{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T14:12:37Z","timestamp":1778249557890,"version":"3.51.4"},"reference-count":9,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,4,22]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>Spinal vascular malformations are rare causes of progressive myelopathy, often leading to misdiagnosis as inflammatory disorders like neuromyelitis optica spectrum disorder (NMOSD). We present the case of a man in his late 30s who developed a 9-month history of progressive low back pain, ascending paraesthesia and worsening paraparesis. Initial MRI showed longitudinally extensive transverse myelitis (LETM), and he was treated for seronegative NMOSD with steroids and plasmapheresis despite negative AQP4-IgG and MOG-IgG. As his condition didn\u2019t improve, a spinal dural arteriovenous fistula (SDAVF) was suspected and confirmed via digital subtraction angiography (DSA). Following successful endovascular embolisation, the patient\u2019s motor strength improved substantially and he regained the ability to ambulate with a cane. This case highlights that while double-negative (DN) NMOSD is a challenging clinical syndrome, the identification of mimics like SDAVF is of higher diagnostic priority to prevent the morbidity associated with inappropriate long-term immunosuppression<\/jats:p>","DOI":"10.1136\/bcr-2026-272118","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T13:25:32Z","timestamp":1778246732000},"page":"e272118","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Spinal dural arteriovenous fistula mimicking neuromyelitis optica spectrum disorder: a diagnostic pitfall"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5912-285X","authenticated-orcid":false,"given":"Ammar Abd Alrahman","family":"Alobaidy","sequence":"first","affiliation":[{"name":"Medicine Department-Neurology Unit, Sultan Qaboos University Hospital, Muscat, Oman"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iman","family":"Al-Lawati","sequence":"additional","affiliation":[{"name":"Neurology and Interventional Neuroradiology Departments, Khoula Hospital, Muscat, Oman"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Al-Habsi","sequence":"additional","affiliation":[{"name":"Neurology and Interventional Neuroradiology Departments, Khoula Hospital, Muscat, Oman"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"2026050806250890000_19.5.e272118.1","doi-asserted-by":"crossref","unstructured":"Hafiz B , Aldahlawi A , Ashqar A , et al . Outcomes of Surgical versus Endovascular Treatment of Spinal Dural Arteriovenous Fistula: A Systematic Review and Meta-Analysis. World Neurosurg 2025;202. doi:10.1016\/j.wneu.2025.124420","DOI":"10.1016\/j.wneu.2025.124420"},{"key":"2026050806250890000_19.5.e272118.2","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.nrl.2016.12.001","article-title":"Spinal arteriovenous fistulas in adults: Management of a series of patients treated at a neurology department","volume":"33","author":"Ortega-Suero","year":"2018","journal-title":"Neurologia (Engl Ed)"},{"key":"2026050806250890000_19.5.e272118.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0090-3019(99)00038-5"},{"key":"2026050806250890000_19.5.e272118.4","doi-asserted-by":"crossref","unstructured":"Choi CW , Suen CH , Chu PY . Spinal Dural Arterio-Venous Fistula: A Vital Differential Diagnosis to Consider for Myelopathy. Eur J Case Rep Intern Med 2023;10. doi:10.12890\/2023_003861","DOI":"10.12890\/2023_003861"},{"key":"2026050806250890000_19.5.e272118.5","doi-asserted-by":"crossref","first-page":"402","DOI":"10.18203\/2349-3933.ijam20241287","article-title":"Spinal dural arteriovenous fistula: a case-based review","volume":"11","author":"Pore","year":"2024","journal-title":"Int J Adv Med"},{"key":"2026050806250890000_19.5.e272118.6","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001729"},{"key":"2026050806250890000_19.5.e272118.7","first-page":"10","article-title":"Application of NMOSD IPND-2015 Criteria in AQP4-IgG Positive, MOG-IgG Positive and Seronegative Inflammatory Demyelinating Diseases (P10-14.004)","volume":"102","author":"Apostolos-Pereira","year":"2024","journal-title":"Neurology (ECronicon)"},{"key":"2026050806250890000_19.5.e272118.8","doi-asserted-by":"crossref","first-page":"17030","DOI":"10.1038\/scsandc.2017.30","article-title":"Clinical pitfall: false-positive aquaporin-4 IgG leading to misdiagnosis of neuromyelitis optica spectrum disorder in patient with spinal arteriovenous fistula","volume":"3","author":"Suthiphosuwan","year":"2017","journal-title":"Spinal Cord Ser Cases"},{"key":"2026050806250890000_19.5.e272118.9","doi-asserted-by":"publisher","DOI":"10.1177\/13524585231199819"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-272118","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T13:25:36Z","timestamp":1778246736000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-272118"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":9,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,8]]},"published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1136\/bcr-2026-272118"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-272118","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}