Subarachnoid hemorrhage secondary to a ruptured inflammatory aneurysm: a possible manifestation of neurocysticercosis: case report.
We report a case of a 32-year-old man who presented with subarachnoid hemorrhage. As revealed by lumbar puncture, the cerebrospinal fluid had low glucose, high protein levels, and pleocytosis with 5% of eosinophils. Cultures were negative. Enzyme-linked immunosorbent assay and complement fixation reactions for cysticercosis in cerebrospinal fluid were positive. An angiogram revealed an aneurysm of the right anteroinferior cerebellar artery. At surgery, the aneurysm was found to be surrounded by thickened leptomeninges, which histologically presented dense inflammation and remains of Cysticercus. The aneurysm could not be clipped, and it was wrapped. Postoperatively, the patient had dizziness and right ear tinnitus. He received prednisone therapy on alternate days and subsequently received albendazole for subarachnoid cysticerci. At the 4-year follow-up, the patient was asymptomatic and had normal cerebrospinal fluid. Although we cannot rule out a congenital aneurysm, its location inside an area of severe arachnoiditis around a cysticercus suggests an inflammatory origin. This type of vascular lesion not reported before should be suspected in patients with chronic cysticercotic meningitis.
Soto-Hernandez
J L
JL
Department of Infectious Diseases, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
Gomez-Llata Andrade
S
S
Rojas-Echeverri
L A
LA
Texeira
F
F
Romero
V
V
D000328:Adult; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D001100:Arachnoiditis / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D001158:Arteries / Q000473:pathology / Q000601:surgery; D002531:Cerebellum / Q000098:blood supply; D003551:Cysticercosis / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D008297:Male; D008581:Meningitis / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*