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Cerebral aneurysm presenting with aseptic meningitis: a case report.

Saleem MA, Macdonald RL - J Med Case Rep (2013)

Bottom Line: 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.A 61-year-old Caucasian woman presented with nonspecific insidious onset of headache, a superior cerebellar artery aneurysm and 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: 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. macdonaldlo@smh.ca.

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.

No MeSH data available.


Related in: MedlinePlus

Computed tomography at first presentation. Cranial computed tomographic scan showing density in the right interpeduncular cistern (A) and no subarachnoid hemorrhage or hydrocephalus (B). A computed tomographic angiogram sagittal view (C) and lateral view of a reconstruction (D) show an aneurysm arising from the basilar artery distal to the origin of the right superior cerebellar artery.
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Figure 1: Computed tomography at first presentation. Cranial computed tomographic scan showing density in the right interpeduncular cistern (A) and no subarachnoid hemorrhage or hydrocephalus (B). A computed tomographic angiogram sagittal view (C) and lateral view of a reconstruction (D) show an aneurysm arising from the basilar artery distal to the origin of the right superior cerebellar artery.

Mentions: 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 at the origin of the right superior cerebellar artery (Figure 1). Cerebrospinal fluid obtained by lumbar puncture showed 513×106/L erythroid and 293×106/L nonerythroid cells (98% lymphocytes) in the first tube and 16×106/L erythroid and 371×106/L nonerythroid cells (92% lymphocytes) in the third tube. Her total protein level was 0.57g/L (normal range 0.15 to 0.45g/L) and glucose was 2.4mmol/L (serum was 9mmol/L). There was no xanthochromia on visual inspection of the CSF. Culture of the CSF did not yield any bacteria. Enterovirus, herpes simplex virus, Epstein-Barr virus, cytomegalovirus, human herpes virus 8 and West Nile virus immunoglobulin M ribonucleic acids were not detected by polymerase chain reaction in the CSF. A diagnosis of viral meningitis with associated right superior cerebellar artery aneurysm was made. The patient was discharged home and seen as an outpatient 20 days later, at which time she complained of fatigue and blurry vision in the right eye. There was no diplopia or pupil abnormality on examination. It was recommended that she undergo endovascular coil repair of the aneurysm, which she went home to consider.


Cerebral aneurysm presenting with aseptic meningitis: a case report.

Saleem MA, Macdonald RL - J Med Case Rep (2013)

Computed tomography at first presentation. Cranial computed tomographic scan showing density in the right interpeduncular cistern (A) and no subarachnoid hemorrhage or hydrocephalus (B). A computed tomographic angiogram sagittal view (C) and lateral view of a reconstruction (D) show an aneurysm arising from the basilar artery distal to the origin of the right superior cerebellar artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4016604&req=5

Figure 1: Computed tomography at first presentation. Cranial computed tomographic scan showing density in the right interpeduncular cistern (A) and no subarachnoid hemorrhage or hydrocephalus (B). A computed tomographic angiogram sagittal view (C) and lateral view of a reconstruction (D) show an aneurysm arising from the basilar artery distal to the origin of the right superior cerebellar artery.
Mentions: 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 at the origin of the right superior cerebellar artery (Figure 1). Cerebrospinal fluid obtained by lumbar puncture showed 513×106/L erythroid and 293×106/L nonerythroid cells (98% lymphocytes) in the first tube and 16×106/L erythroid and 371×106/L nonerythroid cells (92% lymphocytes) in the third tube. Her total protein level was 0.57g/L (normal range 0.15 to 0.45g/L) and glucose was 2.4mmol/L (serum was 9mmol/L). There was no xanthochromia on visual inspection of the CSF. Culture of the CSF did not yield any bacteria. Enterovirus, herpes simplex virus, Epstein-Barr virus, cytomegalovirus, human herpes virus 8 and West Nile virus immunoglobulin M ribonucleic acids were not detected by polymerase chain reaction in the CSF. A diagnosis of viral meningitis with associated right superior cerebellar artery aneurysm was made. The patient was discharged home and seen as an outpatient 20 days later, at which time she complained of fatigue and blurry vision in the right eye. There was no diplopia or pupil abnormality on examination. It was recommended that she undergo endovascular coil repair of the aneurysm, which she went home to consider.

Bottom Line: 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.A 61-year-old Caucasian woman presented with nonspecific insidious onset of headache, a superior cerebellar artery aneurysm and 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: 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. macdonaldlo@smh.ca.

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.

No MeSH data available.


Related in: MedlinePlus