2025年 · 第105卷第10期

A 60-year-old male was admitted with "weakness of both lower limbs for 3 months, neck stiffness for 20 d, aggravation with pain for 3 d". Three months before admission, the patient developed weakness in both lower limbs after labor, which could be relieved by rest. Later, the symptoms aggravated with numbness, which gradually failed to be completely relieved. 20 days ago, he felt neck stiffness and discomfort, and 3 days ago, it aggravated with local persistent pain. Physical examination: Muscle strength of both lower limbs grade 4, no hypoesthesia, and bilateral pathological signs were negative. Twenty years of previous history of hypertension. MRI: Thickening of medulla oblongata and cervical spinal cord, T₂Long strip abnormal lesions with high signal were seen in WI (Figure 1, arrows), T₂FLAIR showed hyperintensity lamellar abnormal lesions in the medulla oblongata (Figure 2, arrow), which was suspected of myelitis. After hormone therapy, limb weakness was aggravated. Physical examination: muscle strength of both lower limbs was grade 4, accompanied by superficial hypoesthesia, and bilateral pathological signs were positive. Enhanced MRI showed abnormally enhanced vascular shadows on the ventral side of the medulla oblongata and cervical cord (Figure 3, arrow), and high cervical spinal dural arteriovenous fistula (SDAVF) was suspected. Digital subtraction angiography (DSA): a thick drainage vein connected to a branch of the left vertebral artery V3 segment was visible, and the spinal vein was thickened (Figure 4, arrows), and SDAVF was diagnosed. SDAVF is a rare spinal vascular malformation, which is caused by the communication between the arteries supplying the dura and the drainage veins of the spinal cord on the dura, and is clinically characterized by progressive aggravation of limb motor and sensory dysfunction. Hormone therapy aggravates the condition. MRI shows long-segment myelitis-like abnormal changes, similar to long-segment myelitis of neuromyelitis optica spectrum diseases, but with local vascular flow empty shadows or abnormal enhancement of malformed vessels on the spinal cord surface. DSA examination can confirm the diagnosis.