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Subarachnoid haemorrhage due to a lateral spinal artery aneurysm misdiagnosed as a posterior inferior cerebellar artery aneurysm: case report and literature review

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Abstract

Clinical Description

A 61 year old man presenting with subarachnoid haemorrhage had a distal posterior inferior cerebellar artery (PICA) aneurysm diagnosed on the initial cerebral angiogram. However, a PICA aneurysm was not found during surgery. A follow-up, super-selective vertebral artery (VA) performed demonstrated a saccular aneurysm located on the lateral spinal artery (LSA). A right sub-occipital craniotomy was performed and the aneurysm arising was identified and obliterated with a small titanium clip.

Conclusion

We describe the first example of an LSA aneurysm without occlusion or severe stenosis of the VA and PICA. This extremely rare lesion illustrates how knowledge of the angiographic features and super-selective cerebral angiography aids the precise diagnosis and the prevention of surgical complications.

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Abbreviations

CT:

computerised tomography

PICA:

posterior inferior cerebellar artery

VA:

vertebral artery

SAH:

subarachnoid haemorrhage

AVM:

arterio-venous malformation

LSA:

lateral spinal artery

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Authors and Affiliations

  1. Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa, 228-8555, Japan

    Mari Kurita, Masataka Endo, Takao Kitahara & Kiyotaka Fujii

Authors
  1. Mari Kurita
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  2. Masataka Endo
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  3. Takao Kitahara
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  4. Kiyotaka Fujii
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Corresponding author

Correspondence to Mari Kurita.

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Comment

Aneurysms located on distal portions of the cerebellar arteries are rare lesions demonstrated in less than 1% (1). The authors present a 61-year-old man with subarachnoid hemorrhage. The initial angiogram revealed a small distal PICA aneurysm. On the admission day, the patient was operated but the aneurysm could not be found. Three days later a superselective cerebral angiography demonstrated a saccular aneurysm located on a thin perforator of the lateral spinal artery. The patient was reoperated and the aneurysm was secured from the circulation with a 5 mm straight titanium clip. In cases like this, superselective angiography adds information about the location and will help to prevent surgical complications. Even if the patient is in good clinical condition, endovascular treatment with coil or patent vessel ocklusion can be an option for distally located cerebral aneurysms.

1. Distal aneurysms of cerebellar arteries: incidence, clinical presentation, and outcome of endovascular patent vessel occlusion. Peluso JP, van Rooij WJ, Sluzewski M, Beute GN (2007) AJNR 28:1573–78.

Bertil Romner

Copenhagen

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Kurita, M., Endo, M., Kitahara, T. et al. Subarachnoid haemorrhage due to a lateral spinal artery aneurysm misdiagnosed as a posterior inferior cerebellar artery aneurysm: case report and literature review. Acta Neurochir (Wien) 151, 165–169 (2009). https://doi.org/10.1007/s00701-009-0183-y

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  • DOI: https://doi.org/10.1007/s00701-009-0183-y

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