Mucinous lung cancer is an exceedingly rare cause of cerebral aneurysms, we report a case of a patient who presented with ischemic stroke and was found to have multiple oncotic cerebral aneurysms, one of which later ruptured.

CASE:

66-year-old female presented with mild right hemispheric stroke.  Her CT head showed small infarct in right frontal area but her CTA head/neck revealed a 17.6 x 14.5 mm saccular aneurysm in the distal cavernous segment of left ICA & multiple bilateral distal MCA aneurysms, confirmed by cerebral angiography.

She had negative infectious workup & trans-esophageal echocardiogram. Her oncological workup revealed new bilateral adrenal gland enlargement for which biopsy was undertaken. This showed non-small cell carcinoma likely originating from her lungs as she had pulmonary nodules &was a chronic smoker. While waiting for outpatient PET imaging, she experienced subarachnoid hemorrhage within 10 days. Repeat cerebral angiogram showed multiple new aneurysms & enlargement of the previously seen aneurysms. She underwent embolization of the presumably ruptured left M4 aneurysm. She was deemed a poor candidate for chemotherapy & was discharged on comfort care where she later passed away.

DISCUSSION:

While it is not uncommon for malignancy to cause ischemic stroke, it is extremely rare for tumors to present with oncotic cerebral aneurysms and is usually associated with cardiac myxoma and choriocarcinoma. This is the 7th reported case of lung cancer associated with oncotic cerebral aneurysms, prior cases are summarized below