Subarachnoid hemorrhage due to isolated spinal artery aneurysm in four patients

Abstract

Spinal artery aneurysms are usually found with arteriovenous malformations or other entities that increase hemodynamic stress. Isolated spinal artery aneurysms are rare. Four patients who presented with the acute onset of lower back pain underwent MR imaging, which revealed spinal subarachnoid hemorrhage. In all patients, work-up yielded a diagnosis of isolated spinal aneurysm, and operative treatment was successful. In the appropriate clinical setting, spinal aneurysm should be considered as a possible cause of spinal subarachnoid hemorrhage.

Fig 1.

Selective angiogram of the left artery of Adamkiewicz at T11 showing a fusiform aneurysm (arrow). Reprinted with permission from Lippincott Williams & Wilkins.

Fig 2.

(A) Selective angiogram of the left L1 spinal artery showing 2 aneurysms (arrows). (B) Additional view of left L1 spinal artery injection showing 2 aneurysms (arrows).

Fig 3.

(A) Initial sagittal T2-weighted MR image showing a large amount of subarachnoid hemorrhage (arrows) at the thoracolumbar junction but no definite focal lesion. (B) Initial axial T2-weighted MR images showing a large amount of subarachnoid hemorrhage (arrows).

Fig 4.

(A) Sagittal and (B) axial T2-weighted images obtained 11 days after the patient’s first MR imaging showing a more focal lesion adjacent to the conus medullaris at T12 (arrow).

Fig 5.

Selective angiographic injection of the left T6 spinal artery showing an aneurysm (arrow) involving the radicular branch.