K) Case 4, postresection sagittal T2 MRI demonstrating regression of intramedullary hyperintensity. (L) Case 4, spinal DSA with selective injection of left L1 segmental spinal artery showing a left L1 SDAVF in the typical location of the nerve root dura under the left L1 pedicle. The fistula is supplied by dural branch and drains to congested ascending medullary veins. DSA, digital subtraction angiography; SDAVF, spinal dural arteriovenous fistula.
bmjno-2019-000019f01.jpg
PMC7871706_07_bmjno-2019-000019f01.jpg
F1
SDAVF and secondary myelopathic changes (Foix-Alajouanine syndrome) (figure 2). Subsequent DSA under general anaesthesia confirmed a left L1 SDAVF (figure 1L). There was also radiological improvement in the degree of cord signal change (figure 1K).
PMC7871706_04
(A) Case 1, sagittal T2 MRI demonstrating intramedullary hyperintensity to T2. (B) Case1, post-SDAVF resection sagittal T2 MRI demonstrating regression of hyperintensity to T6. (C) Case 1, spinal DSA demonstrating left L3 SDAVF. (D) Case 2, sagittal T2 MRI demonstrating intramedullary hyperintensity to T5. (E) Case 2, postembolisation sagittal T2 MRI demonstrating regression of intramedullary hyperintensity. (F) Case 2, spinal DSA demonstrating left L3 SDAVF. (G) Case 3, sagittal T2 MRI demonstrating intramedullary hyperintensity to T5. (H) Case 3, postembolisation sagittal T2 MRI demonstrating regression of intramedullary hyperintensity. (I) Case 3, spinal DSA demonstrating right L1 SDAVF. (J) Case 4, sagittal T2 MRI demonstrating intramedullary hyperintensity to T6. (K) Case 4, postresection sagittal T2 MRI demonstrating regression of intramedullary hyperintensity. (L) Case 4, spinal DSA with selective injection of left L1 segmental spinal artery showing a left L1 SDAVF in the typical location of the nerve root dura under the left L1 pedicle. The fistula is supplied by dural branch and drains to congested ascending medullary veins. DSA, digital subtraction angiography; SDAVF, spinal dural arteriovenous fistula.
bmjno-2019-000019f01.jpg
PMC7871706_07_bmjno-2019-000019f01.jpg
F1
SDAVF and secondary myelopathic changes (Foix-Alajouanine syndrome) (figure 2). Subsequent DSA under general anaesthesia confirmed a left L1 SDAVF (figure 1L). There was also radiological improvement in the degree of cord signal change (figure 1K).
PMC7871706_05
(A) Case 1, sagittal T2 MRI demonstrating intramedullary hyperintensity to T2. (B) Case1, post-SDAVF resection sagittal T2 MRI demonstrating regression of hyperintensity to T6. (C) Case 1, spinal DSA demonstrating left L3 SDAVF. (D) Case 2, sagittal T2 MRI demonstrating intramedullary hyperintensity to T5. (E) Case 2, postembolisation sagittal T2 MRI demonstrating regression of intramedullary hyperintensity. (F) Case 2, spinal DSA demonstrating left L3 SDAVF. (G) Case 3, sagittal T2 MRI demonstrating intramedullary hyperintensity to T5. (H) Case 3, postembolisation sagittal T2 MRI demonstrating regression of intramedullary hyperintensity. (I) Case 3, spinal DSA demonstrating right L1 SDAVF. (J) Case 4, sagittal T2 MRI demonstrating intramedullary hyperintensity to T6. (K) Case 4, postresection sagittal T2 MRI demonstrating regression of intramedullary hyperintensity. (L) Case 4, spinal DSA with selective injection of left L1 segmental spinal artery showing a left L1 SDAVF in the typical location of the nerve root dura under the left L1 pedicle. The fistula is supplied by dural branch and drains to congested ascending medullary veins. DSA, digital subtraction angiography; SDAVF, spinal dural arteriovenous fistula.
bmjno-2019-000019f01.jpg
PMC7871706_07_bmjno-2019-000019f01.jpg
F1
SDAVF and secondary myelopathic changes (Foix-Alajouanine syndrome) (figure 2). Subsequent DSA under general anaesthesia confirmed a left L1 SDAVF (figure 1L). There was also radiological improvement in the degree of cord signal change (figure 1K).
