Cerebral aneurysm presenting with aseptic meningitis: a case report
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JOURNAL OF MEDICAL
CASE REPORTS
CASE REPORT
Open Access
Cerebral aneurysm presenting with aseptic meningitis: a case report Muhammad Azfar Saleem1,2 and R Loch Macdonald1,2*
Abstract Introduction: This case highlights the potential importance of new-onset headache, even in the absence of other worrisome features, in a patient with a cerebral aneurysm. Case presentation: A 61-year-old Caucasian woman presented with nonspecific insidious onset of headache, a superior cerebellar artery aneurysm and cerebrospinal fluid lymphocytosis. She had a subarachnoid hemorrhage 21 days later, at which time the aneurysm had enlarged. The aneurysm was repaired endovascularly and the patient recovered with a modified Rankin score of 1. Conclusions: This case suggests that new onset of chronic headache in a patient with an unruptured aneurysm may be due to aneurysm growth and can be associated with cerebrospinal fluid lymphocytosis. Headaches are common and may occur incidentally in patients with cerebral aneurysms, but new-onset headache, even if mild, should prompt consideration for timely aneurysm repair. Keywords: Cerebral aneurysm, Cerebrospinal fluid inflammation, Subarachnoid hemorrhage
Introduction Improvement and advancements in diagnostic tools, and their application, has increased the incidence of diagnosis of unruptured aneurysms [1]. Unruptured aneurysms have been associated with headache, cranial nerve palsies and seizures [1,2]. The most common chronic symptom is nonspecific headache. The etiology of these headaches is controversial and, in some cases, chronic or slow-onset headache may not be due to an unruptured aneurysm. We describe a patient with an unruptured superior cerebellar artery aneurysm who presented with new onset of chronic headache, normal cranial computed tomography (CT) and cerebrospinal fluid (CSF) containing lymphocytes. The aneurysm ruptured 21 days later. This case is important because it suggests that new-onset headache in a patient with an unruptured intracranial aneurysm could indicate that there is a risk that the aneurysm could rupture soon, particularly if there is evidence of inflammation in the CSF. * Correspondence: [email protected] 1 Division of Neurosurgery, St. Michael’s Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada 2 Department of Surgery, University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada
Case presentation A 61-year-old, right-handed Caucasian woman presented with a two-week history of increasing headache, which was not described as severe. There was no specific time when the headache began. Her blood pressure was 130/ 80mmHg. A plain CT scan of the head with 5mm thick axial slices obtained on a 64-slice scanner did not show any subarachnoid hemorrhage (SAH). Her CT angiogram showed an aneurysm with a transverse diameter of 0.6cm and a maximum diameter of 0.8cm arising from the basilar artery
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