Abstract
Background
Isolated spinal aneurysms (ISAs) represent a rare etiology of subarachnoid hemorrhage (SAH). There are very few published reports of the rupture of an ISA, which has led to ongoing debate regarding the optimal therapeutic approach. We report a rare case of an isolated radiculomedullary artery aneurysm associated with SAH. Endovascular treatment was attempted but was unsuccessful. However, imaging confirmed that the aneurysm thrombosed relatively early following the procedure.
Case Description
A 59-year-old woman presented with a sudden headache and vomiting. Head computed tomography showed SAH with a thick hematoma in the posterior fossa. Initial angiography could not detect the source of bleeding, but follow-up angiography revealed an aneurysm ventral to the C5 spinal cord. Endovascular embolization was attempted but was terminated without placing embolizing material due to difficulty in guiding the microcatheter. Thrombus and shrinkage were observed on follow-up imaging, and complete occlusion of the aneurysm was observed on angiography.
Conclusion
Although rare, manipulation during endovascular therapy likely caused thrombus formation, leading to occlusion of the aneurysm. Therefore, postoperative imaging follow-up is important even in cases of unsuccessful endovascular treatment.