Subarachnoid Hemorrhage due to Ruptured Spinal Artery Aneurysm: A Diagnostic Challenge

Abstract

Subarachnoid hemorrhage (SAH) due to a solitary spinal aneurysm is extremely rare. Early diagnosis of spinal SAH is challenging, particularly when the spinal cord has not been compressed. We report a case of a 45-year-old male who presented with sudden onset of abdominal pain, followed by severe headache, vomiting, and generalized seizure. Three days after admission to the hospital, he developed progressive paraparesis. Magnetic resonance imaging (MRI) revealed spinal SAH with hematoma resulting in cord compression at the level of T9. Diagnostic spinal angiography identified a ruptured aneurysm of a radiculomedullary artery. In conclusion, rupture of a spinal aneurysm should be considered a possible cause of SAH in appropriate clinical settings, and clinicians must be aware of the possibility of cord compression.

Dorsal intradural spinal arteriovenous fistula associated with giant intradural spinal aneurysm, a case report

“…Microsurgery provides better parent vessel preservation and decompressive benefits rather than an endovascular approach. 4 , 15 , 16 Madhugiri et al conducted a systematic review of spinal aneurysms and concluded that AVM and cord dysfunction‐associated spinal aneurysms will benefit from the microsurgical approach. 18 Mansour et al reported a craniovertebral junction AVF and aneurysm in the anterior spinal artery (ASA) territory that was microsurgically treated.…”

“…Mass effect and acute neurological deficits are the main indications for microsurgical intervention for spinal aneurysms while smaller lesions with a silent clinical course can be treated via endovascular approaches. Microsurgery provides better parent vessel preservation and decompressive benefits rather than an endovascular approach 4,15,16 . Madhugiri et al conducted a systematic review of spinal aneurysms and concluded that AVM and cord dysfunction‐associated spinal aneurysms will benefit from the microsurgical approach 18 .…”

“…In terms of histologic features, these lesions are homologues to intracranial aneurysms with true three‐wall angio‐architecture. Due to its rarity, less is known about real clinical manifestations, natural course, and best treatment strategy 4 . In this rare case, we report dorsal intradural SAVF associated with a simultaneous intraspinal aneurysm that was treated in a hybrid vascular approach.…”

“…Due to its rarity, less is known about real clinical manifestations, natural course, and best treatment strategy. 4 In this rare case, we report dorsal intradural SAVF associated with a simultaneous intraspinal aneurysm that was treated in a hybrid vascular approach.…”

Dissecting a radiculomedullary artery as an infrequent cause of low back pain: illustrative case

“… 12 MRI is considered the gold standard to locate the hematoma and describe its relationship with the spinal cord, 4 authors such as Kirsch et al 13 classify them according to their imaging characteristics as acute (1–3 days) highlighting isointense hematomas in T1 and mixed in T2, subacute (4–7 days) characterized by a high-intensity image in T1 and T2 and finally in the chronic stages (weeks to months) a high diffuse signal is seen, it is also described that they are generally located in the anterolateral region of the spinal cord and present a compressive pattern. 14 After the identification of the hematoma, some authors suggest performing spinal angiography according to availability, the degree of neurosurgical emergency, and the suspicion of vascular malformation, in this way it is intended to better characterize some lesions such as radicular aneurysms, arteriovenous malformations, and radicular dissections. 15 …”