J Korean Neurosurg Soc.  2013 Jul;54(1):50-53. 10.3340/jkns.2013.54.1.50.

Solitary Ruptured Aneurysm of the Spinal Artery of Adamkiewicz with Subarachnoid Hemorrhage

• Son S
• Lee SG
• Park CW

• KMID: 2190859
• DOI: http://doi.org/10.3340/jkns.2013.54.1.50

Abstract

Spinal subarachnoid hemorrhage (SAH) due to solitary spinal aneurysm is extremely rare. A 45-year-old female patient visited the emergency department with severe headache and back pain. Imaging studies showed cerebral SAH in parietal lobe and spinal SAH in thoracolumbar level. Spinal angiography revealed a small pearl and string-like aneurysm of the Adamkiewicz artery at the T12 level. One month after onset, her back pain aggravated, and follow-up imaging study showed arachnoiditis. Two months after onset, her symptoms improved, and follow-up imaging study showed resolution of SAH. The present case of spinal SAH due to rupture of dissecting aneurysm of the Adamkiewicz artery underwent subsequent spontaneous resolution, indicating that the wait-and-see strategy may provide adequate treatment option.

Keyword

Subarachnoid hemorrhage; Aneurysm; Spine

MeSH Terms

Aneurysm
Aneurysm, Dissecting
Aneurysm, Ruptured
Angiography
Arachnoid
Arachnoiditis
Arteries
Back Pain
Emergencies
Female
Follow-Up Studies
Headache
Humans
Middle Aged
Parietal Lobe
Spine
Subarachnoid Hemorrhage

Figure

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  Fig. 1 Initial enhanced lumbar MRI. Sagittal image (B) view reveals thick SAH and focal intradural extramedullary mass lesion measuring 4×13 mm (white arrow) at the T12 level. Axial (A) view reveals focal mass lesion with peripheral rim enhancement (white arrow) at left anterolateral side of spinal cord. SAH : spinal subarachnoid hemorrhage.

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  Fig. 2 Spinal angiography of the segmental artery at the left L1 level shows fusiform aneurysm of the radiculomedullary branch of the Adamkiewicz artery with a diameter of approximately 3×11 mm.

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  Fig. 3 Follow-up enhanced lumbar MRI at one month after onset. Sagittal and axial views revealing slightly decreased hematoma with developed arachnoiditis of cauda equina and mass lesion at the T12 level.

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  Fig. 4 Follow-up enhanced lumbar MRI at two months after onset. Sagittal and axial views showing resolution of SAH with septated intradural fluid collection and remaining mass lesion at the T12 level.

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