Abstract Number: Esoc2026a1639 Spinal Dural Arteriovenous Fistula as a Diagnostic Pitfall in Progressive Myelopathy: A Case Report and Literature Review

Abstract Background and aims Spinal dural arteriovenous fistulas (sDAVFs) are rare but potentially reversible vascular causes of progressive myelopathy resulting from venous hypertensive congestion of the spinal cord. Because of their insidious onset and nonspecific clinical and radiological features, they are frequently misclassified in acute and pre-hospital settings, leading to delayed neurology referral and preventable neurological disability. Methods We report a 61-year-old man with several months of progressive gait impairment, lower limb numbness, and urinary retention. Examination showed spastic paraparesis (Aminoff–Logue G4 U3). Spinal MRI demonstrated longitudinal T2 hyperintensity from T7 to L1 with dilated perimedullary flow voids. Cerebrospinal fluid showed elevated protein, initially suggesting inflammatory or degenerative etiologies. However, progressive symptoms with sphincter dysfunction and characteristic imaging raised suspicion for a vascular cause. Digital subtraction angiography confirmed a right-sided dural arteriovenous fistula at L2. Endovascular embolization resulted in clinical improvement with recovery of motor function and resolution of urinary symptoms (Aminoff–Logue G3 U1). Results A brief literature review indicates that median diagnostic delays range from 12 to 44 months, primarily due to misinterpretation of MRI, attribution of symptoms to nonvascular spinal disorders, and low awareness during stroke-mimic triage and early neurological assessment. Prolonged delays are consistently associated with poorer neurological outcomes. Conclusions This case emphasizes the importance of including sDAVF in stroke-mimic algorithms and neurology referral pathways for patients with unexplained progressive myelopathy, to enable timely angiographic confirmation and definitive treatment. Conflict of interest Oneda Cibuku: nothing to disclose Figure 1 - belongs to Methods Figure 2 - belongs to Methods Figure 3 - belongs to Methods