Subarachnoid Hemorrhage due to Ruptured Spinal Artery Aneurysm: A Diagnostic Challenge

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.

Download Full-text

Conus Perimedullary Arteriovenous Fistula with Intracranial Drainage: Case Report

Neurosurgery ◽

10.1097/00006123-200108000-00038 ◽

2001 ◽

Vol 49 (2) ◽

pp. 457-462 ◽

Cited By ~ 3

Author(s):

G. Edward Vates ◽

Alfredo Quiñones-Hinojosa ◽

Van V. Halbach ◽

Michael T. Lawton

Keyword(s):

Subarachnoid Hemorrhage ◽

Artery Aneurysm ◽

Venous Drainage ◽

Sudden Onset ◽

Clinical Findings ◽

Left Middle Cerebral Artery ◽

Lower Extremity Weakness ◽

Posterior Laminectomy ◽

Cerebral Artery Aneurysm ◽

Left Middle

Abstract OBJECTIVE AND IMPORTANCE Perimedullary arteriovenous fistulae (AVFs) do not commonly present with subarachnoid hemorrhage or intracranial venous drainage causing neurological symptoms. We present a case with both of these features. The patient was inadvertently treated for an unruptured intracranial aneurysm before his true problem was recognized. CLINICAL PRESENTATION A 65-year-old man presented with sudden-onset lower-extremity weakness, diplopia, nausea, and dysarthria on the day of admission. A lumbar puncture documented subarachnoid hemorrhage, and imaging studies revealed a left middle cerebral artery aneurysm. It was noted during surgery that this aneurysm was unruptured, and the patient did not exhibit improvement after surgery. INTERVENTION Spinal angiography demonstrated a spinal perimedullary AVF feeding from the left T12 radicular artery; venous drainage extended rostrally into the posterior fossa venous system. The AVF was surgically occluded via a posterior laminectomy at the level of the AVF. After surgery, the patient's symptoms began to abate. CONCLUSION Conus perimedullary AVFs can have venous drainage that extends as far as intracranial veins, which can lead to confusing clinical findings because the symptoms may suggest an intracranial process, although the lesion is in the spine. Surgeons must be aware of this confusing presentation.

Download Full-text

Cervical Spine Dural Arteriovenous Fistula With Coexisting Spinal Radiculopial Artery Aneurysm Presenting as Subarachnoid Hemorrhage

Neurosurgery ◽

10.1227/neu.0b013e31822ac0fb ◽

2011 ◽

Vol 70 (1) ◽

pp. 259-263 ◽

Cited By ~ 7

Author(s):

Joshua W. Lucas ◽

Jesse Jones ◽

Azadeh Farin ◽

Paul Kim ◽

Steven L. Giannotta

Keyword(s):

Native American ◽

Cervical Spine ◽

Subarachnoid Hemorrhage ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Clinical Presentation ◽

Artery Aneurysm ◽

Sudden Onset ◽

Spinal Dural Arteriovenous Fistula ◽

The Right

Abstract BACKGROUND AND IMPORTANCE We present a patient with a cervical spine dural arteriovenous fistula associated with a radiculopial artery aneurysm at the same vertebral level presenting with subarachnoid hemorrhage. CLINICAL PRESENTATION A 45-year-old Native American man presented with sudden-onset severe headache, lethargy, and right hemiparesis. Computed tomography (CT) of the head showed subarachnoid hemorrhage and hydrocephalus. A subsequent CT of the neck showed an anterior spinal subdural hematoma from C2 to C4 causing mild cord compression. Carotid and vertebral angiography failed to demonstrate an intracranial aneurysm, but showed a spinal dural arteriovenous fistula originating from the right vertebral artery at the C5 neuroforamen. The severity of the patient's symptoms, atypical for rupture of a dural arteriovenous fistula, prompted more thorough angiographic evaluation. Thus, injection of the right thyrocervical trunk was performed, demonstrating a 4-mm spinal radiculopial artery aneurysm. Following ventriculostomy, a hemilaminectomy from C4 to C7 was performed with disconnection of the fistula from its drainage system. Subsequent resection of the aneurysm, which was determined to be the cause of the hemorrhage, was accomplished. The patient improved neurologically and was discharged to rehabilitation. CONCLUSION Spinal cord aneurysms from a separate vascular distribution may coexist with spinal dural arteriovenous fistulas. In the setting of spinal hemorrhage, especially in situations with an atypical clinical presentation, comprehensive imaging is indicated to rule out such lesions.

