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This case concerns a 73-year-old man who developed progressive paraparesis and hypoesthesia in the lower limbs. MRI revealed a large intramedullary lesion extending from T6 to L1. Further investigation, including spinal angiography, revealed an ascending vessel—raising a critical question: was it the artery of Adamkiewicz or a dilated ascending dural vein?
The suspected diagnosis was a filum terminale arteriovenous fistula, but further analysis led to a different conclusion. Discover the final diagnosis, the therapeutic strategy, and the patient outcome in this complex and challenging case.