title: A completely thrombosed, nongiant middle cerebral artery aneurysm mimicking an intra-axial neoplasm.
abstract: BACKGROUND
  Few reports exist regarding thrombosed aneurysms where the initial work up was concerning for a neoplasm. To date, no published reports exist regarding a nongiant thrombosed middle cerebral artery aneurysm, where the primary workup and treatment plan was directed toward a preliminary diagnosis of intra-axial neoplasm.
  
  
  METHODS
  We report a 43-year-old female who presented with a generalized tonic-clonic seizure attributed to a lesion along the right superior temporal gyrus. The lesion enhanced on initial magnetic resonance imaging (MRI) of the brain, as well as on follow-up MRI. Subsequent vascular studies and metastatic work up were negative. A craniotomy with image guidance was performed and an intraoperative diagnosis was made of a thrombosed aneurysm along a branch of the middle cerebral artery. The aneurysm was trapped and resected as there was no significant flow from the branch as seen on the prior cerebral angiogram. The patient had an uneventful postoperative course.
  
  
  CONCLUSIONS
  Completely thrombosed, nongiant aneurysms can mimic an intra-axial neoplasm. Typical imaging features for thrombosed aneurysms may be missed, especially if the aneurysms are small, where imaging characteristics of the intraluminal contents is more difficult to appreciate. Although imaging may be consistent with a neoplastic lesion, there should be suspicion for a potential underlying aneurysm.
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Ha Son
authors.initials: HS
authors.lastname: Nguyen
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Ninh
authors.initials: N
authors.lastname: Doan
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: Eckardt
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Gelsomino
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Saman
authors.initials: S
authors.lastname: Shabani
authors.affiliation: Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: W Douglas
authors.initials: WD
authors.lastname: Brown
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Wade
authors.initials: W
authors.lastname: Mueller
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Glen
authors.initials: G
authors.lastname: Pollock
keywords: Complete thrombosis; middle cerebral artery; neoplasm; seizures; thrombosed cerebral aneurysm