BACKGROUND

Intracranial Aneurysm (IA) is characterized by abnormal dilation of intracranial arterial walls, a tumor-like protrusion, often occurring in the anterior communicating artery. Intracranial Dissecting Aneurysm (IDA) refers to hemodynamic changes within intracranial arteries, leading to ruptures between blood vessel walls, disrupting normal arterial blood flow within the arterial lumen. IDA is relatively uncommon in the anterior circulation. To date, there have been no reported cases of dissecting aneurysms misdiagnosed as cerebral aneurysms before surgical intervention. This case report presents a patient's detailed clinical diagnosis, treatment, and imaging data.

CASE PRESENTATION

A 56-year-old female patient experienced post-work headaches. Cranial Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Digital Subtraction Angiography (DSA) examinations revealed a small hemorrhage following infarction and aneurysms in the initial part of the right A2 segment. Initially, the patient was diagnosed with a ruptured cerebral aneurysm, accompanied by hemorrhage and cerebral vasospasm (cerebral infarction in the right frontal lobe). Subsequently, cerebral aneurysm clipping was performed. During surgery, it was observed that the aneurysm originated from the ipsilateral A2 starting site and displayed dissecting-like changes extending towards the distal end. The final diagnosis confirmed an aneurysm evolving from intracranial artery dissection. Artificial meninges were employed to encase and clip the aneurysm. Post-surgery, the patient was transferred to a superior hospital for A3 bypass. Follow-up assessments indicated a successful recovery.

CONCLUSION

Cerebral aneurysms typically involve larger arteries with rare possibilities of stenosis. Moreover, the cerebral artery is relatively small, making it challenging for Brain Computed Tomography Angiography (CTA) to distinguish true and false lumen within blood vessels. The diagnosis of dissecting aneurysms is difficult and often susceptible to clinical misdiagnosis.