We present the case of a distal anterior inferior cerebellar artery (AICA) aneurysm
masquerading as a cerebellopontine angle tumor in a 60-year-old right-handed man with
previously undiagnosed polyarteritis nodosa (PAN). The patient presented with a 2-month
history of progressive right-sided hearing loss, intermittent severe headache, and
sudden onset of complete facial paralysis 3 weeks before admission. Magnetic resonance
imaging, including postgadolinium images, showed a 1.2-cm heterogenously enhancing
mass that slightly enlarged the right internal auditory canal. A right suboccipital
craniotomy was performed, and a partially thrombosed fusiform AICA aneurysm was discovered
just anterior to the VII/VIII nerve complex. The aneurysm was trapped and opened,
and a thrombectomy was performed. Postoperatively, the patient experienced abdominal
pain; liver function tests were abnormal. Investigation revealed a small retroperitoneal
hemorrhage and aneurysms of the celiac axis and gastroduodenal arteries. Further investigation
revealed an increased erythrocyte sedimentation rate, and a diagnosis of PAN was made.
PAN is a well-identified factor in the genesis of peripheral vascular aneurysms. Aneurysms
involving the hepatic, renal, coronary, pancreatic, and tibial arteries have been
described. PAN is an extremely rare cause of intracranial aneurysm. Patients who present
with aneurysms in unusual locations (e.g., distal AICA) should be investigated for
vasculopathy and collagen vascular disorders.
KEYWORDS
Anterior inferior cerebellar artery - aneurysm - peripheral vascular aneurysms - polyarteritis
nodosa
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Michael J LinkM.D.
Department of Neurologic Surgery, Mayo Clinic
200 First Street SW
Rochester, MN 55905
eMail: link.michael@mayo.edu