Download Full-text

Compressive Myelopathy Due to Ossification of the Ligamentum Flavum: Case Report and Review of the Literature

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0037-1603554 ◽

2017 ◽

Vol 36 (02) ◽

pp. 117-121

Author(s):

Alisson Teles ◽

Frederico Farias ◽

Marcelo Roxo ◽

Albert Brasil

Keyword(s):

Genetic Factors ◽

Black People ◽

Ligamentum Flavum ◽

Rare Condition ◽

Cord Compression ◽

Resonance Imaging ◽

Asian Populations ◽

Magnetic Resonance Imaging Mri ◽

Compressive Myelopathy ◽

Progressive Paraparesis

AbstractOssification of the ligamentum flavum (OLF) is a rare condition in which the ligamentum flavum, due to mechanical, biological and genetic factors, becomes ossified. Due to its nature and anatomic location, OLF produces symptoms characteristic of spinal cord compression. The diagnostic confirmation is based primarily on imaging tests such as computed tomography (CT) and magnetic resonance imaging (MRI). Ossification of the ligamentum flavum most often affects Asian populations, rarely occurring in black people. The authors report a case of a 61-year-old black man with progressive paraparesis due to OLF, and review the literature regarding the pathology's prevalence, pathogenesis, clinical features, diagnosis, treatment and prognosis.

Download Full-text

Non-aneurysmal subarachnoid hemorrhage: When is a second angiography indicated?

The Neuroradiology Journal ◽

10.1177/1971400917743100 ◽

2017 ◽

Vol 31 (3) ◽

pp. 244-252 ◽

Cited By ~ 6

Author(s):

Asma Bashir ◽

Ronni Mikkelsen ◽

Leif Sørensen ◽

Niels Sunde

Keyword(s):

Subarachnoid Hemorrhage ◽

Ct Scan ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Artery Aneurysm ◽

Diagnostic Workup ◽

Vascular Pathology ◽

Vascular Abnormalities ◽

Magnetic Resonance Imaging Mri ◽

Anterior Choroidal

Purpose Repeat imaging in patients with non-aneurysmal subarachnoid hemorrhage (NASAH) remains controversial. We aim to report our experience with NASAH with different hemorrhage patterns, and to investigate the need for further diagnostic workup to determine the underlying cause of hemorrhage. Method We conducted a retrospective analysis of all spontaneous SAH with an initial negative computed tomography (CT) with angiography (CTA) and/or digital subtraction angiography (DSA) from October 2011 through May 2017. According to the bleeding pattern on the admission CT scan, NASAH was divided into two subgroups: (1) perimesencephalic SAH (PMSAH) and (2) non-perimesencephalic SAH (nPMSAH). Radiological data included the admission CT, CTA, DSA, and magnetic resonance imaging (MRI) with angiography (MRA). Results Seventy-four patients met the inclusion criteria. Thirty-nine (52.7%) patients had PMSAH on the initial CT scan, and 35 (47.3%) had nPMSAH. All underwent CTA and/or DSA revealing no vascular abnormalities. Forty-seven (63.5%) patients underwent subsequent diagnostic workup. DSA was performed in all patients at least once. No abnormalities were found on the repeat DSA or other radiological follow-up studies except in one (1.4%) patient with nPMSAH, in whom a follow-up DSA revealed a small saccular anterior choroidal artery aneurysm, considered to be the source of hemorrhage. Conclusion A repeat DSA may not be needed in case of PMSAH, if the initial negative DSA is technically adequate with absence of hematoma and vasospasm. In contrast, a follow-up DSA should be mandatory for confirming or excluding vascular pathology in case of nPMSAH in order to prevent rebleeding.

