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McGuire LS, Fuentes A, Charbel FT, Alaraj A, Amin-Hanjani S. Ruptured isolated spinal artery aneurysms: Case series of five patients and a review of the literature on management strategies. Interv Neuroradiol 2023:15910199221149562. [PMID: 36628492 DOI: 10.1177/15910199221149562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Aneurysms of the spinal arteries are rare entities, the majority of which are associated with other vascular lesions, such as spinal vascular malformations. Isolated spinal artery aneurysms (SAAs) are even less frequently encountered, and their incidence is largely unknown, as the literature is limited to case reports and small series. The optimal management strategy for SAAs is not well defined. OBJECTIVE To review the institutional experience of five patients with isolated SAAs. METHODS Five cases of isolated SAAs were identified at our institution, including two cases with multiple simultaneous SAAs. Clinical presentation, imaging, and management strategies for each case were reviewed. A literature review of all SAAs reported between 1950 and 2020 was performed. RESULTS A total of five patients with eight isolated SAAs presented to our institution: one aneurysm was lumbar in location, while the remaining seven were thoracic. Two patients were treated with glue embolization followed by laminectomy for hematoma evacuation; one was treated with only surgery; and the other two, which both had multiple lesions, were managed conservatively with interval complete regression of their aneurysms. All five patients had good neurological outcomes. Literature review found 124 patients with at least 137 isolated SAAs and revealed treatment strategies including conservative management, glue or coil embolization, muslin wrapping, and surgical resection or clipping. CONCLUSION Multiple management strategies exist for SAAs, and clinical consideration of patient presentation and lesion morphology determine appropriate strategy. Our case series demonstrates three of these treatment paradigms.
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Affiliation(s)
- Laura Stone McGuire
- Department of Neurological Surgery, 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Angelica Fuentes
- Department of Neurosurgery, 2358University of Virginia, Charlottesville, VA, USA
| | - Fady T Charbel
- Department of Neurological Surgery, 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Ali Alaraj
- Department of Neurological Surgery, 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Sepideh Amin-Hanjani
- Department of Neurological Surgery, 2546Case Western Reserve University, Cleveland, OH, USA
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Verheijen DBH, Stöger JL, van der Kley F, Schalij MJ, Jongbloed MRM, Vliegen HW, Kiès P, Egorova AD. A percutaneous treatment strategy of an adult patient with a bicuspid aortic valve, coarctation of the aorta, and an exceptionally large aneurysm of a collateral artery: Case report and literature overview. Front Cardiovasc Med 2022; 9:1012147. [PMID: 36620635 PMCID: PMC9815109 DOI: 10.3389/fcvm.2022.1012147] [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: 08/05/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Coarctation of the aorta (CoA) is a congenital heart defect that is associated with a bicuspid aortic valve (BAV), ascending aorta dilatation, intracerebral aneurysms, and premature atherosclerotic disease. The first presentation during late adulthood is rare and is frequently driven by late sequelae. Hypertrophic collateral arteries can develop aneurysms which are at risk for spontaneous rupture, however, treatment recommendations for these aneurysms are scarce. Here, we describe the clinical course and percutaneous treatment strategy of a patient with a late diagnosis of a pin-point CoA, a BAV with moderate regurgitation, and an exceptionally large aneurysm of a collateral artery. A 59-year-old woman was diagnosed with Streptococcus bovis endocarditis of a BAV with moderate aortic valve regurgitation and small vegetation (<5 mm) on the non-coronary cusp. Work-up revealed hypertension and adenocarcinoma in situ of the ascending colon, considered the bacteremia porte d'entrée, for which a curative hemicolectomy was performed. Echocardiography showed a narrowing of the aorta distal from the origin of the left subclavian artery with the antegrade diastolic flow with a pathognomonic "sawtooth" pattern and an estimated pressure gradient of >70 mmHg. Computed tomography angiography (CTA) showed a network of well-developed collateral arteries and a levoatriocardinal vein. One of the collateral arteries arising from the left subclavian artery revealed an exceptionally large aneurysmatic dilation (29 × 24 × 24 mm). The invasive assessment confirmed a hemodynamically significant CoA. Treatment involved balloon dilatation and placement of a covered stent at the site of the pin-point CoA and a percutaneous coronary intervention (PCI) of the stenosis in the left anterior descending artery. No residual gradient over the CoA was observed. Antihypertensive drugs could be discontinued, and CTA performed 4 months later showed regression and thrombosis of the numerous collaterals and, importantly, thrombosis of the large aneurysm. This case illustrates the late diagnosis of CoA with associated congenital heart defects and late sequelae including hypertension, BAV endocarditis, coronary artery disease, and aneurysm formation of the extensive collateral network. The patient underwent pharmacological and percutaneous treatment, ultimately resulting in the alleviation of the CoA, normalization of the blood pressure, reduction of collateral flow, and thrombosis of the large aneurysm of the collateral artery.
