A 57-year-old woman came to our attention with 3 months of progressive headaches and amnesia. Neurologic examination did not show any focal deficits other than impaired short-term memory.
Brain computed tomography scan showed a large mass in the right frontotemporal area with surrounding edema and calcified wall without prominent enhancement after contrast injection. Brain magnetic resonance imaging revealed a large heterogenous round mass with mixed signals and a flow void that made us suspect an underlying vascular lesion. Computed tomography angiogram revealed a large aneurysm in the right middle cerebral artery (MCA) bifurcation with thrombosis in the aneurysm wall. Computed tomography angiogram showed a large thrombosed aneurysm in MCA bifurcation, which was confirmed on conventional angiography (Figure 1).
Figure 1.
A, Axial brain CT scan showing a large mass in the right frontotemporal area with surrounding edema and calcified wall (red arrows). B, Axial T2-weighted MRI shows a large heterogenous lesion (red arrows) with mixed signals and flow void (white star). C, The CT angiogram (axial view) shows the aneurysm in the right MCA bifurcation (red arrow). D, Angiogram shows aneurysm (white arrow). CT indicates computed tomography, MCA, middle cerebral artery; MRI, magnetic resonance imaging.
Giant intracranial aneurysms are more susceptible to thrombosis and can present as intra-axial masses compressing adjacent structures. In clinical practice, these aneurysms can be misdiagnosed as brain tumors.1 It is important to consider cerebral aneurysms in the differential diagnosis of intracranial space–occupying lesions, especially if there are heterogeneity and signal voids.
Footnotes
Authors’ Note: Dr Naderafshar Fereydonian contributed in critical revision of the manuscript for important intellectual content. Dr Sadra Rohani and Dr Morteza Taheri contributed in acquisition of data. Dr Mohammad Rohani contributed in primary drafting of the manuscript.
Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
Reference
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