Ch74 Special Conditions affecting the spinal cord

Question 1

What is the most common type of spinal vascular malformation in adults?

Answer 1

AVF (type 1)

• Fed by radicular artery
• AV shunt at the dural root sleeve
• Slow flow
• drains into engorged spinal vein on posterior aspect of cord, rarely bleed but can cause progressive myeloradiculopathy due to venous congestion

Question 2

How do you classify spinal vascular malformations?

Answer 2

Type 1 - Dural AV fistula

Type 2 - Spinal gloms AVM (intramedullary true AVM of spinal cord)

Type 3 - Juvenile spinal AVM (essentially an enlarged glomus AVM, invades bone too and can cause scoliosis)

Type 4 - Intradural perimedullary AVF (supplied by spinal artery)

Question 3

What is Coup de poignard of Michon?

Answer 3

sudden excruciating back pain with SAH (clinical evidence of SVM).

Question 4

What is Foix-Alajouanine syndrome?

Answer 4

acute or subacute neurologic deterioration in a patient with an SVM without evidence of hemorrhage.