Rupture of Thoracic Radicular Artery Aneurysm Presenting with Subdural Hematoma and Subarachnoid Hemorrhage: Two Case Reports

Spinal artery aneurysms are exceedingly rare, and their natural history remains poorly understood. Diagnosis can be challenging due to their small size and the difficulty in detection by MR angiography (MRA) or CT angiography (CTA); Digital Subtraction Angiography (DSA) is considered the gold standard diagnostic tool. This case report presents two cases of ruptured thoracic radicular artery aneurysms leading to subdural hematoma (SDH) and subarachnoid hemorrhage (SAH). The first patient, a 71-year-old female, presented with bilateral leg weakness, headache, and severe back pain, where multiple fusiform dilatations of the left T9 radiculopial artery were identified. She showed significant improvement after surgical intervention. The second patient, a 75-year-old female, presented with paraplegia and severe back pain, and a saccular dilatation in the right T10 radiculopial artery was found. She underwent endovascular embolization but showed no neurological improvement. These cases highlight the diverse clinical presentations, diagnostic challenges, and uncertainties in management strategies for ruptured spinal artery aneurysms, emphasizing the need for prompt intervention, especially in cases with significant or progressive neurological deficits.