THORACIC ISCHEMIC MYELOPATHY (FOIX–ALAJOUANINE SYNDROME)

The syndrome of Foix–Alajouanine (SFA) is a group of rare vascular diseases of the spinal cord. Etiological factors of development of this condition are anomalies of spinal veins, spinal dural arterio-venous fi stulas in the leading arteries, in the intramedullary network, as well as in venous collectors. The disease has a progressive and step-like course with periods of exacerbations and incomplete remissions, while the beginning can be both acute and subacute. The clinical picture is dominated by symptoms of myelopathy. Depending on the level of the lesion of the spinal cord violation of its functions can be characterized by a symptom complex of: 1) movement disorders (tetra – or paraparaesis spastic or peripheral); 2) changes in superfi cial and deep sensitivity (anesthesia, hypoesthesia, hyperesthesia at polyneuritises, conduction or segmental type, hyperpathia, allodynia, sensory ataxia); 3) infringement of functions of pelvic organs by type of Central delay or incontinence; 4) autonomic-trophic disorders. The manifestation of myelopathy may be initially asymmetric. Nonspecifi c symptoms often mask the disease, which causes diffi culties in timely diagnosis, diff erential search, establishing the true cause of disorders of the spinal cord. As a rule, only with a detailed clinical picture that determines the topical level of the lesion, and after a targeted MRI study with a vascular program, it is possible to establish a fi nal diagnosis. Lethal outcomes in this disease are possible in the case of thromboembolic complications associated with opportunistic infections of the pulmonary and urinary systems. We have presented a description of two patients with signs of progressive myelopathy at the thoracic level. One of them had background diseases – atherosclerosis and diabetes mellitus. Identifi ed the syndrome of Foix–Alajouanine vascular anomalies require immediate surgical intervention. With untimely treatment, a severe irreversible neurological defi cit, especially motor function, can form, which prevents the social adaptation of patients.