An unruptured aneurysm of the posterior inferior cerebellar artery presenting with meningitis

We report a rare case of unruptured intracranial aneurysm presenting with meningitis. The patient showed symptoms and signs of meningitis without focal neurological deficit. A large PICA aneurysm compressing the medulla was diagnosed. The aneurysm was successfully clipped with remodeling of the parent artery, and the patient had an excellent recovery. Meningitic presentation of an unruptured aneurysmis unusual and may be misleading. On the basis of histopathological and clinical findings, we hypothesized a secondary infection of a berry aneurysm. Aggressive microsurgical strategy resulted in complete occlusion of the aneurysm and parent vessel preservation with brainstem relief and excellent outcome.