Rupture of a true anterior spinal artery aneurysm at its intracranial origin: a short report

Rupture of an anterior spinal artery (ASA) aneurysm at its intracranial origin is an exceptionally rare cause of subarachnoid hemorrhage (SAH). We report a case of a 69- year old adult male presented with agitation and neck pain, initially without neurological deficit, which worsened to coma upon admission to our center, approximately 8 h after the onset of symptoms. Computerized tomography (CT) revealed massive SAH in the basal cisterns with intraventricular extension (Fisher IV), and CT angiography identified a ruptured aneurysm at the ASA origin, with no visualization of the distal ASA. The only surgical procedure performed was external ventricular drainage due to the development of obstructive hydrocephalus, together with conservative management based on the patient's clinical status and neuroradiological findings, with a fatal outcome 17 days later. This is the first reported case of a ruptured intracranial ASA aneurysm originating directly from the ASA main stem, and highlights the challenges of managing SAH combined with catastrophic spinal cord damage.