Hanai Sho, Yanaka Kiyoyuki, Akimoto Ken, Marushima Aiki, Nakamura Kazuhiro, Takahashi Nobuyuki, Matsumaru Yuji, Ishikawa Eiichi
Departments of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan.
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
J Neurosurg Case Lessons. 2024 Nov 4;8(19). doi: 10.3171/CASE24441.
Venous hypertensive myelopathy (VHM), formerly known as "Foix-Alajouanine syndrome," is a spinal cord dysfunction caused by impaired perfusion of the spinal cord. Most cases are attributed to spinal dural arteriovenous fistulas (dAVFs), but there are scattered reports of VHM without concomitant dAVF. Furthermore, no cases of VHM associated with intracranial hemorrhage exist.
A 68-year-old man with a history of hypertension presented with a sudden headache, proximal paresis of the left upper extremity, impaired pain and temperature sensation in the right upper extremity, dysphagia, and dysarthria. Computed tomography scans showed intraparenchymal hemorrhage in the left medulla oblongata and a linear, continuous high-density area extending from the medulla oblongata to the cervical spinal cord. Magnetic resonance images showed cervical spondylosis at the C5-6 and C6-7 levels, with high signal intensity changes from the medulla oblongata to the lower cervical cord on T2-weighted images. Cerebral angiography showed no abnormal vessels. Conservative treatment gradually improved symptoms and the high signal intensity areas.
This case highlights intracranial hemorrhage occurring from extracranial causes and the possibility of VHM due to cervical spondylosis. When hemorrhagic lesions of the craniovertebral junction or spinal parenchymal lesions are encountered, the underlying pathology should be investigated thoroughly and systematically. https://thejns.org/doi/10.3171/CASE24441.
静脉性高血压脊髓病（VHM），以前称为“福-阿二氏综合征”，是一种由脊髓灌注受损引起的脊髓功能障碍。大多数病例归因于硬脊膜动静脉瘘（dAVF），但也有散在报道称VHM不伴有dAVF。此外，尚无VHM与颅内出血相关的病例。
一名68岁有高血压病史的男性，出现突发头痛、左上肢近端无力、右上肢痛温觉减退、吞咽困难和构音障碍。计算机断层扫描显示左延髓实质内出血，以及从延髓延伸至颈髓的线性连续高密度区。磁共振成像显示C5-6和C6-7水平的颈椎病，T2加权图像上从延髓到下颈髓有高信号强度改变。脑血管造影未显示异常血管。保守治疗使症状和高信号强度区逐渐改善。
该病例突出了颅外原因导致的颅内出血以及颈椎病引起VHM的可能性。当遇到颅颈交界区出血性病变或脊髓实质病变时，应全面、系统地调查其潜在病理。https://thejns.org/doi/10.3171/CASE24441
