Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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April 23, 2015
Radiculopial Artery Aneurysm Rupture
- Isolated spinal artery aneurysms are rare. Such aneuysms can be seen arising from the anterior, posterior spinal arteries or branches and collaterals, including the radiculopial and radiculomedullary arteries.
- A recent review of the literature found descriptions of spinal artery aneurysms in 43 patients, 60.5% of which had other underlying vascular pathologies such as arterial dissection, aortic coarctation, vasculitis, fibromuscular dysplasia, infection, pseudoxanthoma elasticum, and connective tissue disorder. The average age at diagnosis was 46 years of age.
- Unlike cerebral artery aneurysms, spinal artery aneurysms seldom occur at branching points, and are not usually associated with atherosclerotic disease.
- Clinical Presentation: Acute headache, meningismus, severe back pain (related to the blood in the spinal canal and not the arterial dissection), and focal cord ischemia and/or compression
- Key Diagnostic Features:
- SAH with disproportoniate amount of blood in the spinal canal, foramen magnum and posterior fossa. Epidural-subdural spinal hematomas may be present. In any patient presenting with a SAH and symptoms related to the spinal cord, a spinal artery aneurysm has to be considered as one of the potential sources of hemorrhage.
- Focal clot within the spinal canal may point to the location of the aneurysm. A perimedullary focal enhancement can be seen representing blood and contrast stasis in the pseudoaneurysm.
- Localized spinal angiogram is necessary to confirm the diagnosis.
- Rx: If the aneurysm is located in the dorsal surface of the cord, surgery may be performed. Conservative management is an option, specially in patients who are poor surgical candidates or when the aneurysm is located on the ventral surface of the cord. Endovascular treatment is usually not recommended.
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