• Aponte A

• Adult
• Aneurysm
• Male
• Open Access Document
• Paresthesia
• Thrombosis

Objective: To describe the rare case of a patient with complex neurological symptomatology who received conflicting differential diagnoses of cerebral cavernous malformation and posterior cerebral artery aneurysm. Each condition is described to help clinicians better recognize them in private practice.

Clinical Features: A 24-year-old male athlete had left-sided facial, upper, and lower extremity paresthesia and decreased left-hand grip strength immediately following a weightlifting injury. The patient immediately sought medical care. His medical team ordered a cervical and lumbar spine MRI, all unfortunately non-explanatory of his chief complaint. He then came 2 months after the onset of symptoms for a chiropractic evaluation. At this time he still had numbness on the left face and still complained of left arm and left foot numbness.

Intervention and Outcome: After evaluating the patient’s history and correlating it with the clinical findings, it raised suspicion of possible brain neurological involvement. The patient was referred to a neurologist for a brain MRI with contrast. After the MRI was obtained the neurologist ordered a brain MRA. The MRI revealed a 2.1cm T1 hyperintense lesion in the medial aspect right temporal lobe and a small T2 hyperintense lesion within the right thalamus. The MRA revealed a 1.2 cm lesion involving the medial right temporal lobe. With the obtained imaging results there were multiple differential diagnoses. The patient was promptly referred for a neurosurgical consult where the neurosurgeon performed a cerebral CTA with contrast. They concluded that the patient had a thrombosed PCA aneurysm. The patient was cleared by neurologist to resume all activities, including weightlifting. His paresthesia to left face, upper and lower extremity persists.

Conclusion: This case serves as reminder to primary care physicians of all taxonomies of the importance of proper correlation of mechanism of injury, symptomatology, and physical exam to promptly recognize red flags and perform an accurate and timely referral, especially in cases where brain involvement is suspected. I also highlight the importance of an accurate diagnosis to determine the ability for the patient to resume activities of daily living (ADL’s), in this case weightlifting.

Author keywords: Paresthesia; Chiropractic; Thrombosis; Aneurysm

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