Subarachnoid haemorrhage due to a lateral spinal artery aneurysm misdiagnosed as a posterior inferior cerebellar artery aneurysm: case report and literature review

Abstract

We describe the first example of an LSA aneurysm without occlusion or severe stenosis of the VA and PICA. This extremely rare lesion illustrates how knowledge of the angiographic features and super-selective cerebral angiography aids the precise diagnosis and the prevention of surgical complications.

Aneurysms Arising from Persistent Arteries in the Vertebrobasilar Paramedian Longitudinal Axis: Two Case Reports

“…With respect to the PLA, aneurysms on the lateral spinal artery have been reported. [10][11][12][13][14] However, only one other aneurysm rostral to the origin of the PICA has been documented. 3) In their patient, the aberrant artery, called the bulbar artery, arose from the distal part of the intracranial VA to supply the PICA as one of the collateral pathways.…”

Clipping of Ruptured Aneurysm of Lateral Spinal Artery Associated with Anastomosis to Distal Posterior Inferior Cerebellar Artery: A Case Report

“…Aneurysms that originate from arteries that anastomose with the PICA are rarely described. Some of these arteries are the bulbar artery 1 , leptomeningeal collateralization 2 and LSA [3][4][5] . The case reported here is remarkable, because the LSA was the most important anatomized vessel to take over the PICA territory supply, leading to an increased flow condition from its origin to the level of anastomosis with the PICA, evolving into an aneurysm formation and rupture as a result.…”

Cerebellar Glioblastoma Multiforme Presenting as Hypertensive Cerebellar Hemorrhage: Case Report

“…11,13,14 Patients often have headaches, signs of increased intracranial pressure, and cerebellar signs including cerebellar ataxia, an inability to perform a tandem gait, dysmetria, and dysdiadochokinesia. 3,8,[10][11][12][13][14]16 The duration of symptoms before presentation varies from 1 to 4 months, a period significantly shorter than that of the more common tumors of the posterior fossa, which tend to have a longer history before presentation. 9,23,25,26 GBMs of the cerebellum may also occur and present in atypical ways.…”

“…Long-standing hypertension with degenerative changes in the vessel walls and subsequent rupture is believed to be the most common cause of a typical cerebellar hemorrhage. 10,13,28 Blood dyscrasias, amyloid angiopathy, arteriovenous malfor-mations, trauma, and sympathomimetic abuse are less common causes of cerebellar hemorrhage. Cerebellar hemorrhages have been reported to be rare in patients after supratentorial or spinal surgery and in patients with spontaneous intracranial hypotension.…”

“…18,29,30 The location of the hemorrhage is important in determining the symptoms and clinical course, and the location may be more important than the absolute hematoma size for prognosis. 13,30,31 Generally speaking, the more lateral the hemorrhage and the smaller the hematoma, the more likely the brainstem structures are spared and the better the prognosis. Brainstem damage by compression from an expanding mass in the posterior fossa is a common and feared complication.…”