Lateral sacral artery aneurysm of the lumbar spine: hemorrhage resulting in cauda equina syndrome.

OBJECTIVE

To describe the effective treatment of a ruptured lateral sacral artery aneurysm presenting as a spinal epidural hematoma.

DESIGN

Case report and literature review.

SETTING

University teaching hospital, neurovascular center.

PARTICIPANT

A man with a history of renal allograft who presented with sudden onset low back pain.

INTERVENTION

The patient underwent emergent decompressive surgery, diagnostic angiogram and endovascular embolization.

MAIN OUTCOME MEASURE

Obliteration of aneurysm and restoration of neurological function.

RESULTS

Surgery resulted in decompression of the cauda equina. The patient's aneurysm was endovascularly obliterated. There was complete restoration of neurological function.

CONCLUSION

Lateral sacral artery aneurysm formation and rupture is a rare cause of epidural hemorrhage and one described only in patients who have undergone renal transplantation. It may be caused by high flow from transpelvic collaterals between both internal iliac arteries. Treatment includes endovascular obliteration and may necessitate operative decompression in the setting of neurological compromise.