PMC4686455_01
Initial neuroradiological imagings. A: Brain computed tomography showing intracranial subarachnoid hemorrhage (arrows). B: Spinal MRI (T2-weighted image). The hypointensity lesion at Th10-11 (arrow) suggests a localized subarachnoid hematoma.
nmc-55-915-g1.jpg
PMC4686455_01_nmc-55-915-g1.jpg
F1
SAH (Fig. 1A); however, magnetic resonance angiography (MRA) failed to identify an intracranial aneurysm. Spinal magnetic resonance imaging (MRI) detected a localized subarachnoid hematoma at Th10-11 (Fig. 1B).
Contrast-enhanced computed tomography (day 1: A) and spinal magnetic resonance imaging (day 5: B). A: There is an area of enhancement on left dorsal aspect of the spinal cord at Th10-11 (arrow). B: Contrast-enhanced T1-weighted image showing an area of enhancement within the hematoma (arrow).
nmc-55-915-g2.jpg
PMC4686455_01_nmc-55-915-g2.jpg
F2
Contrast-enhanced spinal CT revealed an area of enhancement on the left dorsal aspect of spinal cord at Th10-11 (Fig. 2A). Enhanced MRI and MRA 5 days after the onset of symptoms also showed enhancement in the center of the localized hematoma (Fig. 2B).
Spinal digital subtraction angiography (day 9). Superselective angiographic image of the Th12 intercostal artery showing a faintly enhanced area in the venous phase (arrow). The connections with surrounding vessels are not clear.
nmc-55-915-g3.jpg
PMC4686455_01_nmc-55-915-g3.jpg
F3
However, the connections with the surrounding vessels were unclear (Fig. 3).
Intraoperative image (day 13). After removal of the yellowish-white hematoma on the left dorsal aspect of the spinal cord, a fusiform aneurysm was detected on the radiculopial artery. An: aneurysm, Radiculopial a.: radiculopial artery.
nmc-55-915-g4.jpg
PMC4686455_01_nmc-55-915-g4.jpg
F4
The parent artery was coagulated and cut both distal and proximal to the aneurysm and the aneurysm resected en bloc (Fig. 4).