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Sankarappan K, Doucet D, Daly SR, Nguyen AV, Garrett D, Lesley WS, Feng D, Vance AZ, Huang JH. Exploring Spinal Subarachnoid Hemorrhage: A Neurosurgical Case Series. Cureus 2023; 15:e45627. [PMID: 37868412 PMCID: PMC10588961 DOI: 10.7759/cureus.45627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Spinal subarachnoid hemorrhage (SSAH) is a rare condition that can cause spinal cord or nerve root compression and permanent neurologic damage. The reported etiologies include trauma, vascular malformations or aneurysms, coagulopathies, neoplasms, autoimmune disease, and spontaneous hemorrhage. If there is evidence of neurologic deterioration, it is commonly managed as a surgical emergency, but cases of conservative management have also been reported. In this case series, we present three patients who suffered from SSAH. The first was a spontaneous cervical SSAH that occurred following cardiac catheterization, the second was a spontaneous thoracolumbar SSAH in a patient with a known history of coagulopathy, and the third was a thoracolumbar SSAH that was caused by a dural arteriovenous fistula (dAVF). All three patients exhibited neurologic deficits and thus underwent emergent decompression and hematoma evacuation. The patient with the dAVF also required open ligation of the fistula. Following surgical intervention, all three patients regained at least partial neurologic function, but one patient developed symptomatic arachnoid cysts that required further intervention. The presented case series highlights the importance and time-sensitivity of surgical decompression in patients experiencing neurologic deficits from SSAH. These cases underscore the urgency of timely neurosurgical intervention to mitigate neurologic impairment and add insights to the existing literature on this rare condition.
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Affiliation(s)
| | - Dakota Doucet
- Neurosurgery, Baylor Scott & White Medical Center, Temple, USA
| | - Samuel R Daly
- Neurosurgery, Baylor Scott & White Medical Center, Temple, USA
| | | | - David Garrett
- Neurosurgery, Baylor Scott & White Medical Center, Temple, USA
| | - Walter S Lesley
- Neurosurgery, Baylor Scott & White Medical Center, Temple, USA
| | - Dongxia Feng
- Neurosurgery, Baylor Scott & White Medical Center, Temple, USA
| | - Awais Z Vance
- Neurosurgery, Baylor Scott & White Medical Center, Temple, USA
| | - Jason H Huang
- Neurosurgery, Baylor Scott & White Medical Center, Temple, USA
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Alrazooqi MK, Skikic E, Iqbal SS, Sulaiman L, Muhammed Noori OQ. Traumatic Spinal Epidural Hematoma With Significant Neurologic Findings: A Case Report. Cureus 2023; 15:e38869. [PMID: 37188062 PMCID: PMC10181898 DOI: 10.7759/cureus.38869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 05/17/2023] Open
Abstract
Traumatic spinal epidural hematoma (TSEH) is a rare neurosurgical emergency. Our case report centers around a young 34-year-old female brought into our emergency department after a front and rear motor vehicle collision. Clinical deterioration and imaging studies revealed a large spinal epidural hematoma extending from levels C5 to T2. The patient was subsequently transferred to a different hospital for further management. This case involved a multidisciplinary approach by the combined effort of emergency medicine physicians, neurosurgeons, orthopedic trauma surgeons, general surgeons, radiologists, intensive care specialists, anesthesiologists, paramedics and nurses.
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Affiliation(s)
- Maryam K Alrazooqi
- Emergency Medicine, Rashid Hospital Trauma Centre/Dubai Academic Health Corporation, Dubai, ARE
| | - Ena Skikic
- Emergency Medicine, Rashid Hospital Trauma Centre/Dubai Academic Health Corporation, Dubai, ARE
| | - Shaikh S Iqbal
- Radiology, Rashid Hospital Trauma Centre/Dubai Academic Health Corporation, Dubai, ARE
| | - Lara Sulaiman
- Emergency Medicine, Rashid Hospital Trauma Centre/Dubai Academic Health Corporation, Dubai, ARE
| | - Omar Q Muhammed Noori
- Emergency Medicine, Rashid Hospital Trauma Centre/Dubai Academic Health Corporation, Dubai, ARE
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de Andrada Pereira B, Meyer BM, Alvarez Reyes A, Orenday-Barraza JM, Brasiliense LB, Hurlbert RJ. Traumatic cervical spine subarachnoid hemorrhage with hematoma and cord compression presenting as Brown-Séqüard syndrome: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22431. [PMID: 36471576 PMCID: PMC9724008 DOI: 10.3171/case22431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Spinal hematomas are a rare entity with broad etiologies, which stem from idiopathic, tumor-related, and vascular malformation etiologies. Less common causes include traumatic blunt nonpenetrating spinal hematomas with very few cases being reported. In the present manuscript presents a case report and review of the literature of a rare traumatic entity of a cervical subarachnoid hematoma in association with Brown-Séquard syndrome in a patient on anticoagulants. Searches were performed on PubMed and Embase for specific terms related. OBSERVATIONS A well-documented case of an 83-year-old female taking anticoagulants with traumatic cervical subarachnoid hematoma presenting as Brown-Séquard syndrome was reported. Six similar cases were identified, scrutinized, and analyzed in the literature review. LESSONS Traumatic blunt nonpenetrating cervical spine subarachnoid hematomas are a rare entity that can happen more specifically in anticoagulant users and in patients with arthritic changes and stenosis of the spinal canal. Rapid neurological deterioration and severe disability warrant early aggressive surgical treatment. This report has the intention to record this case in the medical literature for registry purposes.
