Anterior Spinal Artery Steal Syndrome Complicated by Ruptured Flow-Related Aneurysm of the Anterior Radiculomedullary Artery.

Abstract

Anterior spinal artery steal syndrome, radiculomedullary artery aneurysms, and pulmonary arteriovenous malformations with a systemic origin are each, considered individually, exceptional conditions. We describe the coexistence of all these conditions and their pathophysiologic relationship by presenting the case of a woman who referred to the emergency department for loss of consciousness and a history of 2 days of medullary symptoms and a subsequent acute respiratory failure. Detailed imaging revealed a subarachnoid hemorrhage due to the rupture of a spinal aneurysm located in a C8 radiculomedullary artery that had its flow reversed toward the deep cervical artery from which a systemic to pulmonary arteriovenous malformation originated. Eventually, the lesion was treated with the exclusion of the left C8 spinal segmental branch and embolization of the arteriovenous malformation.