Successfully Treated Isolated Posterior Spinal Artery Aneurysm Causing Intracranial Subarachnoid Hemorrhage: Case Report

There are very few published reports of rupture of an isolated posterior spinal artery (PSA) aneurysm, and consequently the optimal therapeutic strategy is debatable. An 84-year-old man presented with sudden onset of restlessness and disorientation. Neuroradiological imaging showed an intracranial subarachnoid hemorrhage (SAH) with no visible intracranial vascular lesion. Spinal magnetic resonance imaging (MRI) detected a localized subarachnoid hematoma at Th10–11. Both contrast-enhanced spinal computed tomography and enhanced MRI and magnetic resonance angiography revealed an area of enhancement within the hematoma. Superselective angiography of the left Th12 intercostal artery demonstrated a faintly enhanced spot in the venous phase. Thirteen days after the onset of symptoms, a small fusiform aneurysm situated on the radiculopial artery was resected. The patient's postoperative course was uneventful and he was eventually discharged in an ambulatory condition. To our knowledge, this 84-year-old man is the oldest reported case of surgical management of a ruptured isolated PSA aneurysm. This case illustrates both the validity and efficacy of this therapeutic approach.

[1]  M. Takayama,et al.  An Isolated Posterior Spinal Aneurysm Resection in Which Intraoperative Electrophysiological Monitoring Was Successfully Used to Locate the Lesion and to Detect the Possibility of Ischemic Complications , 2016, Spine.

[2]  G. Lanzino,et al.  A Cause of Atypical Intracranial Subarachnoid Hemorrhage: Posterior Spinal Artery Aneurysms , 2015, Neurocritical Care.

[3]  D. Yavagal,et al.  Posterior spinal artery aneurysm rupture after ‘Ecstasy’ abuse , 2014, Journal of NeuroInterventional Surgery.

[4]  C. Ogilvy,et al.  Clinical presentation and treatment considerations of a ruptured posterior spinal artery pseudoaneurysm , 2014, Journal of clinical neuroscience.

[5]  D. Yavagal,et al.  Posterior spinal artery aneurysm rupture after ‘Ecstasy’ abuse , 2014, BMJ Case Reports.

[6]  P. Brouwer,et al.  Management Considerations in Ruptured Isolated Radiculopial Artery Aneurysms , 2013, Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences.

[7]  L. Roccatagliata,et al.  Multiple aneurysms of thoracic spinal cord arteries presenting with spinal infarction and subarachnoid hemorrhage: case report and literature review. , 2012, Neurosurgery.

[8]  O. Tanweer,et al.  Endovascular obliteration of a ruptured posterior spinal artery pseudoaneurysm. , 2012, Journal of neurosurgery. Spine.

[9]  Hyun Jeong Kim,et al.  Dissecting aneurysm of the posterior spinal artery: case report and review of the literature. , 2012, Neurosurgery.

[10]  T. Krings,et al.  Subarachnoid Hemorrhage Following Posterior Spinal Artery Aneurysm Rupture , 2012, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[11]  T. Krings,et al.  Subarachnoid Hemorrhage following Posterior Spinal Artery Aneurysm , 2010, Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences.

[12]  H. Çavuşoğlu,et al.  Isolated posterior spinal artery aneurysm causing intracranial acute subarachnoidal hemorrhage , 2010, Acta Neurochirurgica.

[13]  R. Hevner,et al.  Dissecting aneurysm of the thoracic posterior spinal artery. Case illustration. , 2006, Journal of neurosurgery. Spine.

[14]  K. Saraç,et al.  Isolated posterior spinal artery aneurysm , 2006, British journal of neurosurgery.

[15]  F. Torun,et al.  Ruptured aneurysm of the posterior spinal artery of the conus medullaris , 2005, Journal of Clinical Neuroscience.

[16]  F. Götz,et al.  Solitary spinal artery aneurysms as a rare source of spinal subarachnoid hemorrhage: potential etiology and treatment strategy. , 2005, AJNR. American journal of neuroradiology.

[17]  K. Miyasaka,et al.  Vascular Anatomy of the Spinal Cord and Classification of Spinal Arteriovenous Malformations , 2000, Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences.

[18]  P. Kragel,et al.  Spinal arterial aneurysm: case report. , 1993, Neurosurgery.

[19]  K. Sugita,et al.  Isolated intramedullary spinal artery aneurysm presenting with quadriplegia. Case report. , 1992, Journal of neurosurgery.

[20]  Y. Yonekawa,et al.  Ruptured aneurysm of the posterior spinal artery of the upper cervical spinal cord: case report. , 1988, Neurosurgery.