{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:16:51Z","timestamp":1787163411778,"version":"build-2736575974"},"reference-count":19,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Dural arteriovenous fistulas (DAVFs) at the craniocervical junction (CCJ) involving the first spinal nerve represent a particularly rare and challenging subtype of DAVFs, with holocord myelopathy secondary to cerebrospinal DAVFs being an exceedingly rare presentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st2\">\n                    <jats:title>Case Description:<\/jats:title>\n                    <jats:p>We report the case of a 70-year-old woman who presented with progressive paraparesis over 2 weeks. Initial magnetic resonance imaging (MRI) of the spine showed extensive holocord myelopathy, leading to a misdiagnosis of inflammatory myelopathy and subsequent inappropriate steroid treatment at a local hospital, which exacerbated her neurological symptoms. On transfer to our institution and further evaluation with MRI and magnetic resonance angiography, a lower thoracic DAVF was initially suspected. However, comprehensive spinal angiography failed to localize the fistula, prompting cranial angiography, which ultimately identified a DAVF at the CCJ along the C1 nerve root, supplied by a small radiculomeningeal branch of the left vertebral artery. Successful management involved coagulation of the proximal draining vein, with follow-up imaging confirming complete fistula obliteration and resolution of the holocord edema.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st3\">\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This case highlights the diagnostic and therapeutic challenges associated with DAVFs at the CCJ, particularly when presenting with holocord myelopathy. It underscores the importance of a high index of suspicion and the need for timely, accurate diagnosis and intervention to prevent permanent spinal cord damage in such rare and complex cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.25259\/sni_138_2024","type":"journal-article","created":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T04:05:51Z","timestamp":1718942751000},"page":"209","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Holocord myelopathy misdiagnosed as neuromyelitis optica spectrum disorder (NMOSD): A unique case of dural arteriovenous fistula at the craniocervical junction along first spinal nerve"],"prefix":"10.25259","volume":"15","author":[{"given":"Prasert","family":"Iampreechakul","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Neurological Institution of Thailand, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Intouch","family":"Sopchokchai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institution of Thailand, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Korrapakc","family":"Wangtanaphat","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institution of Thailand, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songpol","family":"Chuntaroj","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Neurological Institution of Thailand, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yodkhwan","family":"Wattanasen","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Neurological Institution of Thailand, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunisa","family":"Hangsapruek","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Neurological Institution of Thailand, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Punjama","family":"Lertbutsayanukul","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Neurological Institution of Thailand, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Somkiet","family":"Siriwimonmas","sequence":"additional","affiliation":[{"name":"Department of Radiology, Bumrungrad International Hospital, Bangkok, Thailand."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2024,6,21]]},"reference":[{"key":"10.25259\/SNI_138_2024\/ref-1","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1055\/s-0042-1743211","article-title":"Longitudinally extensive 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