BACKGROUND: Dorsal arachnoid web (DAW) is a rare spinal pathology involving a thickened band of arachnoid tissue that compresses the thoracic spinal cord, potentially causing myelopathy. Patients with DAW who present with pain or neurological complaints should be evaluated thoroughly to determine the most likely cause of symptoms, particularly in the context of clinical presentations that overlap with other neurological or pain syndromes.

CASE REPORT: A 76-year-old man with a history of inclusion body myositis and prior middle cerebral artery stroke presented with left-sided pain and weakness. Although DAW was noted on imaging, further evaluation indicated that the patient’s pain symptoms were due to central pain syndrome secondary to his previous stroke, given the correlation between symptom localization and stroke territory. He was managed successfully with pregabalin and amitriptyline without the need for surgical intervention.

CONCLUSION: In patients with overlapping neurological and pain syndromes, accurate diagnosis is essential to determining the best choice of treatment.

KEYWORDS: Chronic pain, case report, central pain syndrome, diagnostic imaging, dorsal arachnoid web