Dissection Aneurysm of the Radiculomedullary Branch of the Artery of Adamkiewicz With Subarachnoid Hemorrhage  -Case Report-

Iihoshi, Satoshi; Miyata, Kei; Murakami, Tomohiro; Kaneko, Takahisa; Koyanagi, Izumi

doi:10.2176/nmc.51.649

Cited by 28 publications

(18 citation statements)

References 19 publications

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“…However, some patients with thoracic and even thoracolumbar SAs had cranial SAH on CT scans. 27,37,68,75,100,107 All patients who present with angiography-negative SAH that is most prominent in the posterior fossa or fourth ventricle may therefore need to be evaluated with spinal DSA or MR angiography. Some SAs may bleed into the cord, causing hematomyelia.…”

Section: Hemorrhagementioning

confidence: 99%

Spinal aneurysms: clinicoradiological features and management paradigms

Madhugiri

Ambekar

Kumar

et al. 2013

SPI

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Object Spinal aneurysms (SAs) are rare lesions. The clinicoradiological features and the exact degree of their association with comorbid conditions such as arteriovenous malformations (AVMs) and coarctation of the aorta have not been definitively described. The ideal management paradigm has not been established. The authors reviewed literature to determine the clinical patterns of presentation, management, and outcome of spinal aneurysms. Methods A systematic review of literature was performed using 23 separate strings. A total of 10,190 papers were screened to identify 87 papers that met the inclusion criteria. A total of 123 SAs could be included for analysis. Results The mean age of patients at presentation was 38 years; 10% of patients were aged less than 10 years and nearly 50% were greater than 38 years. Spinal aneurysms can be divided into 2 groups: those associated with AVMs (SA-AVMs, or Type 1 SAs) and those with isolated aneurysms (iSAs, or Type 2 SAs). Patients with Type 2 SAs were older and more likely to present with bleeding than those with Type 1 SAs. The acute syndromes can be divided into 3 groups of patients: those with spinal syndrome, those with cranial/craniospinal syndrome, and those with nonspecific presentation. Overall, 32.6% presented with angiography-negative cranial subarachnoid hemorrhage (SAH). Presentation with evidence of cord dysfunction (myelopathy/weakness/sensory loss/bladder involvement) correlated with poor outcome, as did presentation with hemorrhage and association with other comorbid conditions. Surgery and endovascular therapy both led to comparable rates of complete aneurysm obliteration for Type 2 SAs, whereas for the AVM-associated Type 1 SAs, surgery led to better rates of lesion obliteration. The authors propose a classification scheme for spinal aneurysms based on whether the lesion is solitary or is associated with a coexistent spinal AVM; this would also imply that the ideal therapy for the aneurysm would differ based on this association. Conclusions The clinical and radiological patterns that influence outcome are distinct for Type 1 and Type 2 SAs. The ideal treatment for Type 1 SAs appears to be excision, whereas surgery and endovascular therapy were equally effective for Type 2 SAs.

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Section: Hemorrhagementioning

confidence: 99%

Spinal aneurysms: clinicoradiological features and management paradigms

Madhugiri

Ambekar

Kumar

et al. 2013

SPI

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“…Only 7 cases of ruptured solitary aneurysm of Adamkiewicz artery, including the present case, have been reported (Table 1)1,2,5,8,10).…”

Section: Discussionmentioning

confidence: 76%

Solitary Ruptured Aneurysm of the Spinal Artery of Adamkiewicz with Subarachnoid Hemorrhage

Son

Lee

Park

2013

J Korean Neurosurg Soc

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Spinal subarachnoid hemorrhage (SAH) due to solitary spinal aneurysm is extremely rare. A 45-year-old female patient visited the emergency department with severe headache and back pain. Imaging studies showed cerebral SAH in parietal lobe and spinal SAH in thoracolumbar level. Spinal angiography revealed a small pearl and string-like aneurysm of the Adamkiewicz artery at the T12 level. One month after onset, her back pain aggravated, and follow-up imaging study showed arachnoiditis. Two months after onset, her symptoms improved, and follow-up imaging study showed resolution of SAH. The present case of spinal SAH due to rupture of dissecting aneurysm of the Adamkiewicz artery underwent subsequent spontaneous resolution, indicating that the wait-and-see strategy may provide adequate treatment option.

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“…Spontaneous lesions are not uncommonly reported but we were unable to identify any similar cases of post-traumatic cervical spinal subarachnoid hemorrhage associated with a spinal artery pseudoaneurysm in the literature. Fusiform dissecting aneurysms, arising from the principle thoracic rediculomedullary supply (T6–T12 levels), have previously been described by Iihoshi et al 4 who also reviewed five similar published cases. Three of these cases were managed conservatively and each had a favorable outcome.…”

Section: Discussionmentioning

confidence: 91%

Conservative management of a post-traumatic pseudoaneurysm of the artery of cervical enlargement–anterior spinal artery junction

et al. 2015

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A 22-year-old man suffered severe sudden onset head and neck pain after being pushed from behind during an assault. Physical examination was normal. Cervical MRI demonstrated an intradural hematoma, anterior to the cord, between C2–4. Subsequent contrast enhanced MR angiography and digital subtraction vertebral angiography confirmed that the cause of the hemorrhage was a fusiform (presumed dissecting) pseudoaneurysm of the artery of the cervical enlargement at its junction with the anterior spinal artery. The aneurysm was managed conservatively. Follow-up angiography demonstrated that the aneurysm had spontaneously thrombosed within 10 days and remained occluded at 2 months. The patient remained occluded at 6 months following the initial injury. Anterior spinal aneurysms represent a management dilemma and options are discussed.

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Dissection Aneurysm of the Radiculomedullary Branch of the Artery of Adamkiewicz With Subarachnoid Hemorrhage -Case Report-

Cited by 28 publications

References 19 publications

Spinal aneurysms: clinicoradiological features and management paradigms

Spinal aneurysms: clinicoradiological features and management paradigms

Solitary Ruptured Aneurysm of the Spinal Artery of Adamkiewicz with Subarachnoid Hemorrhage

Conservative management of a post-traumatic pseudoaneurysm of the artery of cervical enlargement–anterior spinal artery junction

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