A Ruptured Aneurysm in the Branch of the Anterior Spinal Artery
A 47-year-old male was transferred to our emergency room in a semicomatose state. Initially, he presented with posterior neck pain that gradually became more aggravated during the transfer. Brain computerized tomography scans showed subarachnoid and intraventricular hemorrhages that were denser in the cisterns around the pons and medulla than in the basal and anterior interhemispheric cisterns (). By the next morning, the patient's condition had improved from a semicomatose to a drowsy state. His family requested further treatment at this time.\nWe performed an immediate cerebral angiography. We found an aneurysm in the anterior communicating artery and performed embolization of the aneurysm using detachable coils (). We did not notice a small aneurysm in the branch of the anterior spinal artery until the following day during a review of the angiograms (). We expected spontaneous occlusion of the aneurysm; therefore, we decided to follow this aneurysm with cerebral angiography. We took this course of action because the family did not want the aneurysm to be clipped. In addition, we believed that endovascular treatment carried the risks of both parent artery occlusion and additional hemorrhaging.\nOn the sixth day of hospitalization, follow-up cerebral angiography showed that the aneurysm was still present in the anterior spinal artery branch with a small filling defect in the aneurysm sac (). Therefore, we decided to continue to follow the aneurysm with cerebral angiography. Due to progression of the patient's end-stage common bile duct cancer, his condition slowly worsened. We performed a final cerebral angiography on the 23rd day of hospitalization. The angiograms showed no significant interval change in the aneurysm from previous examinations (). The general condition of the patient continued to deteriorate. He returned to his hometown where he died of the cancer on the 103rd day after the SAH. No rebleeding from the aneurysm was observed.