Case Report: Diagnostic anchoring in spinal dural arteriovenous fistula: a case-based analysis of clinical-radiological mismatch and delayed recognition

作者：Xiaobin Luo, Yali Zhong, Cong Hou, Yong Zou, Hao Ding, Yang Chenghao · 发表于：Frontiers in Medicine · 年份：2026 · DOI：10.3389/fmed.2026.1845311 · 研究领域：Vascular Malformations Diagnosis and Treatment、Spinal Hematomas and Complications、Cervical and Thoracic Myelopathy

Spinal dural arteriovenous fistula (SDAVF) is an uncommon but treatable cause of progressive myelopathy, and its diagnosis is frequently delayed because early symptoms may be misattributed to lumbar degenerative disease, inflammatory myelopathy, or peripheral neurological disorders. We report a 49-year-old man with progressive bilateral lower-limb weakness and numbness over 1 week, followed by marked deterioration within 2 days. Initial lumbar imaging showed disc bulging and degenerative changes, creating a potential diagnostic anchor; however, the bilateral deficits, rapid progression, gait impairment, and urinary and bowel dysfunction were disproportionate to the lumbar findings. Thoracic magnetic resonance imaging (MRI) demonstrated longitudinal intramedullary T2 hyperintensity extending from T5 to T12 and suspected dorsal serpiginous perimedullary flow voids, suggesting venous congestive myelopathy caused by a spinal vascular lesion. Although inflammatory or demyelinating myelopathy was considered, cerebrospinal fluid examination was deferred at that stage because dorsal perimedullary flow voids and the overall imaging pattern made a vascular etiology more likely and more urgent to confirm. Digital subtraction angiography (DSA) was therefore prioritized and confirmed a right T5 SDAVF. The patient underwent microsurgical disconnection, with postoperative angiography confirming complete obliteration and gradual neurological improvement thereafter. The educational value of t...