Download Full-text

An isolated ruptured spinal aneurysm presents with a thalamic Infarct: case report

BMC Neurology ◽

10.1186/s12883-021-02055-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Alexander Tenorio ◽

Brandon B. Holmes ◽

Adib A. Abla ◽

Matthew Amans ◽

Karl Meisel

Keyword(s):

Abdominal Pain ◽

Treatment Strategies ◽

Artery Aneurysm ◽

Cord Compression ◽

Partial Recovery ◽

Lower Extremity Weakness ◽

Posterior Spinal Artery ◽

Thoracolumbar Region ◽

Spinal Aneurysm ◽

Thalamic Infarct

Abstract Background Isolated spinal artery aneurysms are extremely rare, and their pathogenesis, clinical presentation, and treatment strategies are poorly established. We report only the second case of a patient with an isolated posterior spinal aneurysm and concurrent left thalamic infarct and review the literature to help clarify treatment strategies of isolated spinal aneurysms. Case presentation A 49-year-old patient presented with acute onset walking difficulty followed by diaphoresis, back and abdominal pain, and paraplegia. Imaging was notable for a hemorrhagic spinal lesion with compression at T12 through L4 and an acute left thalamic infarct. Surgical exploration revealed an isolated posterior spinal artery aneurysm. The aneurysm was surgically resected and the patient had partial recovery six months post-operatively. Conclusions Isolated posterior spinal artery aneurysms of the thoracolumbar region are rare lesions that commonly present with abdominal pain, radiating back pain, and lower extremity weakness. Imaging may not provide a definitive diagnosis. The three primary treatment strategies are conservative management, endovascular treatment, or surgical resection. In patients with symptomatic cord compression, immediate surgical intervention is indicated to preserve neurologic function. In all other cases, the artery size, distal flow, morphology, and location may guide management.

Download Full-text

Massive intracerebral hemorrhages due to peripheral middle cerebral artery aneurysm rupture: A case report with a surgical video

Surgical Neurology International ◽

10.25259/sni_479_2021 ◽

2021 ◽

Vol 12 ◽

pp. 412

Author(s):

Takuma Aoki ◽

Yukihiro Goto ◽

Yujiro Komaru ◽

Shigeomi Yokoya ◽

Hideki Oka

Keyword(s):

Subarachnoid Hemorrhage ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Parietal Lobe ◽

Artery Aneurysm ◽

Surgical Excision ◽

Sudden Onset ◽

Aneurysm Rupture ◽

Saccular Aneurysm ◽

The Right

Background: Saccular aneurysm in the distal segment of the middle cerebral artery (DMCA) occurs very rarely and often represents with a rupture. We report a successful surgical case of a DMCA aneurysm rupture with large cerebral and subarachnoid hemorrhage. Case Description: A 44-year-old female presented a sudden onset headache and coma (the Glasgow Coma Scale was 3). Head computed tomography (CT) revealed a subarachnoid hemorrhage around the right Sylvian fissure and large intracranial hematoma in the right parietal lobe. The CT angiography showed a saccular aneurysm in the peripheral cortical segment of the right angular branch of the right DMCA. We decided to perform a right craniotomy to evacuate hematoma and interrupt the aneurysm. Just after the dural incision, the aneurysm ruptured again. We applied a temporary clip on the artery proximal to the aneurysm before excising it. Conclusion: Aneurysm in DMCA can be treated safely with surgical excision and risk of sudden recurrent hemorrhage needs to be anticipated.

Download Full-text

Repeated electromagnetic field stimulation lowers amyloid-β peptide levels in primary human mixed brain tissue cultures

Scientific Reports ◽

10.1038/s41598-020-77808-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Felipe P. Perez ◽

Bryan Maloney ◽

Nipun Chopra ◽

Jorge J. Morisaki ◽

Debomoy K. Lahiri

Keyword(s):

Electromagnetic Field ◽

Late Onset ◽

Amyloid Β ◽

Clinical Settings ◽

Amyloid Β Peptide ◽

Field Stimulation ◽

Amino Acid Residues ◽

Hyperphosphorylated Tau Protein ◽

Magnetic Resonance Imaging Mri

AbstractLate Onset Alzheimer’s Disease is the most common cause of dementia, characterized by extracellular deposition of plaques primarily of amyloid-β (Aβ) peptide and tangles primarily of hyperphosphorylated tau protein. We present data to suggest a noninvasive strategy to decrease potentially toxic Aβ levels, using repeated electromagnetic field stimulation (REMFS) in primary human brain (PHB) cultures. We examined effects of REMFS on Aβ levels (Aβ40 and Aβ42, that are 40 or 42 amino acid residues in length, respectively) in PHB cultures at different frequencies, powers, and specific absorption rates (SAR). PHB cultures at day in vitro 7 (DIV7) treated with 64 MHz, and 1 hour daily for 14 days (DIV 21) had significantly reduced levels of secreted Aβ40 (p = 001) and Aβ42 (p = 0.029) peptides, compared to untreated cultures. PHB cultures (DIV7) treated at 64 MHz, for 1 or 2 hour during 14 days also produced significantly lower Aβ levels. PHB cultures (DIV28) treated with 64 MHz 1 hour/day during 4 or 8 days produced a similar significant reduction in Aβ40 levels. 0.4 W/kg was the minimum SAR required to produce a biological effect. Exposure did not result in cellular toxicity nor significant changes in secreted Aβ precursor protein-α (sAPPα) levels, suggesting the decrease in Aβ did not likely result from redirection toward the α-secretase pathway. EMF frequency and power used in our work is utilized in human magnetic resonance imaging (MRI, thus suggesting REMFS can be further developed in clinical settings to modulate Aβ deposition.

