Ruptured aneurysm of the artery of Adamkiewicz with spinal intradural hematoma: A case report and literature review

Ruptured aneurysms of the artery of Adamkiewicz are very rare. Thus, few reports have discussed the management of these aneurysms, particularly cases requiring the removal of the spinal hematoma. A 41-year-old man was transferred to our hospital because of worsening, acute-onset, severe lower limb paralysis and bladder bowel disturbance. He was initially diagnosed with an intradural extramedullary tumor at the T12 vertebral level. He underwent an emergency excision; however, hematoma collected in the intradural space. Postoperative spinal angiography revealed a ruptured aneurysm of the Adamkiewicz artery. Conservative treatment for the ruptured aneurysm was selected. Follow-up contrast-enhanced computed tomography confirmed the complete occlusion of the aneurysm. The patient's symptoms finally improved to American Spinal Injury Association grade D. Optimal management of ruptured aneurysms entails interventions tailored to each individual case. Even when spinal cord decompression is required, removing the hematoma while conservatively managing the ruptured aneurysm is a viable treatment option.