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Affiliation(s)
- D. B. H. Verheijen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - J. Lauran Stöger
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - F. van der Kley
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - M. J. Schalij
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - M. R. M. Jongbloed
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - H. W. Vliegen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - P. Kiès
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - A. D. Egorova
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Leiden, Netherlands,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands,*Correspondence: A. D. Egorova,
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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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Isolated aneurysms of the spinal circulation: a systematic review of the literature. Neurosurg Rev 2021; 45:989-1008. [PMID: 34541624 DOI: 10.1007/s10143-021-01645-8] [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: 04/21/2021] [Revised: 08/19/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
Aneurysms arising in the spinal circulation are rare and underreported. The objective of this study was to systematically review the English literature on different aspects of isolated spinal aneurysms using the PubMed, Ovid MEDLINE, and Google Scholar databases. Eighty-two papers reporting 107 individual patient cases were included. Most isolated spinal aneurysms have a fusiform morphology, and are most commonly found in the anterior spinal artery at the thoracic or cervical levels. Subarachnoid hemorrhage is the most common form of presentation, and sudden onset back pain is the most common initial symptom. The diagnosis of spinal aneurysms requires a high degree of clinical suspicion. Because of their small size, they can be missed on CT/MR angiography and spinal angiogram may be employed. Treatment of spinal aneurysms should be individualized on a case-by-case basis. Conservative management can be a valid option in spinal aneurysms where the risk of treatment is high. Surgical or endovascular intervention may be indicated in cases of significant or progressive neurologic decline due aneurysmal mass effect, or progressive growth of the aneurysm despite conservative treatment.
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Shima S, Sato S, Motizuki T, Niimi Y. Endovascular treatment for ruptured cervical anterior spinal artery aneurysm caused by occlusive disease of bilateral vertebral arteries: A case report and literature review. Clin Neurol Neurosurg 2021; 208:106862. [PMID: 34391976 DOI: 10.1016/j.clineuro.2021.106862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
A cervical anterior spinal artery (ASA) aneurysm not concomitant with vascular malformations is extremely rare, and is treated by conservative management or direct surgery in most cases. The endovascular treatment approach for these lesions is not well-documented. We present a case of a ruptured flow-related cervical ASA aneurysm due to the occlusive disease of the bilateral vertebral arteries (VA) treated by endovascular therapy. A 77-year-old woman with acute onset of headache and right hemiparesis was transferred to our hospital. Computed tomography revealed subarachnoid hemorrhage thick in the posterior fossa. A cerebral angiogram showed tandem stenosis of the left VA and the occlusion of the right VA at the V4 segment, with an enlarged C4 radiculomedullary artery and a subsequent aneurysm on the ASA. VA angiography revealed retrograde flow through the lesion and ASA axis to posterior circulation, suggesting a flow-related etiology of the aneurysm. We embolized the aneurysm using a flow-directed microcatheter and coils, preserving the ASA axis. Then, we dilated the VA stenosis using stents to prevent aneurysm recurrence by reducing hemodynamic stress on the ASA.
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Affiliation(s)
- Shogo Shima
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan; Department of Neuroendovascular therapy, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan.
| | - Shinsuke Sato
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan; Department of Neuroendovascular therapy, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan
| | - Tatsuki Motizuki
- Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular therapy, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan
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Ruptured Isolated Aneurysm of a Coronal Branch of the Anterior Spinal Artery: Case Report and Discussion of Treatment Strategies. World Neurosurg 2020; 145:119-126. [PMID: 32949802 DOI: 10.1016/j.wneu.2020.09.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Isolated spinal artery aneurysms are an extremely rare cause of subarachnoid hemorrhage. A limited number of case reports and case series have been reported in the literature. Treatment options include conservative management, surgical clipping/trapping, and endovascular procedures. Owing to the uncertain natural history of these lesions, there is no consensus about the optimal treatment. CASE DESCRIPTION A 64-year-old man presented with subarachnoid hemorrhage from a ruptured anterior spinal artery aneurysm at the C1 level. Following initial conservative management, surgical treatment was proposed owing to an increase in lesion size at angiographic follow-up. A partially thrombosed aneurysm was found during surgery, suggesting that spontaneous resolution of the aneurysm was occurring. Despite initial worsening of neurological symptoms, the patient gradually recovered after rehabilitation. CONCLUSIONS Treatment decisions for spinal aneurysms should be made on a case-by-case basis, the goal being to offer the patient the best option, while avoiding exposure to unnecessary invasive procedures. As spontaneous resolution of a spinal artery aneurysm is unpredictable, our case highlights the importance of performing a perioperative vascular study if surgery is planned.
