(Kiosk 4) Posterior Spinal Artery Aneurysm Resulting in Acute Paraplegia

Case Diagnosis: Posterior Spinal Artery Aneurysm resulting in paraplegia in an 80 year old female, complicated by dissection and subarachnoid hemorrhage

Case Description or Program Description: The patient is a 80-year old female with a history of hypertension and hyperlipidemia developed acute back pain followed by nausea on 2/16 prompting presentation to hospital where workup showed elevated troponin and TTE showed hypokinetic inferolateral wall. Aspirin and heparin started for NSTEMI. However, on 2/17 patient developed acute paraplegia and angiography revealed dissecting posterior spinal artery aneurysm at T12 leading to extensive hemorrhage. Hospital course was further complicated by subarachnoid hemorrhage, likely redistribution of spinal hematoma and seizures. Patient has impaired proprioception of bilateral lower extremities and is only able to move her toes.

Setting: Bellevue Hospital Acute Inpatient Rehabilitation

Assessment/Results: IR angiography revealed posterior spinal artery aneurysm at T12, Decision was made by Neurointerventional radiologist to not treat surgically due to risk for spinal cord infarction. Ultimately, a decision was made to treat it conservatively with nimodipine. Patient was discharged from neurosurgical service to inpatient rehabilitation for lower extremity paraplegia

Discussion (relevance): Posterior spinal artery dissection is a rare but often devastating disorder typically caused by arteriovenous malformations pathologic states. Patients typically present with acute paraparesis or quadriparesis, depending on the level of the spinal cord involved. The diagnosis is generally made clinically, with neuroimaging to confirm the diagnosis and exclude other conditions.

Conclusions: Posterior spinal artery aneurysm is a rare but life threatening condition that is typically due to vascular malformations. They can lead to further complications such as acute subarachnoid hemorrhage and paraplegia as seen in the case of this patient.