Objective: To investigate the clinical and imaging characteristics of spinal dural arteriovenous fistula (SDAVF) and improve the understanding of SDAVF in the clinical practice.

Methods: The clinical diagnosis and treatment of a patient with SDAVF were reported. Neurology and imaging experts were invited to discuss the clinical and imaging characteristics of SDAVF based on literature reviews.

Results: A SDAVF patient manifested progressive numbness of the right lower extremity and unstable working with numbness starting from the right little toe and propagating upwards along the outboard of the right leg to crissum. The patient developed low back pain and incontinence later. Thoracic spine magnetic resonance imaging (MRI) enhanced scan showed a long central strip with hyper-intensity on T2-weighted imaging below the ninth thoracic vertebrae, and small vascular shadows were enhanced around the spinal cord. Lumbar spine MRI showed the signal of T2-weighted imaging of the conus was increased. A surgical resection for SDAVF under general anesthesia was performed. One and a half years later after the surgery, the symptoms of the patient were alliviated a lot.

Conclusion: The clinical manifestation of SDAVF is mixed and usually atypical. However, SDAVF should be considered in the elders with slowly progressive myelopathic symptoms. Spinal MRI plays an important role in suggesting the diagnosis of SDAVF. Both clinicians and radiologists should be well aware of the classical MRI characteristics of SDAVF to make the correct diagnosis as soon as possible. Early treatment can improve the prognosis and prevent the symptoms from irreversibility.