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Case Reports
. 2015 Sep 7:6:146.
doi: 10.4103/2152-7806.164696. eCollection 2015.

A completely thrombosed, nongiant middle cerebral artery aneurysm mimicking an intra-axial neoplasm

Ha Son Nguyen  1 , Ninh Doan  1 , Gerald Eckardt  1 , Michael Gelsomino  1 , Saman Shabani  1 , W Douglas Brown  2 , Wade Mueller  1 , Glen Pollock  1
Affiliations
Case Reports

A completely thrombosed, nongiant middle cerebral artery aneurysm mimicking an intra-axial neoplasm

Ha Son Nguyen et al. Surg Neurol Int. .

Abstract

Background: Few reports exist regarding thrombosed aneurysms where the initial work up was concerning for a neoplasm. To date, no published reports exist regarding a nongiant thrombosed middle cerebral artery aneurysm, where the primary workup and treatment plan was directed toward a preliminary diagnosis of intra-axial neoplasm.

Case description: We report a 43-year-old female who presented with a generalized tonic-clonic seizure attributed to a lesion along the right superior temporal gyrus. The lesion enhanced on initial magnetic resonance imaging (MRI) of the brain, as well as on follow-up MRI. Subsequent vascular studies and metastatic work up were negative. A craniotomy with image guidance was performed and an intraoperative diagnosis was made of a thrombosed aneurysm along a branch of the middle cerebral artery. The aneurysm was trapped and resected as there was no significant flow from the branch as seen on the prior cerebral angiogram. The patient had an uneventful postoperative course.

Conclusion: Completely thrombosed, nongiant aneurysms can mimic an intra-axial neoplasm. Typical imaging features for thrombosed aneurysms may be missed, especially if the aneurysms are small, where imaging characteristics of the intraluminal contents is more difficult to appreciate. Although imaging may be consistent with a neoplastic lesion, there should be suspicion for a potential underlying aneurysm.

Keywords: Complete thrombosis; middle cerebral artery; neoplasm; seizures; thrombosed cerebral aneurysm.

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Figures

Figure 1
Figure 1
Magnetic resonance imaging brain with contrast and T2 fluid-attenuated inversion recovery (a) and (b) initial magnetic resonance imaging, (c) and (d) 1-month follow-up magnetic resonance imaging
Figure 2
Figure 2
Initial negative computed tomography angiogram
See this image and copyright information in PMC

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