Subarachnoid Hemorrhage Caused by a Ruptured Anterior Spinal Artery Aneurysm -Case Report-

Abstract

A 51-year-old man presented with an extremely rare case of intracranial subarachnoid hemorrhage caused by rupture of an anterior spinal artery aneurysm manifesting as disturbance of consciousness following sudden onset of neck pain and numbness of the extremities. Cranial computed tomography revealed subarachnoid hemorrhage, mainly in the posterior fossa. Cerebral angiography studies on admission and on the 4th day demonstrated no definite abnormality as a bleeding source. A ventricular catheter was inserted to treat the acute hydrocephalus, and conservative management was continued during the acute period. Third angiography on the 18th day demonstrated an anterior spinal artery aneurysm at the C1 level which was considered to be the bleeding site. After conservative treatment, the patient was discharged without neurological deficits. Fourth angiography on the 108th day disclosed spontaneous disappearance of the aneurysm, which was confirmed by the fifth angiography on the 269th day. If subarachnoid hemorrhage of unknown etiology is encountered, spinal artery aneurysm should be considered as the bleeding source. Despite the controversy concerning the treatment strategy, ruptured spinal artery aneurysms can be treated conservatively because of the possibility of spontaneous regression. Follow-up angiography is required to evaluate the natural course of the lesion.

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

“…The pathogenesis of spinal artery aneurysms has been discussed. 10,18) Spinal artery aneurysms without inflammatory reaction, infection, or connective tissue disease have also been reported, as in the present case. Most spinal artery aneurysms are small with diameters of º3 mm, and although both saccular and fusiform aneurysms have been identified, the latter are more frequent.…”

“…Most spinal artery aneurysms are small with diameters of º3 mm, and although both saccular and fusiform aneurysms have been identified, the latter are more frequent. 1,3,5,10,12,14,16,18,20,21) Three cases of spinal artery aneurysms were found to be fusiform dissecting lesions at surgery. 15) Some spinal artery aneurysms appear to be dissecting lesions.…”

Dissecting spinal aneurysms: conservative management as a therapeutic option

“…Ikeda et al presented a case of a ruptured PSA aneurysm that underwent spontaneous thrombosis confirmed intraoperatively with ICG video angiography and confirmed by histological examination which revealed organized thrombus formation within the aneurysm 3. Karakama et al reported a case of a ruptured ASA aneurysm causing subarachnoid hemorrhage that was managed conservatively with confirmed angiographic occlusion on follow-up 4. Pahl et al reported the spontenous resolution of a ruptured isolated cervical ASA aneurysm 7.…”

Rotational angiography for diagnosis and surgical planning in the management of spinal vascular lesions

“…A recent review reported only 26 cases of ruptured isolated spinal artery aneurysms in the literature. 15 Seven of those 26 aneurysms were located on the ASA, 5 on the artery of Adamkiewicz, 4 on the PSA, and the remaining aneurysms were fed by segmental or radiculomedullary branches.…”