A Metastatic Middle Cerebral Artery Aneurysm Caused by an Intraluminal Bronchogenic Tumor Embolus

Abstract

Objective and Importance: To describe the clinical presentation and neuropathological findings of metastatic cerebral aneurysms of bronchogenic origin. Metastatic bronchogenic cerebral aneurysms are exceptionally rare and have only been reported in association with high grade hemorrhage. Clinical Presentation: One patient presenting with a history of headache, speech difficulty, left-sided “numbness”, left seventh nerve palsy and left hemiparesis was found to have intraparenchymal and subarachnoid hemorrhage with an aneurysm of the right distal Sylvian middle cerebral artery. Intervention: Pterional craniotomy with excision of mycotic segment. Surgical specimen sent to pathology for routine histology and immunohistochemistry. Conclusion: Patients with metastatic cerebral aneuryms of bronchogenic origin usually present with subarachnoid hemorrhage, contrary to prior observations that “hemorrhage from neoplasia-induced aneurysms is paradoxically rare.” A tumor embolus should be considered in the differential diagnosis of a mycotic aneurysm.