Spontaneous Spinal Subarachnoid Hemorrhage from a Ruptured Radiculopial Artery Aneurysm

Cadieux, Magalie; Tso, Michael K; Fox, Shandy; Jacobs, W. Bradley

doi:10.1016/j.wneu.2020.08.208

Cited by 3 publications

(4 citation statements)

References 12 publications

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“…[13][14][15] Initial presentation with thunderclap headache and nuchal rigidity followed by acute onset of paraplegia has also been described. 16 This was the case with our patient because the presentation was a more classic thunder clap headache with depressed level of consciousness, prompting neuroimaging.…”

Section: Observationsmentioning

confidence: 62%

“…Surgical management has been the mainstay modality among reported cases. 3,8,11,[13][14][15][16] A common approach is hemilaminectomy and clipping or parent vessel sacrifice given the dorsolateral location of the PSA aneurysms. 3,11 Adjunctive neuromonitoring has been described in addition to the use of intraoperative indocyanine green (ICG), although in cases with thrombosed aneurysms at the time of surgery, ICG has limited utility.…”

Section: Observationsmentioning

confidence: 99%

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Posterior spinal artery aneurysm as an unlikely culprit for perimesencephalic pattern subarachnoid hemorrhage: illustrative case

Malhotra¹,

Ku²,

Pereira

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Angiogram-negative nontraumatic subarachnoid hemorrhage (SAH) can be diagnostically challenging, and a broad differential diagnosis must be considered. Particular attention to initial radiographic hemorrhage distribution is essential to guide adjunctive investigations. Posterior spinal artery aneurysms are rare clinical entities with few reported cases in the literature. An understanding of isolated spinal artery aneurysm natural history, diagnosis, and management is evolving as more cases are identified. OBSERVATIONS Isolated thoracic posterior spinal artery aneurysm can be the culprit lesion in perimesencephalic distribution SAH. Embolization resulted in complete aneurysm occlusion and did not result in periprocedural morbidity. At the 1-year follow-up, the patient was neurologically intact with no recurrence on magnetic resonance angiography. LESSONS This case report highlighted the presentation, diagnostic workup, clinical decision-making, and endovascular intervention for a woman who presented with SAH secondary to posterior spinal artery aneurysm. After initially negative results on vascular imaging, dedicated spinal vascular imaging revealed the location of the aneurysm. Multiple treatment modalities exist for isolated spinal artery aneurysms and must be selected on the basis of patient- and lesion-specific characteristics.

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Section: Observationsmentioning

confidence: 62%

Section: Observationsmentioning

confidence: 99%

Posterior spinal artery aneurysm as an unlikely culprit for perimesencephalic pattern subarachnoid hemorrhage: illustrative case

Malhotra¹,

Ku²,

Pereira

et al. 2021

Journal of Neurosurgery: Case Lessons

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show abstract

“…The propensity for ischemic changes in the thoracolumbar region is significantly higher, as it is mainly supplied by a single vessel, namely the Adamkiewicz artery ( 26 , 27 ). A ruptured spinal aneurysm also causes paralysis ( 28 ). Of note, the present study has certain limitations: Spinal angiography was not performed to preclude paraplegia due to spinal vascular disease.…”

Section: Discussionmentioning

confidence: 99%

Acute paraplegia after aneurysmal subarachnoid hemorrhage: Case report of a rare complication with a 2‑year follow‑up

et al. 2023

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The current overall incidence of subarachnoid hemorrhage (SAH) is ~9/100,000 individuals/year and rupture of an intracranial aneurysm is the main cause of SAH, accounting for ~85% of cases. Only a small number of cases of paraplegia after intracranial aneurysmal SAH have so far been reported and its pathogenesis has remained to be fully elucidated. The present study reports the case of a patient with an aneurysm localized in the medial and inferior lateral wall of the C5 segment of the right internal carotid artery that was treated by coil interventional embolization. The muscle strength of both lower extremities of the patient was grade I and grade 0 before and after the operation, respectively. Lumbar and thoracic magnetic resonance imaging examinations revealed slight hematoma in the subarachnoid space below the L2 level. At two weeks after the operation, the muscle strength of both lower extremities was grade II, while the muscle strength was grade III and grade V at 30 and 60 days after the operation, respectively.

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“…Subarachnoid hemorrhage (SAH) originating from spinal lesions is rare, occurring in <1.5% of spinal tumors; they are typically spinal ependymomas or cavernous angiomas. [ 2 , 9 ] Even more unusual, are hemorrhages occurring in spinal schwannomas resulting in both SAH and subdural hematomas (SDHs); there are approximately 20 such cases reported in the literature. [ 9 ]…”

Section: Introductionmentioning

confidence: 99%

Cauda equina schwannoma presenting with subarachnoid and subdural hemorrhage: Its underlying mechanism

Shiraishi¹,

Tomita²,

Akai³

et al. 2021

Surgical Neurology International

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Background: A patient presented with a spinal subarachnoid hemorrhage (SAH) and subdural hematoma (SDH) attributed to a spinal schwannoma at the T12-L1 level. Case Description: A 67-year-old male acutely presented with severe back pain and L1 paraparesis/sensory loss, with urinary incontinence. CT/MR studies showed a spinal SAH and SDH within a likely T12-L1 schwannoma. At surgery, the hemorrhage within the tumor was continuous through the lower pole of the tumor into the subarachnoid and subdural spaces; tumor was dissected away from the surrounding tissues and totally removed. The postoperative course was uneventful, and the preoperative neurological deficits gradually resolved. Histopathologically, the lesion was a schwannoma with intratumoral hemorrhage. Conclusion: This case demonstrates the rare acute presentation of a T12-L1 schwannoma with an accompanying intratumoral hemorrhage resulting in both a SDH/SAH.

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Spontaneous Spinal Subarachnoid Hemorrhage from a Ruptured Radiculopial Artery Aneurysm

Cited by 3 publications

References 12 publications

Posterior spinal artery aneurysm as an unlikely culprit for perimesencephalic pattern subarachnoid hemorrhage: illustrative case

Posterior spinal artery aneurysm as an unlikely culprit for perimesencephalic pattern subarachnoid hemorrhage: illustrative case

Acute paraplegia after aneurysmal subarachnoid hemorrhage: Case report of a rare complication with a 2‑year follow‑up

Cauda equina schwannoma presenting with subarachnoid and subdural hemorrhage: Its underlying mechanism

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