Dissecting Aneurysm of the L1 Radiculomedullary Artery Associated with Subarachnoid Hemorrhage: A Case Report

2021 ◽  
Author(s):  
Emanuela Crobeddu ◽  
Giulia Pilloni ◽  
Francesco Zenga ◽  
Christian Cossandi ◽  
Diego Garbossa ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Rare Event ◽  
Artery Aneurysm ◽  
Dissecting Aneurysm ◽  
Motor Deficit ◽  
Motor Weakness ◽  
Conservative Strategy ◽  
Severe Motor ◽  
Spinal Subarachnoid Hemorrhage ◽  
The Right

Abstract Background Both spinal artery aneurysm and spinal subarachnoid hemorrhage represent a very rare event. Methods We report a case of a ruptured dissecting aneurysm of the right L1 radiculomedullary artery associated with subarachnoid hemorrhage and severe motor weakness. Results An urgent decompressive hemilaminectomy was performed due to worsening in motor deficit. A subsequent spinal angiography showed a dissection of radiculomedullary artery of L1 on the right side, treated conservatively. Conclusion Nowadays, therapeutic strategies for this aneurysm remain controversial. Conservative strategy can represent a valid alternative.

Dissecting Aneurysm of the Posterior Spinal Artery

Neurosurgery ◽  
2012 ◽  
Vol 71 (3) ◽  
pp. E749-E756 ◽  
Author(s):  
Hyun Jeong Kim ◽  
In Sup Choi
Keyword(s):  
Abdominal Pain ◽  
Subarachnoid Hemorrhage ◽  
Arteriovenous Malformations ◽  
Intracranial Aneurysms ◽  
Clinical Presentation ◽  
Artery Aneurysm ◽  
Dissecting Aneurysm ◽  
Posterior Spinal Artery ◽  
Spinal Subarachnoid Hemorrhage ◽  
Distal Flow

Abstract BACKGROUND AND IMPORTANCE: Because of their rarity, the pathogenesis and clinical features of isolated spinal artery aneurysms are still unclear, and their diagnoses and treatments are challenging. We report a case of an isolated posterior spinal artery aneurysm and review previous reports thoroughly to identify the general features of isolated spinal aneurysms. CLINICAL PRESENTATION: A 52-year-old man presented with abdominal pain followed by back pain and radiculopathy from subarachnoid hemorrhage in the spinal canal. The spinal angiogram demonstrated the presence of a dissecting aneurysm of the posterior spinal artery. He was treated by endovascular occlusion of the origin of the radiculopial artery and recovered completely. CONCLUSION: Isolated spinal artery aneurysms are very rare lesions; however, they should be considered in patients with intracranial or spinal subarachnoid hemorrhage without evidence of arteriovenous malformations. Spinal aneurysms have different etiologies compared with intracranial aneurysms. Cervical aneurysms have worse outcomes than thoracolumbar aneurysms. The etiology and location of the lesion and distal flow to the lesion should be taken into consideration when planning the treatment.

scholarly journals Subarachnoid Hemorrhage following Posterior Spinal Artery Aneurysm

2010 ◽  
Vol 16 (2) ◽  
pp. 183-190 ◽  
Author(s):  
S. Geibprasert ◽  
T. Krings ◽  
J. Apitzsch ◽  
M.H.T. Reinges ◽  
K.W. Nolte ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Resection ◽  
Artery Aneurysm ◽  
Treatment Method ◽  
Dissecting Aneurysm ◽  
Vascular Lesions ◽  
Minor Trauma ◽  
Posterior Spinal Artery ◽  
The Right ◽  
A Minor

Isolated posterior spinal artery aneurysms are rare vascular lesions. We describe the case of a 43-year-old man presenting with spinal subarachnoid hemorrhage after a minor trauma who was found to have a dissecting aneurysm of a posterior spinal artery originating from the right T4 level. Endovascular treatment was not contemplated because of the small size of the feeding artery, whereas surgical resection was deemed more appropriate because of the posterolateral perimedullary location that was well appreciated on CT angiography. After surgical resection of the aneurysm the patient had a complete neurological recovery. In comparison to anterior spinal artery aneurysms whose pathogenesis is diverse, posterior spinal aneurysms are most often secondary to a dissection and represent false or spurious aneurysms. Although the definite diagnosis still requires spinal angiography, MRI and CT may better delineate the relationship of the aneurysm to the spinal cord in order to determine the best treatment method. Prompt treatment is recommended as they have high rebleeding and mortality rates.

scholarly journals Ruptured Bilateral Pericallosal Artery Aneurysm in Mirror Position: Case Report