Download Full-text

An autopsy report of basilar artery aneurysm flow diversion complicated by postoperative day 3 hemorrhage from vessel rupture

BMJ Case Reports ◽

10.1136/bcr-2018-014511 ◽

2018 ◽

Vol 11 (1) ◽

pp. e014511 ◽

Cited By ~ 2

Author(s):

Azeem A Rehman ◽

Ryan C Turner ◽

Stephanie Wright ◽

SoHyun Boo ◽

Ansaar T Rai

Keyword(s):

Subarachnoid Hemorrhage ◽

Basilar Artery ◽

Artery Aneurysm ◽

Symptomatic Improvement ◽

Aneurysm Rupture ◽

Flow Diversion ◽

Atheromatous Plaque ◽

Parent Artery ◽

Autopsy Report ◽

Complete Procedure

A middle-aged patient presented with posterior circulation symptoms attributable to a large eccentric basilar trunk aneurysm. The planned treatment was flow diversion with loose coil packing which was successfully performed using a Pipeline Flex device deployed from the basilar to the left posterior cerebral artery. The complete procedure including live biplane fluoroscopy was digitally recorded. The patient had symptomatic improvement postoperatively and was discharged on day 1. The patient suffered a cardiac arrest on postoperative day 3 secondary to massive intraventricular and subarachnoid hemorrhage. An aneurysm rupture was suspected; however, postmortem examination showed an intact aneurysm sac. The hemorrhage was attributed to a small focal rent in the distal basilar artery next to an atheromatous plaque. The Pipeline device was visible through the rent. This is an autopsy report documenting an injury to the parent artery and not the aneurysm as a source of fatal delayed subarachnoid hemorrhage following flow diversion.

Download Full-text

Rosai-Dorfman disease with spinal cord compression: a diagnostic challenge

European Spine Journal ◽

10.1007/s00586-014-3671-6 ◽

2014 ◽

Vol 24 (S4) ◽

pp. 529-535 ◽

Cited By ~ 3

Author(s):

Sara Sciacca ◽

Kostantinos Barkas ◽

Lauren Heptinstall ◽

Christopher McNamara ◽

Rohit Shetty

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Cord Compression ◽

Diagnostic Challenge ◽

Rosai Dorfman Disease

Download Full-text

Canine Choroid Plexus Tumor with Intracranial Dissemination Presenting as Multiple Cystic Lesions

Case Reports in Veterinary Medicine ◽

10.1155/2013/759054 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Trisha J. Oura ◽

Peter J. Early ◽

Samuel H. Jennings ◽

Melissa J. Lewis ◽

Jeremy R. Tobias ◽

...

Keyword(s):

Choroid Plexus ◽

Brain Lesions ◽

Behavioral Changes ◽

Cystic Lesions ◽

Resonance Imaging ◽

Mri Findings ◽

Choroid Plexus Tumor ◽

Magnetic Resonance Imaging Mri ◽

Mri Characteristics ◽

Possible Cause

A Miniature Pinscher developed acute blindness and behavioral changes. On magnetic resonance imaging (MRI), there were multiple small intra-axial cystic lesions, and primary differential diagnoses included primary or metastatic neoplasia and neurocysticercosis. These cystic lesions were subsequently diagnosed histopathologically as disseminated choroid plexus carcinoma. This is only the second documented description of this diagnosis in a dog, but both patients had very similar MRI findings. This patient adds to the literature about the MRI characteristics of choroid plexus tumors and indicates that choroid plexus tumor should be considered as a possible cause of small multifocal intra-axial cystic brain lesions in dogs, regardless of whether a primary intraventricular lesion is visible.

Download Full-text