Ruptured aneurysm of the artery of Adamkiewicz as a rare cause of spinal cord injury

Abstract

This case report describes a patient who presented with low back pain, headache and urinary retention. He developed altered mental status with right lower extremity hemiparesis. He was subsequently found to have subarachnoid haemorrhage and was ultimately diagnosed with a ruptured aneurysm of the artery of Adamkiewicz. At 11-week follow-up, he had made a significant recovery and was functioning at a modified independent level. This case report explores previous cases of ruptured artery of Adamkiewicz aneurysms as a rare cause of spinal cord injury, and discusses management and recovery for these injuries.

Keywords: Disability; Physiotherapy (rehabilitation); Spinal cord.

Figure 1

Head CT demonstrates hyperdense subarachnoid blood products in the occipital lobe sulci (yellow asterisks) and the prepontine cistern (white arrows). A small amount of intraventricular haemorrhage is also noted (yellow arrow).

Figure 2

T2-weighted MRI of the T-spine at the T10 level demonstrates hypointense haematoma (white arrows) occupying a majority of the spinal canal. The haematoma causes spinal cord compression as well as posterior and leftward displacement of the cord (yellow asterisk).

Figure 3

Angiography image demonstrates fusiform aneurysmal dilatation (black arrow) of the artery of Adamkiewicz (AA) which is seen arising from the right T11 intercostal artery (white arrow). The opacified anterior spinal artery (black asterisks) is also noted to be filling prominently from the AA, indicating patency at the time of this study.

Figure 4

MRI of the T-spine 11 weeks after initial injury demonstrates resolved haematoma with residual T2 hypointense web-like arachnoid adhesions (white arrow) at the level of T10. Increased T2 signal within the centre of the spinal cord represents a small cord syrinx, a well-known complication of spinal cord trauma.

Figure 5

Sagittal view of the thoracic spinal cord demonstrating the artery of Adamkiewicz originating from an intercostal artery and coursing through the dura mater and arachnoid mater to join the anterior spinal artery in the subarachnoid space. Figure digitally created by AH.