Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2021; 9(22): 6380-6387
Published online Aug 6, 2021. doi: 10.12998/wjcc.v9.i22.6380
Ruptured intracranial aneurysm presenting as cerebral circulation insufficiency: A case report
Long Zhao, Shuang-Quan Zhao, Xiao-Ping Tang
Long Zhao, Xiao-Ping Tang, Department of Neurosurgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Shuang-Quan Zhao, Department of Emergency Medicine, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Author contributions: Zhao L, Zhao SQ contributed equally to this work. Zhao L and Zhao SQ-designed this work, analyzed the data, and wrote the manuscript; Zhao SQ collected the patient's clinical data; Tang XP and Zhao L performed the surgery; Tang XP designed and reviewed this paper; all authors have read and approved the final version of this manuscript.
Supported by the Science and Technology Planning Project of Sichuan, No. 2011JY0062.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Ping Tang, MD, Chief Doctor, Department of Neurosurgery, The Affiliated Hospital of North Sichuan Medical College, No. 63 Wenhua Road, Nanchong 637000, Sichuan Province, China. nsmc_txping1971@163.com
Received: February 6, 2021
Peer-review started: February 6, 2021
First decision: April 25, 2021
Revised: May 5, 2021
Accepted: May 27, 2021
Article in press: May 27, 2021
Published online: August 6, 2021
Processing time: 171 Days and 8.6 Hours
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

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.

Keywords: Intracranial aneurysm; Misdiagnosis; Cerebral circulation insufficiency; Case report

Core Tip: This paper reports a case of ruptured intracranial aneurysm presenting as cerebral circulation insufficiency. Furthermore, the causes of misdiagnosis and experiences about the diagnosis and management are discussed by literature review. To the best of our knowledge, this is the first report of intracranial aneurysmal rupture presenting as cerebral circulation insufficiency. Our report also demonstrates a rare case of short-term dilated intracranial cystic aneurysm.