J Cerebrovasc Endovasc Neurosurg.  2013 Mar;15(1):26-29. 10.7461/jcen.2013.15.1.26.

A Ruptured Aneurysm in the Branch of the Anterior Spinal Artery

• Yang TK

• KMID: 2172027
• DOI: http://doi.org/10.7461/jcen.2013.15.1.26

Abstract

Incidence of aneurysm of the anterior spinal artery is known to be very low and the standard treatment strategy has not yet been established. The author experienced a case of subarachnoid hemorrhage (SAH) caused by the rupture of an aneurysm in the branch of the cervical anterior spinal artery, which was managed conservatively. The patient had end-stage common bile duct cancer and survived for 103 days after onset of the SAH without a re-rupture of the aneurysm.

Keyword

Anterior spinal artery; Aneurysm; Subarachnoid hemorrhage

MeSH Terms

Aneurysm
Aneurysm, Ruptured
Arteries
Common Bile Duct
Humans
Incidence
Rupture
Subarachnoid Hemorrhage

Figure

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  Fig. 1 Brain computerized tomography shows more subarachnoid hemorrhage in the cisterns around the pons and medulla (A) than in the basal and interhemispheric cisterns (B).

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  Fig. 2 (A): An angiogram of the right internal carotid artery shows an anterior communicating artery aneurysm (arrow). (B): An angiogram of the right vertebral artery shows an aneurysm (arrow) at the branch of the anterior spinal artery (arrowheads)

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  Fig. 3 (A): Follow-up angiography of the right vertebral artery on the sixth hospital day shows the same aneurysm with a small filling defect (arrow). (B): The last follow-up angiography of the right vertebral artery on the 23rd hospital day shows the persistence of the aneurysm (arrow).

Reference

1. Bahar S, Coban O, Gurvit IH, Akman-Demir G, Gokyigit A. Spontaneous dissection of the extracranial vertebral artery with spinal subarachnoid haemorrhage in a patient with Behcet's disease. Neuroradiology. 1993; 35(5):352–354. PMID: 8327110.

2. Berlis A, Scheufler KM, Schmahl C, Rauer S, Gotz F, Schumacher M. Solitary spinal artery aneurysms as a rare source of spinal subarachnoid hemorrhage: potential etiology and treatment strategy. AJNR Am J Neuroradiol. 2005; 2. 26(2):405–410. PMID: 15709145.

3. Biondi A, Merland JJ, Hodes JE, Pruvo JP, Reizine D. Aneurysms of spinal arteries associated with intramedullary arteriovenous malformations. I. Angiographic and clinical aspects. AJNR Am J Neuroradiol. 1992; May-Jun. 13(3):913–922. PMID: 1590191.

4. Caglar YS, Torun F, Pait G, Bagdatoglu C, Sancak T. Ruptured aneurysm of the posterior spinal artery of the conus medullaris. J Clin Neurosci. 2005; 6. 12(5):603–605. PMID: 15975794.

5. Henson RA, Croft PB. Spontaneous spinal subarachnoid haemorrhage. Q J Med. 1956; 1. 25(97):53–66. PMID: 13323242.

6. Hino H, Maruyama H, Inomata H. [A case of spinal artery aneurysm presenting transverse myelopathy associated with coarctation of the aorta]. Rinsho Shinkeigaku. 1989; 8. 29(8):1009–1012. Japanese. PMID: 2689031.

7. Jiarakongmun P, Chewit P, Pongpech S. Ruptured anterior spinal artery aneurysm associated with coarctation of aorta. Case report and literature review. Interv Neuroradiol. 2002; 9. 8(3):285–292. PMID: 20594486.

8. Karakama J, Nakagawa K, Maehara T, Ohno K. Subarachnoid hemorrhage caused by a ruptured anterior spinal artery aneurysm. Neurol Med Chir (Tokyo). 2010; 50(11):1015–1019. PMID: 21123989.

9. Kawamura S, Yoshida T, Nonoyama Y, Yamada M, Suzuki A, Yasui N. Ruptured anterior spinal artery aneurysm: a case report. Surg Neurol. 1999; 6. 51(6):608–612. PMID: 10369227.

10. Klingler JH, Glasker S, Shah MJ, Van Velthoven V. Rupture of a spinal artery aneurysm attributable to exacerbated Sjogren syndrome: case report. Neurosurgery. 2009; 5. 64(5):E1010–E1011. discussion E1011. PMID: 19404125.

11. Kocak A, Ates O, Cayli SR, Sarac K. Isolated posterior spinal artery aneurysm. Br J Neurosurg. 2006; 20(4):241–244. PMID: 16954077.

12. Lavoie P, Raymond J, Roy D, Guilbert F, Weill A. Selective treatment of an anterior spinal artery aneurysm with endosaccular coil therapy. Case report. J Neurosurg Spine. 2007; 5. 6(5):460–464. PMID: 17542515.

13. Longatti P, Sgubin D, Di Paola F. Bleeding spinal artery aneurysms. J Neurosurg Spine. 2008; 6. 8(6):574–578. PMID: 18518680.

14. Moore DW, Hunt WE, Zimmerman JE. Ruptured anterior spinal artery aneurysm: repair via a posterior approach. Neurosurgery. 1982; 5. 10(5):626–630. PMID: 7099415.

15. Pollock JM, Powers AK, Stevens EA, Sanghvi AN, Wilson JA, Morris PP. Ruptured anterior spinal artery aneurysm: a case report. J Neuroimaging. 2009; 7. 19(3):277–279. PMID: 18681926.

16. Sharma S, Kumar S. Hematomyelia due to anterior spinal artery aneurysm in a patient with coarctation of aorta. Neurol India. 2010; Jul-Aug. 58(4):675–676. PMID: 20739828.

17. Thomson RL. Aneurysm in the cervical spinal canal. Med J Aust. 1980; 3. 1(5):220–222. PMID: 7374566.

18. Vincent FM. Anterior spinal artery aneurysm presenting as a subarachnoid hemorrhage. Stroke. 1981; Mar-Apr. 12(2):230–232. PMID: 7233470.

19. Walz DM, Woldenberg RF, Setton A. Pseudoaneurysm of the anterior spinal artery in a patient with Moyamoya: an unusual cause of subarachnoid hemorrhage. AJNR Am J Neuroradiol. 2006; 8. 27(7):1576–1578. PMID: 16908584.

20. Yonas H, Patre S, White RJ. Anterior spinal artery aneurysm. Case report. J Neurosurg. 1980; 10. 53(4):570–573. PMID: 7420184.

21. Yoong MF, Blumbergs PC, North JB. Primary (granulomatous) angiitis of the central nervous system with multiple aneurysms of spinal arteries. Case report. J Neurosurg. 1993; 10. 79(4):603–607. PMID: 8410233.