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A 15-year-old male high school football player presented with episodes of headache and complete body stiffness, especially in the arms, lower back, and thighs, immediately following a football game. This was accompanied by severe nausea and vomiting for several days. Viral meningitis was suspected by the primary clinician, and treatment with corticosteroids was initiated. Over the next several weeks, there was gradual symptom improvement and the patient returned to his baseline clinical status. The patient experienced a severe recurrence of the previous myriad of symptoms following a subsequent football game, without an obvious isolated traumatic episode. In addition, he experienced a new left sided headache, fatigue, and difficulty ambulating. He was admitted and an extensive workup was performed. CT and MRI of the head revealed concurrent intracranial and spinal subdural hematomas (SDH). Clinical workup did not reveal any evidence of coagulopathy or predisposing vascular lesions. Spinal SDH is an uncommon condition whose concurrence with intracranial SDH is an even greater clinical rarity. We suggest that our case represents an acute on chronic intracranial SDH with rebleeding, membrane rupture, and symptomatic redistribution of hematoma to the spinal subdural space.

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Purpose: Splenic artery aneurysms are the most common visceral aneurysms. While their incidence has grown with increased use of cross-sectional imaging, little is known about the natural history of these lesions. We sought to investigate patient characteristics, clinical risk factors, and growth patterns of splenic artery aneurysms in a large patient cohort. Materials and Methods: A patient list was retrieved from all Kaiser Permanente sites in Southern California via query of the electronic medical records system for the ICD9 code 442.83 (splenic artery aneurysm). Patient charts were retrospectively reviewed and demographics and medical comorbidities documented for each case. Cases of splenic pseudoaneurysm were excluded. Image reports were reviewed to find the oldest and most recent imaging in which the lesion was noted and the size was recorded for each. The patient chart was also reviewed for interventions in the form of open surgical or IR procedures. Results: 569 patient with splenic artery aneurysms were identified with females accounting for 78% (n¼442) of cases. The mean number of pregnancies in the 221 women with a documented obstetrics history was 3.9. The largest proportion of patients were White (69.1%), followed by Hispanic (22.5%), Asian (4.5%), and African American (3.8%). Current or former smokers made up 43.5% of all patients. The most frequent comorbidities in patients with splenic artery aneurysms were hypertension (67.4%), hyperlipidemia (55.9%), obesity (28.9%), diabetes mellitus (27.6%), atherosclerosis (25.3%), and liver cirrhosis (7.9%). 60 patients underwent a therapeutic procedure for their aneurysm including 39 with IR (primarily coil embolization), 18 with surgery, and 3 requiring both surgical and IR management. Longitudinal imaging data were available for 277 patients. 179 (65%) of these patients had aneurysms that were stable or decreased in maximum dimension. In the 98 patients who experienced interval aneurysm growth, the average growth rate was 0.95 mm/year. Conclusion: The preliminary results from our patient cohort represent the largest retrospective review of splenic artery aneurysms and aid in better defining the patient risk factors and natural history of these lesions.