• Kenichi Sato, Luca Roccatagliata, Sebastien Depuydt, and Georges Rodesch.
• Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, Suresnes, France. kenmina@nsg.med.tohoku.ac.jp
• Neurosurgery. 2012 Nov 1;71(5):E1053-8; discussion E1058.

Background And ImportanceArterial aneurysms of the spinal cord are rare. Their pathogenesis is variable, and the therapeutic strategies remain controversial, because their natural history is unclear. We report a case of multiple dissecting aneurysms of radiculomedullary and radiculopial arteries presenting with spinal infarction and subarachnoid hemorrhage, which spontaneously resolved.Clinical PresentationA 67-year-old woman was hospitalized owing to sudden onset of severe back pain with discomfort in the lower extremities. Two days later, she again experienced sudden back pain accompanied by paraparesis and sphincter disturbance. Magnetic resonance imaging of the thoracic spinal cord showed 2 intradural masses of heterogeneous intensity at the levels of T-8 and T-10, spinal infarction, and subarachnoid hemorrhage. Spinal angiography revealed a "pearls and strings" aspect of a radiculomedullary artery arising from the left T-11 and a fusiform aneurysm of a radiculopial artery arising from the left T-8. Infectious and immunological evaluations failed to show any anomaly. Spontaneous dissections were suspected. Conservative treatment was proposed, and the patient's clinical course remained uneventful. Follow-up magnetic resonance imaging and spinal angiography performed 2 months after onset showed disappearance of both arterial lesions.ConclusionArterial dissections of spinal radicular arteries can resolve spontaneously and be managed conservatively. We propose a classification of the pathogenesis of spinal arterial aneurysm to clarify appropriate treatment strategies by a literature review.

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