Zhao Long, Zhao Shuang-Quan, Tang Xiao-Ping
Department of Neurosurgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China.
Department of Emergency Medicine, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China.
World J Clin Cases. 2021 Aug 6;9(22):6380-6387. doi: 10.12998/wjcc.v9.i22.6380.
Rupture of an intracranial aneurysm is a type of acute stroke that is a serious threat to human health. Misdiagnosis of ruptured intracranial aneurysms is a serious clinical event that may have disastrous consequences in some patients. To date, ruptured intracranial aneurysms have been misdiagnosed as meningitis, tumors, stroke, or trauma, among other conditions. Here, we report what appears to be the first case of a ruptured intracranial aneurysm that presented as cerebral circulation insufficiency.
A middle-aged man was admitted to our hospital because of a parasellar lesion identified on a noncontrast computed tomography (CT) image after a mild traffic accident that was caused by a brief loss of consciousness. Notably, he was diagnosed with cerebral circulation insufficiency after two unexplained episodes of a transient loss of consciousness within the past 8 mo. The patient was diagnosed with right internal carotid artery aneurysm based on CT angiography and completely recovered after a craniotomy at our hospital. A few clots and severe adhesions around the aneurysm were observed in the subarachnoid space during the operation, suggesting that the aneurysm had ruptured and may had been misdiagnosed as cerebral circulation insufficiency.
Ruptured intracranial aneurysms may show negative imaging results and present as cerebral circulation insufficiency, which should be recognized as soon as possible to ensure timely management.
颅内动脉瘤破裂是一种急性卒中类型,对人类健康构成严重威胁。颅内动脉瘤破裂的误诊是一种严重的临床事件,在某些患者中可能会产生灾难性后果。迄今为止,颅内动脉瘤破裂曾被误诊为脑膜炎、肿瘤、中风或创伤等其他病症。在此,我们报告了首例表现为脑循环不足的颅内动脉瘤破裂病例。
一名中年男性因在一次轻微交通事故后意识短暂丧失,经非增强计算机断层扫描(CT)图像发现鞍旁病变而入住我院。值得注意的是,在过去8个月内,他曾两次不明原因地短暂意识丧失,之后被诊断为脑循环不足。基于CT血管造影,该患者被诊断为右侧颈内动脉动脉瘤,并在我院接受开颅手术后完全康复。手术过程中,在蛛网膜下腔观察到动脉瘤周围有一些血凝块和严重粘连,提示动脉瘤已破裂,且可能曾被误诊为脑循环不足。
颅内动脉瘤破裂可能显示影像学阴性结果,并表现为脑循环不足,应尽快识别以确保及时治疗。