Altered mental status with mirror giant middle cerebral artery aneurysms: A case report

• Main Authors: Kamil W. Nowicki, Jasmine L. Hect, Nallamai Muthiah, Arka N. Mallela, Benjamin M. Zussman
• Format: Article
• Language: English
• Published: Elsevier 2021-09-01
• Series: Interdisciplinary Neurosurgery
• Subjects: Altered mental status; Giant cerebral aneurysm; Intracranial
• Online Access: http://www.sciencedirect.com/science/article/pii/S2214751921000669

Introduction: Mirror aneurysms of the middle cerebral artery (MCA) constitute 14% of all MCA aneurysms, which commonly arise from the MCA bifurcation. Giant MCA aneurysms (>25 mm in diameter) have a reported 5-year rupture rate of 40%, though can be difficult to treat surgically given their complex nature. Giant aneurysms may present with symptoms of mass effect, including neurological deficit, headaches, and/or cranial neuropathies. To our knowledge, no case of mirror bilateral giant MCA aneurysms exists in the neurosurgical literature. Case description: Here we present a case of mirror bilateral giant MCA aneurysms in an 84-year-old man who presented with altered mental status and increased falls in the last year. Imaging revealed mirror MCA aneurysms, 3.5 and 4 cm in diameter respectively, arising from bilateral M1 segments. The patient opted to forego further evaluation or surgical intervention and was discharged home. Conclusion: We report the first known case of mirror bilateral giant MCA aneurysms were found in an 84-year-old man presenting with altered mental status and progressive decline across the last year.