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Subarachnoid hemorrhage from a thoracic radicular artery pseudoaneurysm after methamphetamine and synthetic cannabinoid abuse: case report.

ABSTRACT: Background Context Isolated spinal artery aneurysms not associated with vascular malformations are exceedingly rare. Purpose To present a rare case of subarachnoid hemorrhage after thoracic radiculomedullary artery pseudoaneurysm rupture in a patient who abused synthetic cannabinoids and methamphetamines. Study Design Case report. Methods A 41-year-old man with a history of polysubstance abuse presented with acute-onset headache, back pain, and transient bilateral lower-extremity numbness. He reported daily use of the synthetic cannabinoid "Spice." He denied use of other illegal drugs, but laboratory testing was positive for methamphetamines. Magnetic resonance imaging showed a focal hematoma at T2-3, and spinal angiography was negative for vascular abnormalities; however, a follow-up angiogram 6 days later revealed interval development of an irregular dilation of the left T3 radiculomedullary artery originating from the left supreme intercostal artery. Results Surgical trapping and resection of the lesion yielded a good clinical outcome. Conclusions Although two previous case reports have described patients with thoracic radiculomedullary pseudoaneurysm causing spinal subarachnoid hemorrhage (SAH), this is the first reported case associated with synthetic cannabinoids and methamphetamine abuse. Although this diagnosis is exceptionally rare, clinical presentation of SAH with associated back pain and lower-extremity symptoms warrants an aggressive imaging workup. Even in the setting of negative angiography, repeat cerebral and spinal angiograms may be necessary to identify a potentially treatable cause of spinal SAH.

SUBMITTER: Ray WZ

PROVIDER: S-EPMC3854594 | biostudies-other | 2013 Jun

REPOSITORIES: biostudies-other

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Project description:Introduction and importance Subarachnoid hemorrhage (SAH) is mostly associated with head trauma. Non-traumatic subarachnoid hemorrhage is mostly due to vascular abnormalities: either hemorrhage from ruptured aneurysm or bleeding from arteriovenous malformation. Aneurysmal hemorrhage is the biggest cause in non-traumatic cases. Warfarin is associated with cerebral intraparenchymal hemorrhage, but it is rarely associated with SAH. Case presentation Here, we report the case of a 45-year-old male patient who was admitted to the neurology ward of our hospital due to acute ischemic stroke. The patient was treated with a vitamin K antagonist (warfarin). However, on the third day, his condition deteriorated (his GCS regressed from 11/15 to 5/15). His pupils were anisocoric. Brain CT showed extensive subarachnoid hemorrhage without intraparenchymal involvement. Cerebral magnetic resonance angiography ruled out aneurysmal rupture. The patient was intubated and transferred to the intensive care unit. Due to his poor condition, neurosurgical intervention could not be done. The patient was managed conservatively, but the patient passed away 4 days later in the intensive care unit. Clinical discussion Non-traumatic SAH is mostly caused by aneurysmal rupture. Warfarin increases the risk of intracranial hemorrhage and mostly causes intraparenchymal hemorrhage. Isolated warfarin-related SAH without parenchymal involvement is a rare event. Here we present a young male patient with an isolated warfarin-induced SAH. Conclusion Warfarin is rarely associated with isolated subarachnoid hemorrhage. This case highlights a young male patient with spontaneous SAH after warfarin therapy for acute ischemic stroke. Aneurysmal rupture and trauma should be excluded before a diagnosis of warfarin-induced SAH is made. Highlights • Non-traumatic subarachnoid hemorrhage (SAH) is mostly caused by aneurysmal rupture.• Warfarin increases the risk of intracranial hemorrhage and mostly causes intraparenchymal hemorrhage. Isolated warfarin-related SAH without parenchymal involvement is a rare event.• Here we present a young male patient with isolated SAH due to warfarin treatment for acute ischemic stroke.

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Subarachnoid hemorrhage from a thoracic radicular artery pseudoaneurysm after methamphetamine and synthetic cannabinoid abuse: case report.

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