2018 ◽  
Vol 37 (03) ◽  
pp. 263-266
Author(s):  
Lucas Meguins ◽  
Linoel Valsechi ◽  
Ronaldo Fernandes ◽  
Dionei Morais ◽  
Antonio Spotti
Keyword(s):  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
External Ventricular Drain ◽  
Artery Aneurysm ◽  
Operative Management ◽  
Neurological Deficits ◽  
Pericallosal Artery ◽  
Digital Subtraction Arteriography ◽  
The Many ◽  
The Right

Introduction Pericallosal artery (PA) aneurysms represent 2 to 9% of all intracranial aneurysms, and their management remains difficult. Objective The aim of the present study is to describe the case of an adult woman with subarachnoid hemorrhage and bilateral PA aneurysm in mirror position. Case Report A 46-year-old woman was referred to our institution 20 days after a sudden severe headache. She informed that she was treating her arterial hypertension irregularly, and consumed ∼ 20 cigarettes/day. The patient was neurologically intact at admission. A non-contrast computed tomography (CT) on the first day of the onset of the symptoms revealed hydrocephaly and subarachnoid hemorrhage (Fisher III). An angio-CT/digital subtraction arteriography showed bilateral PA aneurysms in mirror position. The patient was successfully treated with surgery via the right interhemispheric approach (because the surgeon is right-handed); the surgeon performed the proximal control with temporary clipping, and introduced an external ventricular drain at the end of the surgery. The patient was discharged on the fourth postoperative day without any additional neurological deficits or ventricular shunts. Conclusion Ruptured PA aneurysm is a surgically challenging aneurysm due to the many anatomical nuances and risk of rebleeding. However, the operative management of ruptured bilateral PA aneurysms is feasible and effective.

Subarachnoid hemorrhage in a case of segmental arterial mediolysis with coexisting intracranial and intraabdominal aneurysms

2012 ◽  
Vol 116 (5) ◽  
pp. 948-951 ◽  
Author(s):  
Ryosuke Matsuda ◽  
Yasuo Hironaka ◽  
Yasuhiro Takeshima ◽  
Young-Su Park ◽  
Hiroyuki Nakase
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Distal Portion ◽  
Dissecting Aneurysm ◽  
Arterial System ◽  
Left Vertebral Artery ◽  
Retroperitoneal Hemorrhage ◽  
Segmental Arterial Mediolysis ◽  
History Of ◽  
The Right ◽  
Distal Anterior Cerebral Artery

The authors report the rare case of a 58-year-old man with segmental arterial mediolysis (SAM) with associated intracranial and intraabdominal aneurysms, who suffered subarachnoid hemorrhage (SAH) due to rupture of an intracranial aneurysm. This disease primarily involves the intraabdominal arterial system, resulting in intraabdominal and retroperitoneal hemorrhage in most cases. The patient presented with severe headache and vomiting. The CT scans of the head revealed SAH. Cerebral angiography revealed 3 aneurysms: 1 in the right distal anterior cerebral artery (ACA), 1 in the distal portion of the A1 segment of the right ACA, and 1 in the left vertebral artery. The patient had a history of multiple intraabdominal aneurysms involving the splenic, gastroepiploic, gastroduodenal, and bilateral renal arteries. He underwent a right frontotemporal craniotomy and fibrin coating of the dissecting aneurysm in the distal portion of the A1 segment of the right ACA, which was the cause of the hemorrhage. Follow-up revealed no significant changes in the residual intracranial and intraabdominal aneurysms. An SAH due to SAM with associated multiple intraabdominal aneurysms is extremely rare. The authors describe their particular case and review the literature pertaining to SAM with associated intracranial and intraabdominal aneurysms.

scholarly journals Fusiform Lenticulostriate Artery Aneurysm with Subarachnoid Hemorrhage: The Role for Superselective Angiography in Treatment Planning

2010 ◽  
Vol 16 (3) ◽  
pp. 259-263 ◽  
Author(s):  
P.S. Kochar ◽  
W.F. Morrish ◽  
M.E. Hudon ◽  
J.H. Wong ◽  
M. Goyal
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Treatment Planning ◽  
Artery Aneurysm ◽  
Cerebral Angiogram ◽  
Perforating Artery ◽  
Ct Angiogram ◽  
Superselective Angiography ◽  
Lenticulostriate Artery ◽  
The Right ◽  
Exact Origin

Aneurysms of the lenticulostriatal perforating arteries are rare and either involve the middle cerebral artery-perforator junction or are located distally in basal ganglia. We describe a rare ruptured fusiform lenticulostriatal perforating artery aneurysm arising from a proximal M2 MCA branch, discerned on superselective microcatheter angiography, presenting solely with subarachnoid hemorrhage (SAH). A 50-year-old previously healthy man presented with diffuse SAH and negative CT angiogram. Cerebral angiogram demonstrated a 2 mm fusiform aneurysm presumably arising from the right lateral lenticulostriate perforator but the exact origin of the perforator was unclear. Superselective angiography was required to precisely delineate the aneurysm and its vessel of origin and directly influenced treatment planning (surgical trapping). Superselective microcatheter angiography provides both an option for endovascular therapy as well as more accurate delineation for surgical planning for these rare aneurysms.

