# Acute paraparesis: do not miss Foix-Alajouanine syndrome

## Paraparesia crural aguda: a síndrome de Foix-Alajouanine não deve ser desconsiderada

Vitor Maia Arca<fnref n="1" /> ID

Geovane Gomes Silva<fnref n="1" /> ID

Luziany Carvalho Araújo<fnref n="2" /> ID

Eduardo Sousa de Melo<fnref n="3" /> ID

Arq. Neuro-Psiquiatr. 2024;82(9):s00441787760.

Address for correspondence Vitor Maia Arca
(e-mail: vitormaiaarca@gmail.com).

A 71-year-old male patient presented with sudden loss of strength and hypoesthesia in the lower limbs. A spinal cord magnetic resonance imaging (MRI) scan revealed a vascular tangle in the spinal canal region with hypersignal on T1 in the spinal cord at the T8–T9 level, corresponding with the clinical presentation of the patient (► **Figure 1**). Arteriogra-

phy was performed to study the patient's anatomy and plan further treatment. Dural arteriovenous fistula (DAVF) was confirmed (► **Figure 2**).

Foix-Alajouanine syndrome (FAS) is a chronic myelopathy with an ischemic lesion in the spinal cord.<fnref n="1" /> The classic clinical picture is of a progressive paraparesis; however,

<figure><img src="image_1.png" /><figcaption>**Figure 1** Magnetic resonance imaging (MRI) scans of the thoracic spine: T2-weighted axial (A) and sagittal (B) images showing centromedullary edema (arrow) and prominent serpiginous intradural extramedullary flow voids (arrow); And T1-weighted sagittal postcontrast image (C) depicting enhancement of these vessels (arrow).</figcaption></figure>

received

February 14, 2024

received in its final form

April 04, 2024

accepted

April 15, 2024

DOI https://doi.org/
10.1055/s-0044-1787760.

ISSN 0004-282X.

Editor-in-Chief: Hélio A. G. Teive.

Associate Editor: João Brainer
Clares Andrade.

© 2024. The Author(s).

This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/).

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<footnote n="1">¹Universidade Federal de Pernambuco, Hospital das Clínicas, Departamento de Neurologia, Recife PE, Brazil.</footnote>

<footnote n="2">²Universidade Federal de Pernambuco, Empresa Brasileira de Serviços Hospitalares, Hospital das Clínicas, Departamento de Radiologia e Diagnóstico por Imagem, Recife PE, Brazil.</footnote>

<footnote n="3">³Universidade Federal de Pernambuco, Centro de Ciências Médicas, Divisão de Neuropsiquiatria, Recife PE, Brazil.</footnote>
<figure><img src="image_2.png" /><figcaption>**Figure 2** Spinal angiography showing the site of the spinal dural arteriovenous fistula (arrow). Through a super-selective microcatheterization of the neurodural branch of T11, we found that the same vessel that supplies the dural arteriovenous fistula also gives rise to the anterior spinal artery.</figcaption></figure>

acute lower-limb paraparesis could be the initial clinical presentation.²

**Authors' Contributions**

VMA: conceptualization, data curation, formal analysis, investigation, project administration, writing – original draft, writing – review & editing; GGS: conceptualization, data curation, investigation, writing – review & editing; LCA: conceptualization, investigation, project administration, resources, software, supervision, validation, writing – review & editing; ESM: conceptualization, data curation, formal analysis, investigation, methodology, project administration, validation, visualization, writing – review & editing.

**Conflict of Interest**

The authors have no conflict of interest to declare.

**References**

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