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Affiliation(s)
| | - Benjamen M. Meyer
- College of Medicine, University of Arizona Tucson, Tucson, Arizona; and
| | | | - Jose Manuel Orenday-Barraza
- Department of Neurosurgery, University of Arizona Phoenix, Banner University Medical Center, Phoenix, Arizona
| | - Leonardo B. Brasiliense
- Department of Neurosurgery, University of Arizona Tucson, Banner University Medical Center, Tucson, Arizona
| | - R. John Hurlbert
- Department of Neurosurgery, University of Arizona Tucson, Banner University Medical Center, Tucson, Arizona
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Bojanowski MW, Stefanovic K, Bergeron D, Farzin B, Létourneau-Guillon L, Chaalala C. Pregnancy as a Subgroup in the Pathophysiologic Classification of Spinal Aneurysms. World Neurosurg 2021; 157:e264-e270. [PMID: 34637940 DOI: 10.1016/j.wneu.2021.10.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Aneurysms of spinal arteries not associated with any known predisposing condition are referred to as isolated spinal aneurysms (SAs). In our series, an SA was found in 2 patients during the postpartum period. The goal of this study is to determine whether an occurrence of an SA may be related to puerperium. METHODS In a retrospective analysis of our consecutive series of 10 cases of SAs from 2008 to 2020, we identified 2 cases of SAs during puerperium. Patients' charts and imaging were reviewed, for potential predisposing factors. RESULTS In both cases, angiography showed fusiform aneurysms of the anterior SA with concomitant bilateral vertebral artery (VA) dissections. Serum vasculitis and inflammatory panel and genetic testing for collagen disorders were negative in both cases. Review of the literature showed that pregnancy is associated with an increased risk of arterial dissections in various locations and supports the hypothesis that hemodynamic and hormonal changes may play a role in the formation of SAs. CONCLUSIONS Pregnancy and peripartum state may be a distinct cause of the formation of SAs, possibly as a result of increased hemodynamic stress and hormonal changes that may alter the arterial wall. It would be appropriate to add pregnancy as a subgroup in the classification of SAs. In our series, both cases were associated with bilateral VA dissections; it is possible that the bilateral VA stenosis may have contributed to the formation of the SAs. It is important to recognize this possibility when considering the occlusion of a dissected VA.
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Affiliation(s)
| | | | - David Bergeron
- Division of Neurosurgery, University of Montreal, Montreal, Canada
| | - Behzad Farzin
- Department of Radiology, University of Montreal, Montreal, Canada
| | | | - Chiraz Chaalala
- Division of Neurosurgery, University of Montreal, Montreal, Canada
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Zhao J, Esemen Y, Rane N, Nair R. Intracranial Subarachnoid Haemorrhage Caused by Cervical Spinal Dural Arteriovenous Fistulas: Case Report. Front Neurol 2021; 12:685332. [PMID: 34447345 PMCID: PMC8383207 DOI: 10.3389/fneur.2021.685332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/24/2021] [Indexed: 11/23/2022] Open
Abstract
Cervical spinal vascular abnormalities commonly present with progressive myelopathy as a result of venous congestion. They are not very prone to bleed and tend to be underdiagnosed due to their subtle clinical presentation. We came across a rare case of intracranial subarachnoid haemorrhage caused by cervical spinal dural fistula in the Imperial College Healthcare NHS Trust Hospitals/UK in June 2020. We diagnosed the patient under strict evidence base medicine guidance, which otherwise would have been missed. We discussed the case in several multidisciplinary team (MDT) meetings, and patient was treated under the joint care of the neurology and neurosurgical teams. Patient made a full recovery and discharged home with no neurological defects or complications. Here, we reported this case with all the evidence we gathered from our MDT discussion. We hope our experience would help improve the diagnosis and management protocol for future patients with a similar condition.
