Ruptured intracranial aneurysm presenting as cerebral circulation insufficiency: A case report

BACKGROUND: Rupture of an intracranial aneurysm is a type of acute stroke that is a serious threat to human health. Misdiagnosis of ruptured intracranial aneurysms is a serious clinical event that may have disastrous consequences in some patients. To date, ruptured intracranial aneurysms have been misdiagnosed as meningitis, tumors, stroke, or trauma, among other conditions. Here, we report what appears to be the first case of a ruptured intracranial aneurysm that presented as cerebral circulation insufficiency. CASE SUMMARY: A middle-aged man was admitted to our hospital because of a parasellar lesion identified on a noncontrast computed tomography (CT) image after a mild traffic accident that was caused by a brief loss of consciousness. Notably, he was diagnosed with cerebral circulation insufficiency after two unexplained episodes of a transient loss of consciousness within the past 8 mo. The patient was diagnosed with right internal carotid artery aneurysm based on CT angiography and completely recovered after a craniotomy at our hospital. A few clots and severe adhesions around the aneurysm were observed in the subarachnoid space during the operation, suggesting that the aneurysm had ruptured and may had been misdiagnosed as cerebral circulation insufficiency. CONCLUSION: Ruptured intracranial aneurysms may show negative imaging results and present as cerebral circulation insufficiency, which should be recognized as soon as possible to ensure timely management.