PMC9389152_01
On admission, cranial magnetic resonance imaging (MRI) of the patient was normal (A), and there was no evidence of intracranial aneurysm on brain magnetic resonance angiography (MRA) (B). On hospital day 7, a brain MRI was done again and showed acute multiple cerebral infarcts in the left cerebral hemisphere (C,D). On hospital day 25, cranial CT revealed significantly increased low-density shadow in the left frontal, temporal, and parietal lobes (E-G). The MRI (H,I) and MRA (J) re-examination demonstrated that the lesions in the left cerebral hemisphere were increased significantly, and a cerebral aneurysm formed in the intracavernous segment of the left internal carotid artery (ICA). On hospital day 29, a repeat head MRI showed markedly enlarged size of the left temporal lesions with abscess formation and bleeding (K,L). On hospital day 37, brain MRI showed a decreased size of the left temporal lesions but with perifocal evident edema (M). On hospital day 55, a repeat head MRI showed that the lesions and edema of the left temporal lobe was improved, but hydrocephalus became even worse (N,O). On hospital day 58, cranial CT showed intraventricular extension and hydrocephalus (P).
fneur-13-889838-g0001.jpg
PMC9389152_01_fneur-13-889838-g0001.jpg
F1
Cranial magnetic resonance imaging (MRI) was normal (Figure 1A), and there was no evidence of intracranial aneurysm on brain magnetic resonance angiography (MRA; Figure 1B). On hospital day 7, the patient developed significant diplopia and weakness in the right upper extremity with a brain MRI showing acute multiple cerebral infarcts in the left cerebral hemisphere (Figures 1C,D). Cranial CT revealed significantly increased low-density shadow in the left frontal, temporal, and parietal lobes (Figures 1E-G). The MRI (Figures 1H,I) and MRA (Figure 1J) re-examination demonstrated that the lesions in the left cerebral hemisphere were increased significantly, and a cerebral aneurysm was formed in the intracavernous segment of the left internal carotid artery (ICA). Head MRI showed a markedly enlarged size of the left temporal lesions with abscess formation and bleeding, accompanied by peripheral ring-shaped enhancement (Figures 1K,L). On hospital day 37, brain MRI showed a decreased size of the left temporal lesions but with perifocal evident edema (Figure 1M). Repeat brain MRI showed that the lesions and edema of the left temporal lobe were improved, but hydrocephalus became even worse (Figures 1N,O). Coma Scale (GCS) of 9 (E2V2M5), right hemiplegia, left eyeball fixation, pupil dilation with ptosis on the left side, and stiffness in the neck. Cranial CT showed intraventricular extension and hydrocephalus (Figure 1P).
Clinical course of the case.
fneur-13-889838-g0002.jpg
PMC9389152_01_fneur-13-889838-g0002.jpg
F2
The clinical course is summarized in Figure 2.