Spontaneous Spinal Subarachnoid Hemorrhage from a Ruptured Radiculopial Artery Aneurysm

2021 ◽  
Vol 145 ◽  
pp. 114-118
Author(s):  
Magalie Cadieux ◽  
Michael Tso ◽  
Shandy Fox ◽  
W. Bradley Jacobs
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Spinal Subarachnoid Hemorrhage

STENT REMODELING TECHNIQUE FOR COILING OF RUPTURED WIDE-NECK CEREBRAL ANEURYSMS: CASE REPORT

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. E1007-E1008 ◽  
Author(s):  
Demetrius K. Lopes ◽  
Kalani Wells
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Acute Subarachnoid Hemorrhage ◽  
The Right ◽  
Wide Neck ◽  
Cordis Corporation

Abstract OBJECTIVE To describe a novel stent remodeling technique for the coiling of ruptured wide-neck cerebral aneurysms. CLINICAL PRESENTATION A 46-year-old man presented with acute subarachnoid hemorrhage (Hunt and Hess grade IV), intracerebral hemorrhage, and hydrocephalus. Cerebral angiography revealed a wide-neck small anterior communicating artery aneurysm. Conventional coiling was not successful because of coil instability and compromise of the dominant anterior cerebral artery. TECHNIQUE A 6-French shuttle sheath (Cook Medical, Indianapolis, IN) was advanced from a right femoral approach into the right common carotid artery. To protect the parent vessel during coiling without compromising blood flow, a Prowler Select Plus catheter (Cordis Corporation, Bridgewater, NJ) was navigated across the aneurysm neck. Subsequently, an Enterprise stent (22-mm length; Cordis Corporation) was partially deployed across the aneurysm's wide neck. It was very important to watch the distal markers of the stent and lock the stent delivery wire to the Prowler Select Plus with a hemostatic valve once the stent was halfway deployed. This maneuver was essential to prevent further deployment of the stent. The SL-10 microcatheter and Synchro 14 wire (Boston Scientific, Natick, MA) were carefully navigated to the aneurysm passing through the partially deployed stent. Coils were then delivered to the aneurysm using the stent as a scaffold. After coiling, the SL-10 microcatheter was removed and the stent was recaptured into the Prowler Select Plus catheter. During the recapture, there was initial resistance. This was easily overcome after deploying the stent a little more before resheathing. During the procedure, the patient received 2000 U of heparin after the first coil was detached in the aneurysm. CONCLUSION The stent remodeling technique is a novel endovascular technique that can be used to treat ruptured wide-neck aneurysms and maintain patency of parent vessels, avoiding the use of antiplatelet therapy in acute subarachnoid hemorrhage.

scholarly journals Dissecting Aneurysms of Bilateral Anterior Cerebral Artery Complicated by Subarachnoid Hemorrhage after Cerebral Infarction: A Case Report

2008 ◽  
Vol 1 ◽  
pp. CCRep.S833
Author(s):  
Akihiro Kurosu ◽  
Shizuo Hatashita ◽  
Hideo Ueno
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Infarction ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Vascular Reconstruction ◽  
Dissecting Aneurysm ◽  
Vascular Anastomosis ◽  
Left Lower Extremity ◽  
The Right ◽  
Dissecting Aneurysms

Introduction Intracranial dissecting aneurysms have been increased due to recent advancements in diagnostic imaging. However there have been little article with subarachnoid hemorrhage and cerebral infarction occurring almost at the same time. We performed the surgical treatment and obtained good result. Case presentation A 47-year-old male presented to our hospital with chief complaints of sudden headache and mild paralysis of the left lower extremity. Brain imaging at admission revealed cerebral infarction in the right frontal lobe and subarachnoid hemorrhage in the frontal convexy and anterior interhemispheric fissure. The left and right internal carotid angiography showed a bulging cerebral aneurysm at the left A1–A2 junction and stenosis and arterial dissections in the peripheral of the bilateral anterior cerebral artery. Wrapping was performed for the dissecting aneurysm of the left anterior cerebral artery. For the right anterior cerebral artery, trapping was performed at the A2 segment without vascular anastomosis. The patient's postoperative course was uneventful. Conclusion A consensus has not been reached on the treatment for intracranial dissecting aneurysms. Proximal trapping without vascular reconstruction was performed for the right anterior cerebral artery without vascular anastomosis to prevent rebleeding. However no symptoms of neurological deficiency were observed. Proximal trapping of dissecting aneurysm seems to be a good option when patient's functional and life prognosis are taken into account in case that vascular reconstruction will be anticipated difficulty.

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