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Agasthi P, Pujari SH, Tseng A, Graziano JN, Marcotte F, Majdalany D, Mookadam F, Hagler DJ, Arsanjani R. Management of adults with coarctation of aorta. World J Cardiol 2020; 12:167-191. [PMID: 32547712 PMCID: PMC7284000 DOI: 10.4330/wjc.v12.i5.167] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023] Open
Abstract
Coarctation of the aorta (CoA) is a relatively common congenital cardiac defect often causing few symptoms and therefore can be challenging to diagnose. The hallmark finding on physical examination is upper extremity hypertension, and for this reason, CoA should be considered in any young hypertensive patient, justifying measurement of lower extremity blood pressure at least once in these individuals. The presence of a significant pressure gradient between the arms and legs is highly suggestive of the diagnosis. Early diagnosis and treatment are important as long-term data consistently demonstrate that patients with CoA have a reduced life expectancy and increased risk of cardiovascular complications. Surgical repair has traditionally been the mainstay of therapy for correction, although advances in endovascular technology with covered stents or stent grafts permit nonsurgical approaches for the management of older children and adults with native CoA and complications. Persistent hypertension and vascular dysfunction can lead to an increased risk of coronary disease, which, remains the greatest cause of long-term mortality. Thus, blood pressure control and periodic reassessment with transthoracic echocardiography and three-dimensional imaging (computed tomography or cardiac magnetic resonance) for should be performed regularly as cardiovascular complications may occur decades after the intervention.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Sai Harika Pujari
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Andrew Tseng
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Joseph N Graziano
- Division of Cardiology, Phoenix Children's Hospital, Children's Heart Center, Phoenix, AZ 85016, United States
| | - Francois Marcotte
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - David Majdalany
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Donald J Hagler
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
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9
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Tsai YT, Lin CW. Primary thoracic endovascular aortic repair to aortic coarctation complicating with spontaneous epidural hemorrhage. JOURNAL OF MEDICAL SCIENCES 2019. [DOI: 10.4103/jmedsci.jmedsci_133_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Yost MD, Rabinstein AA. Spontaneous Spinal Subarachnoid Hemorrhage: Presentation and Outcome. J Stroke Cerebrovasc Dis 2018; 27:2792-2796. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 02/07/2023] Open
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Renieri L, Raz E, Lanzino G, Krings T, Shapiro M, Shirani P, Brinjikji W. Spinal artery aneurysms: clinical presentation, radiological findings and outcome. J Neurointerv Surg 2018; 10:644-648. [DOI: 10.1136/neurintsurg-2017-013687] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/16/2018] [Indexed: 01/16/2023]
Abstract
Background and purposeSpinal arterial aneurysms are a rare cause of spinal subarachnoid hemorrhage (SAH). We performed a retrospective review of spinal arterial aneurysms not associated with spinal arteriovenus shunts from three institutions in order to better understand the clinical and imaging characteristics of these lesions.Materials and methodsWe performed a retrospective review of spinal arterial aneurysms managed at three North American institutions. For each patient, the following information was collected: demographic data, clinical presentation, comorbidities, imaging findings, and neurological status at the last follow-up. Treatment strategies and outcomes were reported.Results11 patients were included; 7 were women and median age was 60 years. The most common presentation was sudden back pain (81.8%). We found 3 aneurysms on the radiculomedullary artery and 8 along the radiculopial arteries. Of the 3 aneurysms on the radiculomedullary artery, 1 was treated conservatively, 1 was treated with coiling of the aneurysm and sacrifice of the radiculomedullary artery, and 1 was treated with surgical trapping. The 8 aneurysms on the radiculopial artery were treated endovascularly in 4 cases, surgically in 1 case, and conservatively in 3 cases. One surgically treated patient had a spinal subdural hematoma. There were no other complications. Mean clinical follow-up time was 20 months, and 87.5% of patients were functionally independent.ConclusionsSpinal arterial aneurysms are lesions which commonly present with sudden back pain and spinal SAH. Conservative, surgical, and endovascular treatment options are safe and effective. Long term outcomes in these patients are generally good.
