Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2024; 12(22): 5145-5150
Published online Aug 6, 2024. doi: 10.12998/wjcc.v12.i22.5145
Mimicking aneurysm in a patient with chronic occlusion of the left middle cerebral artery: A case report
Sen Yang, Rong-Kang Mai
Sen Yang, Rong-Kang Mai, Department of Neurosurgery, The Second Affiliated Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
Author contributions: Yang S contributed to manuscript writing, editing, and data collection; Mai RK contributed to conceptualization and supervision; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rong-Kang Mai, MD, Neurosurgeon, Department of Neurosurgery, The Second Affiliated Hospital of Shenzhen University, No. 118 Longjing Road, Shenzhen 518000, Guangdong Province, China. 1461973198@qq.com
Received: February 22, 2024
Revised: May 10, 2024
Accepted: June 3, 2024
Published online: August 6, 2024
Processing time: 130 Days and 19.6 Hours
Abstract
BACKGROUND

With the popularization of various cerebrovascular imaging methods and increased attention to the field, more cerebrovascular diseases are being detected in asymptomatic patients. Different cerebrovascular diseases are typically isolated but occasionally occur simultaneously, causing difficulties in diagnosis and treatment. Morphological changes in the collateral circulation of blood vessels in chronic cerebral artery occlusion patients are slow and dynamic, intercepting morphological development at a specific moment. Excessive reliance on single imaging tests such as digital subtraction cerebral angiography (DSA) can lead to misdiagnosis.

CASE SUMMARY

We report a 52-year-old male who was admitted to our department for treatment of an unruptured aneurysm during a follow-up examination for brain trauma after 1 mo. Computed tomography (CT) scan was negative, but CT angiography (CTA) revealed a sac-like bulge at the bifurcation of the left middle cerebral artery. DSA revealed an unruptured aneurysm with unique scapular morphology. The stump of a middle cerebral artery occlusion was observed during exposure during aneurysm clipping surgery, and the diagnosis of chronic cerebral artery occlusion was confirmed intraoperatively. This case was confusing because of the peculiar morphology of the arterial stump and compensatory angiogenesis due to multiple cerebral artery stenoses observed on preoperative CTA and DSA. The surgery did not cause secondary damage to the patient, and medical treatment for risk factors was continued postoperatively.

CONCLUSION

Multiple cerebral arterial stenoses can occur in conjunction with aneurysms or arteriovenous malformations, and their unique morphology can lead to misdiagnosis.

Keywords: Chronic occlusion; Misdiagnosis; Aneurysm; Collateral circulation; Case report

Core Tip: We present an asymptomatic patient with chronic occlusion of the left middle cerebral artery who was diagnosed with an aneurysm at the bifurcation of the left middle cerebral artery. This case was confusing because of the peculiar morphology of the arterial stump and compensatory angiogenesis due to multiple cerebral artery stenoses observed on preoperative computed tomography angiography and digital subtraction cerebral angiography. In the absence of comprehensive preoperative imaging, the patient underwent aneurysm clipping, and chronic intracranial artery occlusion was confirmed intraoperatively. The importance of comprehensive imaging evaluations in the routine diagnosis of aneurysms was emphasized.