Spinal subarachnoid hemorrhage secondary to ruptured artery of Adamkiewicz aneurysm: Is conservative management the first best step?

A 43-year-old woman presented to the hospital with severe low back pain and paresthesias in the bilateral lower extremities. MRI of the spine revealed spinal subarachnoid and subdural hemorrhage extending from T11 to L5-S1. A diagnostic spinal angiogram demonstrated a dissecting, partially thrombosed aneurysm of the artery of Adamkiewicz.At four weeks from the sentinel event, her symptoms had completely resolved with resolution on imaging.Isolated artery of Adamkiewicz aneurysms, which are most often dissecting, fusiform aneurysms are extremely rare and management controversial.