PMC7871706_06
(A) Case 1, sagittal T2 MRI demonstrating intramedullary hyperintensity to T2. (B) Case1, post-SDAVF resection sagittal T2 MRI demonstrating regression of hyperintensity to T6. (C) Case 1, spinal DSA demonstrating left L3 SDAVF. (D) Case 2, sagittal T2 MRI demonstrating intramedullary hyperintensity to T5. (E) Case 2, postembolisation sagittal T2 MRI demonstrating regression of intramedullary hyperintensity. (F) Case 2, spinal DSA demonstrating left L3 SDAVF. (G) Case 3, sagittal T2 MRI demonstrating intramedullary hyperintensity to T5. (H) Case 3, postembolisation sagittal T2 MRI demonstrating regression of intramedullary hyperintensity. (I) Case 3, spinal DSA demonstrating right L1 SDAVF. (J) Case 4, sagittal T2 MRI demonstrating intramedullary hyperintensity to T6. (K) Case 4, postresection sagittal T2 MRI demonstrating regression of intramedullary hyperintensity. (L) Case 4, spinal DSA with selective injection of left L1 segmental spinal artery showing a left L1 SDAVF in the typical location of the nerve root dura under the left L1 pedicle. The fistula is supplied by dural branch and drains to congested ascending medullary veins. DSA, digital subtraction angiography; SDAVF, spinal dural arteriovenous fistula.
bmjno-2019-000019f01.jpg
PMC7871706_07_bmjno-2019-000019f01.jpg
F1
SDAVF and secondary myelopathic changes (Foix-Alajouanine syndrome) (figure 2). Subsequent DSA under general anaesthesia confirmed a left L1 SDAVF (figure 1L). There was also radiological improvement in the degree of cord signal change (figure 1K).
PMC7871706_07
(A) Case 1, sagittal T2 MRI demonstrating intramedullary hyperintensity to T2. (B) Case1, post-SDAVF resection sagittal T2 MRI demonstrating regression of hyperintensity to T6. (C) Case 1, spinal DSA demonstrating left L3 SDAVF. (D) Case 2, sagittal T2 MRI demonstrating intramedullary hyperintensity to T5. (E) Case 2, postembolisation sagittal T2 MRI demonstrating regression of intramedullary hyperintensity. (F) Case 2, spinal DSA demonstrating left L3 SDAVF. (G) Case 3, sagittal T2 MRI demonstrating intramedullary hyperintensity to T5. (H) Case 3, postembolisation sagittal T2 MRI demonstrating regression of intramedullary hyperintensity. (I) Case 3, spinal DSA demonstrating right L1 SDAVF. (J) Case 4, sagittal T2 MRI demonstrating intramedullary hyperintensity to T6. (K) Case 4, postresection sagittal T2 MRI demonstrating regression of intramedullary hyperintensity. (L) Case 4, spinal DSA with selective injection of left L1 segmental spinal artery showing a left L1 SDAVF in the typical location of the nerve root dura under the left L1 pedicle. The fistula is supplied by dural branch and drains to congested ascending medullary veins. DSA, digital subtraction angiography; SDAVF, spinal dural arteriovenous fistula.
bmjno-2019-000019f01.jpg
PMC7871706_07_bmjno-2019-000019f01.jpg
F1
SDAVF and secondary myelopathic changes (Foix-Alajouanine syndrome) (figure 2). Subsequent DSA under general anaesthesia confirmed a left L1 SDAVF (figure 1L). There was also radiological improvement in the degree of cord signal change (figure 1K).
Histology from spinal cord biopsy at high (A) and medium (B) power shows abnormal vascularity in the spinal cord parenchyma with an increased number of hyalinised small vessels in keeping with a spinal dural arteriovenous fistula. In addition, there are secondary myelopathic changes. These findings are compatible with Foix-Alajouanine syndrome.
bmjno-2019-000019f02.jpg
PMC7871706_07_bmjno-2019-000019f02.jpg
F2
SDAVF and secondary myelopathic changes (Foix-Alajouanine syndrome) (figure 2). Subsequent DSA under general anaesthesia confirmed a left L1 SDAVF (figure 1L).