title: Venous congestive myelopathy: three autopsy cases showing a variety of clinicopathologic features.
abstract: We describe three patients with progressive myelopathy, in whom autopsy revealed spinal cord pathology compatible with that of venous congestive myelopathy (VCM) associated with dural arteriovenous fistula (AVF), formerly known as angiodysgenetic necrotizing myelopathy (Foix-Alajournine syndrome). In these three patients, common symptoms were gait disturbance and sensory disturbance of the extremities, and these symptoms slowly worsened. The clinical diagnoses varied and included spinal cord intramedullary tumor, cervical spondylosis and multiple sclerosis. At autopsy, all the patients showed enlarged, tortuous venous vessels on the dorsal surfaces of the spinal cord at the affected levels. In the affected spinal cord parenchyma, necrotic lesions manifested by various degrees of neuronal loss and gliosis, with increased numbers of hyalinized vessels, were evident. The presence or absence of associated spinal dural AVF could not be identified histopathologically. Even with the help of modern neurological examination methods, early and accurate clinical diagnosis of VCM is sometimes difficult. When encountering patients with progressive myelopathy, VCM, although recognized as rare, should be considered as an important differential diagnosis.
authors.affiliation: Department of Pathology, Brain Research Institute, University of Niigata, Niigata, Japan. matsuo@pb4.so-net.ne.jp
authors.forename: Koushun
authors.initials: K
authors.lastname: Matsuo
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Kakita
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Ishizu
authors.forename: Kohtaro
authors.initials: K
authors.lastname: Endo
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Takashi
authors.initials: T
authors.lastname: Morita
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D020785:Central Nervous System Vascular Malformations / Q000150:complications; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000473:pathology; D013116:Spinal Cord / Q000098:blood supply / Q000473:pathology; D013118:Spinal Cord Diseases / Q000473:pathology* / Q000503:physiopathology*; D013120:Spinal Cord Neoplasms / Q000473:pathology; D013128:Spinal Osteophytosis / Q000473:pathology