The patient convalesced and began ambulating with use of a walker. He regained some element of sphincter control. At the 1-year follow-up office visit, he was ambulating well with the assistance of a walker. Discussion The cause of FAS has been attributed to infection, thrombophlebitis, and spinal AVM or AVF (Matsuo et al. 2008). Scattered reports Inhibitors,research,lifescience,medical of venous infarction of the spinal cord have been associated with decompression sickness, gliosarcoma, orchiectomy, pulmonary emboli, furunculosis,

leukemia, polycythemia, and thrombosis of leg veins (Srigley et al. 1981; Clarke and Cumming 1987; Niino et al. 1999). In classic FAS, venous drainage of the AVF is to the coronal venous plexus lying posterolaterally over the Inhibitors,research,lifescience,medical cord’s surface (Renowden and Molyneux 1993). Elevation of venous pressure occurs; the absence of valves promotes transmission of high pressure to the radial intramedullary vein and cord parenchyma, causing myelopathy. From a pathophysiologic perspective, VCM represents irreversibly progressive disease due to damage of the spinal cord parenchyma caused by venous congestion. Unlike

cases of hemorrhagic or embolic spinal venous infarction, which typically present with symptoms of sudden onset Inhibitors,research,lifescience,medical of low back pain and progress rapidly, VCM carries more insidious onset and protracted course. Although patients uniformly present with paraparesis or sensory disturbance, the pattern of distribution and progression of VCM can be heterogeneous,

often precluding prompt diagnosis. Inhibitors,research,lifescience,medical Imaging characteristics compound the diagnostic evasiveness of VCM. Typified by an intramedullary lesion with high signal intensity on T2-weighted imaging, flow voids of tortuous vessels can be seen on the dorsal surface of the spinal cord. The increased T2 signal reflects increased water content of necrotic tissue and the proliferated vessels Inhibitors,research,lifescience,medical in VCM. MR imaging can also show mass effect with cord swelling, iso- or hypointense T1 signal changes and parenchymal enhancement with contrast, making it difficult to distinguish VCM from spinal infarction, transverse myelitis, multiple sclerosis (Scolding 2001), second or intramedullary tumor (Rodriguez et al. 2005). Not uncommonly, MR findings of VCM with spinal cord enlargement/enhancement are so suggestive of tumor that they prompt biopsy (Rodriguez et al. 2005), as in this case (biopsy obtained at an outside hospital was negative). It is not inconceivable that a vascular malformation undergoes Dolutegravir ic50 spontaneous thrombosis (Renowden and Molyneux 1993). Although myelography can demonstrate dilated tortuous coronal venous plexus as serpentine filling defects, in reported cases of spontaneous thrombosis, the cause of abnormal veins visualized by myelography cannot be demonstrated by angiography (Wrobel et al. 1988; Renowden and Molyneux 1993).