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Affiliation(s)
- Junjie Zhao
- Department of Neuroscience, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Yagmur Esemen
- Department of Neuroscience, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Neil Rane
- Department of Radiology, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Ramesh Nair
- Department of Neuroscience, Imperial College Healthcare National Health Service Trust, London, United Kingdom
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Condette-Auliac S, Gratieux J, Boulin A, Di Maria F, Consoli A, Coskun O, Smajda S, Rodesch G. Imaging of vascular diseases of the spinal cord. Rev Neurol (Paris) 2021; 177:477-489. [PMID: 33902944 DOI: 10.1016/j.neurol.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/13/2021] [Indexed: 11/15/2022]
Affiliation(s)
- S Condette-Auliac
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France.
| | - J Gratieux
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - A Boulin
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - F Di Maria
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - A Consoli
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - O Coskun
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
| | - S Smajda
- Department of interventional Neuroradiology, Fondation Rotschild, Paris, France
| | - G Rodesch
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France
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Lo SH, Chen PT, Yu WJ, Hsieh KS, Chen TC. Case Report: Spinal Subarachnoid Hemorrhage: A Rare Complication of Hemorrhagic Fever with Renal Syndrome. Am J Trop Med Hyg 2021; 104:1432-1434. [PMID: 33591937 DOI: 10.4269/ajtmh.20-0823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 01/04/2021] [Indexed: 11/07/2022] Open
Abstract
Hemorrhagic fever with renal syndrome (HFRS), caused by hantavirus, is occasionally seen in tropical areas. The virus is carried by specific rodent host species. Hemorrhagic fever with renal syndrome is characterized by renal failure and hemorrhagic manifestations, and its complications may be severe, including massive bleeding, multi-organ dysfunction, and possibly death. In this patient case, a 46-year-old woman diagnosed with HFRS initially presented with fever, impaired function, and thrombocytopenia. Four days after symptom onset, the patient complained of abrupt right lower abdominal pain and numbness. Magnetic resonance imaging revealed a spinal subarachnoid hemorrhage (SAH) beyond the T7 to S2 vertebrae. No cases of spinal SAH in HFRS have been reported until now. This case demonstrates that when a patient's symptoms are atypical, bleeding-related complications must be considered.
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Affiliation(s)
- Shih-Hao Lo
- 1Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Ting Chen
- 2Department of Post Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wan-Jin Yu
- 3Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ke-Syuan Hsieh
- 3Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tun-Chieh Chen
- 2Department of Post Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,3Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,4Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Minardi M, Vercelli GG, Mammi M, Fiumefreddo A, Garbossa D. Dorsal subdural hemorrhage from ruptured thoracic radicular artery pseudoaneurysm. case report and surgical video. Clin Neurol Neurosurg 2021; 202:106505. [PMID: 33486155 DOI: 10.1016/j.clineuro.2021.106505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
Radiculomedullary artery malformations are rare conditions: their rupture usually manifests with subarachnoid hemorrhage. To the best of our knowledge no cases of subdural bleeding have been described in the literature. We present the rare case of a 74 year old woman admitted to our Institute with sudden onset of right lower limb motor deficit and hypoesthesia, with no history of trauma: Magnetic Resonance Imaging of the dorsal spine was performed and a subdural hematoma was detected; subsequent dorsal laminectomy for hematoma evacuation was carried out. As the source of bleeding was not recognized, Digital Subtraction Angiography (DSA) was performed: a new leak of contrast agent from a dilation of a spinal radicular artery at the level of T5 was detected; XperCT imaging (an angiographic acquisition of Computed Tomography-like images) confirmed a new acute subdural bleeding. Urgent repeat surgery was considered the best option to identify and close the malformation. Postoperative DSA confirmed complete exclusion of the radicular artery malformation. This is the first report that describes, with an intraoperative video, a case of radiculomedullary artery pseudoaneurysm, responsible of an acute subdural bleeding and associated neurological deficit.
