A young man was seen at a neurologic center for a slowly progressive m
yelopathy involving the lower limbs in 1983. After examination and inv
estigations, a diagnosis of chronic tuberculous spinal arachnoiditis w
as made and the patient was administered antituberculous treatment. Ho
wever, his condition continued to deteriorate. He was reviewed at anot
her center in 1985, where a diagnosis of demyelinating disorder was ma
de, for which he was treated. However, this also did not help, and he
was diagnosed as having a nonspecific spinal arachnoiditis at yet anot
her center in 1988. His condition continued to worsen, and after ten y
ears of symptoms, when magnetic resonance imaging (MRI) was done, an i
ntramedullary cystic lesion opposite D-12 vertebrae was seen, which on
histopathology was proved to be a vascular malformation. After excisi
on of the lesion his neurologic status has been slowly improving. The
conditions that a malformation could mimic, misleading a clinician, an
d the role of MRI in clinching the diagnosis are highlighted.