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Case report
Ruptured aneurysm of the artery of Adamkiewicz: is conservative management the standard of treatment in the current era?
  1. Pedro Aguilar-Salinas1,
  2. Jussie Lima2,
  3. Leonardo B C Brasiliense3,
  4. Ricardo A Hanel1,
  5. Eric Sauvageau1
  1. 1 Department of Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
  2. 2 Department of Neurology, University of Connecticut, Farmington, Connecticut, USA
  3. 3 Department of Surgery, Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
  1. Correspondence to Dr Eric Sauvageau, Department of Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, FL 32207, USA; Eric.Sauvageau{at}bmcjax.com

Abstract

Spinal aneurysms are rare lesions, and their natural history is not well known. In particular, aneurysms arising from the artery of Adamkiewicz (AA) are an extremely rare phenomenon, and given the lack of solid evidence its management remains unclear. We present the case of a 54-year-old woman with spinal subarachnoid hemorrhage. A spinal angiogram demonstrated a fusiform aneurysm arising from the AA. Based on the location, the absence of evident collateral circulation to the anterior spinal artery, and the available literature supporting spontaneous thrombosis, we opted for conservative management. Fifteen days after the diagnosis, a spinal angiogram demonstrated complete occlusion of the aneurysm with no visualization of the AA. At 10-month follow-up, the patient was able to walk without assistance. Management should be done on a case-by-case basis with the goal of preserving spinal cord perfusion. Similar to previous articles, our report reinforces conservative management as a valid strategy.

  • angiography
  • aneurysm
  • hemorrhage
  • subarachnoid
  • spinal cord

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Footnotes

  • Republished with permission from BMJ Case Reports Published 13 October 2017; doi:10.1136/bcr-2017-013194

  • Contributors PA-S, JL, and LBCB were responsible for study concept and design. JL contributed to acquisition of the data. All the authors were responsible for analysis and interpretation of the data. PA-S, JL, and LBCB contributed to drafting of the manuscript. RH and ES contributed to critical revision of the manuscript for important intellectual content. All the authors were responsible for administrative, technical and material support. RH and ES contributed to study supervision.

  • Competing interests RH is a consultant for Covidien, Stryker, Codman, and MicroVention. The other authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

  • Patient consent Obtained.

  • Ethics approval The Institutional Review Board of Baptist Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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