Abstract：
Dural arteriovenous fistulas may have insidious clinical presentations and are often challenging to diagnose. A small number of cases have been associated with perimedullary venous congestion and cord oedema, mimicking common pathologies, such as cervical myelopathy. We describe a case report of a patient presenting with a constellation of symptoms and radiological signs mimicking C5/6 cervical myelopathy secondary to disc herniation. The patient was managed with anterior cervical discectomy and fusion, with postoperative neurological deterioration unresponsive to steroid therapy. This prompted further investigation of other pathologies. An infratentorial Cognard 5 and Borden type 3 dural arteriovenous fistula was diagnosed on 6-vessel DSA and managed with onyx embolization. Marked improvement of neurological symptoms, notably bilateral lower limb weakness, was achieved postoperatively. In summary, this case demonstrates the importance of considering alternative, less common pathologies that involve the cervical spinal cord when neurological improvement is not achieved following decompressive surgery for cervical myelopathy.
摘要：
硬脑膜动静脉瘘可能具有隐匿的临床表现，并且通常难以诊断。少数病例与髓周静脉充血和脊髓水肿有关，模仿常见的病理，如脊髓型颈椎病。我们描述了一例病例报告，该患者表现出一系列症状和放射学体征，模仿椎间盘突出症继发的C5/6颈脊髓病。患者接受了颈椎前路椎间盘切除术和融合术，术后神经功能恶化对类固醇治疗无反应。这促使进一步调查其他病理。在6血管DSA上诊断为幕下Cognard5和Borden3型硬脑膜动静脉瘘，并通过玛瑙栓塞治疗。神经症状明显改善，尤其是双侧下肢无力，术后实现。总之,这个案例表明了考虑替代方案的重要性，在对脊髓型颈椎病进行减压手术后未实现神经系统改善时，涉及颈脊髓的较不常见的病变。