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12
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Successful Surgical Resection of Spinal Artery Aneurysms: Report of 3 Cases. World Neurosurg 2018; 109:171-178. [DOI: 10.1016/j.wneu.2017.09.174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/24/2017] [Accepted: 09/25/2017] [Indexed: 12/19/2022]
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Kogan M, Morr S, Siddiqui AH. Serial magnetic resonance imaging findings in subarachnoid hemorrhage due to an initially angiographically occult type II spinal aneurysm: Case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:74-78. [PMID: 28467337 PMCID: PMC6166196 DOI: 10.23750/abm.v88i1.5308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/19/2016] [Accepted: 05/24/2016] [Indexed: 11/29/2022]
Abstract
Background: Spinal aneurysms are rare causes of spontaneous subarachnoid hemorrhage. Methods: We present an unusual, initially occult, case of an upper thoracic intradural extramedullary isolated aneurysm arising from the T2 intercostal-radicular circulation that was initially angiographically occult but was discovered due to unique, albeit nonspecific, magnetic resonance imaging findings of spinal cord T2 hyperintensity and contrast enhancement that were noted to progress with a clinical picture of ictal rehemorrhage. Results: Repeat spinal angiography revealed a spinal aneurysm that was treated surgically. Conclusion: In cases of sufficient clinical suspicion and nonspecific imaging findings, continued vigilance is advised in seeking an underlying pathoanatomic etiology. (www.actabiomedica.it)
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Affiliation(s)
- Michael Kogan
- University at Buffalo, State University of New York.
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Singh V, Naik S, Bhoi SK, Phadke RV. Anterior spinal artery aneurysm in aortic stenosis of different etiology: Report of three cases. Neuroradiol J 2017; 30:180-185. [PMID: 28424013 DOI: 10.1177/1971400917690008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Isolated aneurysms of spinal arteries are rare. Spinal artery aneurysms are commonly found in association with spinal cord arteriovenous malformation and coarctation of aorta and rarely with aortic arch interruption and Klippel-Trenaunay syndrome. Spinal angiograms are the gold standard for diagnosing these spinal artery aneurysms but with the advances in computed tomography technology these aneurysms can also be very well demonstrated in computed tomography angiograms. We describe three cases of anterior spinal artery aneurysm, those are flow related aneurysms, associated with coarctation of aorta and with Takayasu arteritis.
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Affiliation(s)
- Vivek Singh
- 1 Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Science, India
| | - Suprava Naik
- 2 Department of Radiodiagnosis, All India Institute of Medical Sciences, India
| | - Sanjeev K Bhoi
- 3 Department of Neurology, All India Institute of Medical Sciences, India
| | - R V Phadke
- 1 Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Science, India
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15
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Vuong SM, Jeong WJ, Morales H, Abruzzo TA. Vascular Diseases of the Spinal Cord: Infarction, Hemorrhage, and Venous Congestive Myelopathy. Semin Ultrasound CT MR 2016; 37:466-81. [PMID: 27616317 DOI: 10.1053/j.sult.2016.05.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Vascular pathologies of the spinal cord are rare and often overlooked. This article presents clinical and imaging approaches to the diagnosis and management of spinal vascular conditions most commonly encountered in clinical practice. Ischemia, infarction, hemorrhage, aneurysms, and vascular malformations of the spine and spinal cord are discussed. Pathophysiologic mechanisms, clinical classification schemes, clinical presentations, imaging findings, and treatment modalities are considered. Recent advances in genetic and syndromic vascular pathologies of the spinal cord are also discussed. Clinically relevant spinal vascular anatomy is reviewed in detail.
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Affiliation(s)
- Shawn M Vuong
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - William J Jeong
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Humberto Morales
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH; Comprehensive Stroke Center, University of Cincinnati Neuroscience Institute, Cincinnati, OH
| | - Todd A Abruzzo
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH; Comprehensive Stroke Center, University of Cincinnati Neuroscience Institute, Cincinnati, OH; Department of Radiology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH.
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16
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Nance JW, Ringel RE, Fishman EK. Coarctation of the aorta in adolescents and adults: A review of clinical features and CT imaging. J Cardiovasc Comput Tomogr 2015; 10:1-12. [PMID: 26639936 DOI: 10.1016/j.jcct.2015.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/12/2015] [Accepted: 11/10/2015] [Indexed: 01/06/2023]
Abstract
Coarctation of the aorta (CoA), while usually identified and treated in the neonatal/infant period, is increasingly seen in adults, either primarily or (more often) following repair. Imaging plays a crucial role in the diagnosis, therapeutic planning, and follow-up of patients with CoA. Clinical management of CoA in adults optimally involves a multidisciplinary team; accordingly, imagers should be familiar with the underlying pathology, associations, and management of CoA in addition to imaging protocoling and interpretation. We will review the relevant clinical and imaging features of CoA, with an emphasis on patients beyond childhood.
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Affiliation(s)
- John W Nance
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N. Caroline St, Baltimore, MD, USA
| | - Richard E Ringel
- Department of Pediatrics, Johns Hopkins School of Medicine, 601 N. Caroline St, Baltimore, MD, USA
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N. Caroline St, Baltimore, MD, USA.
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