title: Spontaneous spinal subarachnoid hemorrhage secondary to spinal aneurysms: diagnosis and treatment paradigm.
abstract: BACKGROUND
  Isolated spinal aneurysms are rare; only a few have been reported. To the best of our knowledge, this series represents the largest experience with four ruptured spinal aneurysms, all of which were treated surgically.
  
  
  METHODS
  Clinical information from the hospital charts and diagnostic images of four patients with the diagnosis of spinal aneurysms were reviewed from the senior authors' (RFS, JMZ) office database, surgical reports, and radiological imaging database. Follow-up examinations were performed by phone interview, when possible, and by chart review.
  
  
  RESULTS
  Between 1997 and 2004, four patients with ruptured spinal aneurysms underwent surgical treatment. All aneurysms were located within the spinal canal and manifested with spinal subarachnoid hemorrhage. No collagen disease, aortic coartaction, arteriovenous fistula, or arteriovenous malformations were identified in these patients.
  
  
  CONCLUSIONS
  Subarachnoid hemorrhage within the spinal cord can be caused by ruptured aneurysms. Spinal aneurysms are rare, but should be considered within the differential diagnosis of patients with intracranial subarachnoid hemorrhage when cranial angiography is negative. Magnetic resonance imaging and selective spinal angiography are useful for workup, but definitive diagnosis may require surgical exploration.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Zabramski
authors.forename: Peyman
authors.initials: P
authors.lastname: Tabrizi
authors.forename: Robert C
authors.initials: RC
authors.lastname: Wallace
authors.forename: Manoj G
authors.initials: MG
authors.lastname: Massand
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
mesh_terms: D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000150:complications*; D000784:Aortic Dissection / Q000150:complications / Q000473:pathology; D017542:Aneurysm, Ruptured / Q000150:complications*; D015901:Angiography, Digital Subtraction; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D013115:Spinal Canal / Q000098:blood supply; D013116:Spinal Cord / Q000098:blood supply*; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery