Solitary Ruptured Aneurysm of the Spinal Artery of Adamkiewicz with Subarachnoid Hemorrhage
A 45-year-old female patient was referred to our emergency department with a sudden burst headache and severe back pain, followed by nausea. On admission, she was alert, oriented, and cooperative. On neurological examination, she had moderate neck stiffness with mild lower limb motor weakness of IV/V. She had no predisposing clinical disease history and trauma history. Laboratory examinations showed no abnormal findings suggestive of inflammation or infection.\nNo abnormal findings were observed on brain computed tomography. However, brain magnetic resonance imaging (MRI) revealed thin SAH in right parietal lobe cortex. Whole spine MRI showed spinal SAH from T5 to sacrum with a small intradural extramedullary signal void lesion at the T12 level (). Spinal angiography revealed a small pearl and string-like aneurysm of a radiculomedullary branch of the left segmental artery (Adamkiewicz artery) originating on the left side at the L1 level (). Arteriovenous shunts or abnormal veins were not seen.\nThe findings and treatment options were discussed with the patient's family, and we refrained from performing operative clipping or endovascular coiling of the aneurysm because of the high risk of occlusion of the anterior spinal artery during the procedure.\nOver time, the patient improved gradually and was discharged without new neurological deficits.\nHowever, one month after onset, she complained aggravation of back pain and radiating pain of both legs, and follow-up lumbar MRI showed decreased hematoma and developed arachnoiditis of cauda equina ().\nTwo months after the initial onset, her symptoms improved completely, and follow-up lumbar MRI showed resolution of SAH with septated intradural fluid collection and remaining signal void lesion at the T12 level. The patient's subsequent clinical follow-up of five months was uneventful ().