Sudden Paraplegia in Anterior Communicating Artery Aneurysm Rupture: A Rare Presentation

Paraparesis is a rare presentation of ruptured anterior communicating artery (ACoA) aneurysms, the pathogenesis of which is unclear. The combination of vasospasm, paraparesis, and cognitive dysfunction has long been referred to as the "ACoA aneurysm paraparesis syndrome." Some authors have proposed hydrocephalus in the absence of vasospasm as the cause for lower-extremity weakness. We report a patient presenting with dense paraplegia because of the rupture of an ACoA aneurysm without any evidence of vasospasm or hydrocephalus on imaging. The possibility of transient severe vasospasm with microvascular ischemia is considered among the possible etiologies.