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Affiliation(s)
- Massimiliano Minardi
- Neurosurgery Unit, Department of Neuroscience, Città della salute e della Scienza Torino, Via Cherasco 15, Turin, Italy.
| | - Giovanni Giulio Vercelli
- Neurosurgery Unit, Department of Neuroscience, Città della salute e della Scienza Torino, Via Cherasco 15, Turin, Italy
| | - Marco Mammi
- Neurosurgery Unit, Department of Neuroscience, Città della salute e della Scienza Torino, Via Cherasco 15, Turin, Italy
| | - Alessandro Fiumefreddo
- Neurosurgery Unit, Department of Neuroscience, Città della salute e della Scienza Torino, Via Cherasco 15, Turin, Italy
| | - Diego Garbossa
- Neurosurgery Unit, Department of Neuroscience, Città della salute e della Scienza Torino, Via Cherasco 15, Turin, Italy
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Nakamura T, Ueno T, Arai A, Iwamura M, Midorikawa H, Murakami K, Tomiyama M. Subarachnoid Hemorrhage Caused by Ruptured Aneurysm of the Artery of Adamkiewicz: a Case Report. J Stroke Cerebrovasc Dis 2020; 29:105224. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/24/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
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Anterior Spinal Artery Steal Syndrome Complicated by Ruptured Flow-Related Aneurysm of the Anterior Radiculomedullary Artery. World Neurosurg 2020; 144:185-191. [PMID: 32889198 DOI: 10.1016/j.wneu.2020.08.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Anterior spinal artery steal syndrome, radiculomedullary artery aneurysms, and pulmonary arteriovenous malformations with a systemic origin are each, considered individually, exceptional conditions. CASE DESCRIPTION We describe the coexistence of all these conditions and their pathophysiologic relationship by presenting the case of a woman who referred to the emergency department for loss of consciousness and a history of 2 days of medullary symptoms and a subsequent acute respiratory failure. Detailed imaging revealed a subarachnoid hemorrhage due to the rupture of a spinal aneurysm located in a C8 radiculomedullary artery that had its flow reversed toward the deep cervical artery from which a systemic to pulmonary arteriovenous malformation originated. CONCLUSIONS Eventually, the lesion was treated with the exclusion of the left C8 spinal segmental branch and embolization of the arteriovenous malformation.
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Nguyen NH, Le VC, Nguyen TQ, Nguyen TH. Subarachnoid Hemorrhage due to Ruptured Spinal Artery Aneurysm: A Diagnostic Challenge. Case Rep Neurol 2020; 12:169-175. [PMID: 33505290 DOI: 10.1159/000507953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 04/10/2020] [Indexed: 12/29/2022] Open
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.
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Affiliation(s)
| | - Vien Chi Le
- Stroke Center, 108 Military Central Hospital, Ha Noi, Vietnam
| | - Trung Quoc Nguyen
- Cerebrovascular Disease Department, People's Hospital 115, Ho Chi Minh City, Vietnam
| | - Thang Huy Nguyen
- Cerebrovascular Disease Department, People's Hospital 115, Ho Chi Minh City, Vietnam.,Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Subarachnoid Hemorrhage as Result of Retrocorporeal Artery Aneurysm Rupture: Rare Sequel of Subclavian Steal Syndrome. World Neurosurg 2019; 133:66-68. [PMID: 31574332 DOI: 10.1016/j.wneu.2019.09.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/25/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Subclavian steal phenomenon can cause retrograde flow in the vertebral artery as a result of ipsilateral occlusion of the subclavian artery. This phenomenon has various clinical presentations, such as claudication of the affected extremity or intermittent vertebrobasilar ischemia. Aneurysm formation in the spinal cord circulation is exceptionally rare but may occur secondary to collateral formation in subclavian steal syndrome. CASE DESCRIPTION The case presented herein is a 53-year-old male who presented with headache and severe neck pain. Imaging studies revealed that the patient had subarachnoid hemorrhage in the perimedullary and cervicomedullary cisterns and extending to C3-C7 ventrally. Computed tomography angiography reconstruction demonstrated an aneurysmally dilated vessel dorsal to the C6 vertebral body within the spinal canal. Catheter-based angiography of the right subclavian artery demonstrated retrograde flow within the left vertebral artery and confirmed proximal left subclavian artery occlusion, findings diagnostic of subclavian steal. Further, a branch of the right thyrocervical trunk supplied a retrocorporeal artery collateral to the left vertebral artery, which also contributed to the anterior spinal artery. CONCLUSIONS After endovascular coiling of the aneurysm, the patient had no neurologic deficits or postoperative complications. Postoperative angiography revealed complete obliteration with no residual aneurysm. Imaging further demonstrated patency of the radiculomedullary (anterior spinal) artery.
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Smith G, Hoh BL, Albayram MS. Anterior spinal artery aneurysm presenting with spinal subarachnoid hemorrhage in a case of polyarteritis nodosa. Clin Imaging 2019; 56:108-113. [DOI: 10.1016/j.clinimag.2019.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 12/21/2022]
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Spinal Cord Hemorrhage. J Stroke Cerebrovasc Dis 2018; 27:1435-1446. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/31/2018] [Accepted: 02/08/2018] [Indexed: 12/13/2022] Open
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