title: Posterior spinal artery aneurysm rupture after 'Ecstasy' abuse.
abstract: Posterior spinal artery (PSA) aneurysms are a rare cause of subarachnoid hemorrhage (SAH). The commonly abused street drug 3,4-methylenedioxymethamphetamine (MDMA) or 'Ecstasy' has been linked to both systemic and neurological complications. A teenager presented with neck stiffness, headaches and nausea after ingesting 'Ecstasy'. A brain CT was negative for SAH but a CT angiogram suggested cerebral vasculitis. A lumbar puncture showed SAH but a cerebral angiogram was negative. After a spinal MR angiogram identified abnormalities on the dorsal surface of the cervical spinal cord, a spinal angiogram demonstrated a left PSA 2 mm fusiform aneurysm. The patient underwent surgery and the aneurysmal portion of the PSA was excised without postoperative neurological sequelae. 'Ecstasy' can lead to neurovascular inflammation, intracranial hemorrhage, SAH and potentially even de novo aneurysm formation and subsequent rupture. PSA aneurysms may be treated by endovascular proximal vessel occlusion or open surgical excision.
authors.affiliation: Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Johnson
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Shnehal
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Efrat
authors.initials: E
authors.lastname: Saraf-Lavi
authors.affiliation: Department of Neurosurgery, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Aziz-Sultan
authors.affiliation: Department of Neurology and Neurosurgery, University of Miami, Miami, Florida, USA.
authors.forename: Dileep R
authors.initials: DR
authors.lastname: Yavagal
mesh_terms: D000293:Adolescent; D017542:Aneurysm, Ruptured / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000009:adverse effects*; D019966:Substance-Related Disorders / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D014711:Vertebral Artery / Q000473:pathology*
chemical_list: D018817:N-Methyl-3,4-methylenedioxyamphetamine
keywords: Aneurysm; Drug; Inflammation; Spinal cord; Spine