• Joseph-Domenico Gabrieli, Giulio Andreatta, Alessandro De Cassai, Giacomo Cester, Francesco Causin, and Marina Munari.
• Neuroradiology Unit, University Hospital of Padua, Padua, Italy. Electronic address: josephdomenico.gabrieli@aopd.veneto.it.
• World Neurosurg. 2020 Dec 1; 144: 185-191.

BackgroundAnterior spinal artery steal syndrome, radiculomedullary artery aneurysms, and pulmonary arteriovenous malformations with a systemic origin are each, considered individually, exceptional conditions.Case DescriptionWe describe the coexistence of all these conditions and their pathophysiologic relationship by presenting the case of a woman who referred to the emergency department for loss of consciousness and a history of 2 days of medullary symptoms and a subsequent acute respiratory failure. Detailed imaging revealed a subarachnoid hemorrhage due to the rupture of a spinal aneurysm located in a C8 radiculomedullary artery that had its flow reversed toward the deep cervical artery from which a systemic to pulmonary arteriovenous malformation originated.ConclusionsEventually, the lesion was treated with the exclusion of the left C8 spinal segmental branch and embolization of the arteriovenous malformation.Copyright © 2020 Elsevier Inc. All rights reserved.

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