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Case Reports
. 2015;55(12):915-9.
doi: 10.2176/nmc.cr.2015-0210. Epub 2015 Oct 30.

Successfully Treated Isolated Posterior Spinal Artery Aneurysm Causing Intracranial Subarachnoid Hemorrhage: Case Report

Yoshinobu Horio  1 , Toshiro Katsuta, Kazuhiro Samura, Naoki Wakuta, Kenji Fukuda, Toshio Higashi, Tooru Inoue
Affiliations
Case Reports

Successfully Treated Isolated Posterior Spinal Artery Aneurysm Causing Intracranial Subarachnoid Hemorrhage: Case Report

Yoshinobu Horio et al. Neurol Med Chir (Tokyo). 2015.

Abstract

There are very few published reports of rupture of an isolated posterior spinal artery (PSA) aneurysm, and consequently the optimal therapeutic strategy is debatable. An 84-year-old man presented with sudden onset of restlessness and disorientation. Neuroradiological imaging showed an intracranial subarachnoid hemorrhage (SAH) with no visible intracranial vascular lesion. Spinal magnetic resonance imaging (MRI) detected a localized subarachnoid hematoma at Th10-11. Both contrast-enhanced spinal computed tomography and enhanced MRI and magnetic resonance angiography revealed an area of enhancement within the hematoma. Superselective angiography of the left Th12 intercostal artery demonstrated a faintly enhanced spot in the venous phase. Thirteen days after the onset of symptoms, a small fusiform aneurysm situated on the radiculopial artery was resected. The patient's postoperative course was uneventful and he was eventually discharged in an ambulatory condition. To our knowledge, this 84-year-old man is the oldest reported case of surgical management of a ruptured isolated PSA aneurysm. This case illustrates both the validity and efficacy of this therapeutic approach.

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Conflict of interest statement

Conflicts of Interest Disclosure

The authors report no conflicts of interest concerning the materials or methods used in this study or the findings specified in this article. All authors have registered online Self-reported COI Disclosure Statement Forms through the website for JNS members. This study is not supported by any grant. The authors declare that no work resembling the enclosed article has been published or is being submitted for publication elsewhere.

Figures

Fig. 1
Fig. 1
Initial neuroradiological imagings. A: Brain computed tomography showing intracranial subarachnoid hemorrhage (arrows). B: Spinal MRI (T2-weighted image). The hypointensity lesion at Th10–11 (arrow) suggests a localized subarachnoid hematoma.
Fig. 2
Fig. 2
Contrast-enhanced computed tomography (day 1: A) and spinal magnetic resonance imaging (day 5: B). A: There is an area of enhancement on left dorsal aspect of the spinal cord at Th10–11 (arrow). B: Contrast-enhanced T1-weighted image showing an area of enhancement within the hematoma (arrow).
Fig. 3
Fig. 3
Spinal digital subtraction angiography (day 9). Superselective angiographic image of the Th12 intercostal artery showing a faintly enhanced area in the venous phase (arrow). The connections with surrounding vessels are not clear.
Fig. 4
Fig. 4
Intraoperative image (day 13). After removal of the yellowish-white hematoma on the left dorsal aspect of the spinal cord, a fusiform aneurysm was detected on the radiculopial artery. An: aneurysm, Radiculopial a.: radiculopial artery.
See this image and copyright information in PMC

References

    1. Ronchetti G, Morales-Valero SF, Lanzino G, Wald JT: A cause of atypical intracranial subarachnoid hemorrhage: posterior spinal artery aneurysms. Neurocrit Care 22: 299– 305, 2015. - PubMed
    1. Berlis A, Scheufler KM, Schmahl C, Rauer S, Götz F, Schumacher M: Solitary spinal artery aneurysms as a rare source of spinal subarachnoid hemorrhage: potential etiology and treatment strategy. AJNR Am J Neuroradiol 26: 405– 410, 2005. - PMC - PubMed
    1. Rengachary SS, Duke DA, Tsai FY, Kragel PJ: Spinal arterial aneurysm: case report. Neurosurgery 33: 125– 130; discussion 129–130, 1993. - PubMed
    1. Kim HJ, Choi IS: Dissecting aneurysm of the posterior spinal artery: case report and review of the literature. Neurosurgery 71: E749– E756; discussion E756, 2012. - PubMed
    1. Miyasaka K, Asano T, Ushikoshi S, Hida K, Koyanagi I: Vascular anatomy of the spinal cord and classification of spinal arteriovenous malformations. Interv Neuroradiol 30( 6 Suppl 1): 195– 198, 2000. - PMC - PubMed

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