Unusual Case of an Intracranial Aneurysm Misdiagnosed as Focal Basal Meningitis

• Published in: Sultan Qaboos University medical journal 2017-08, Vol.17 (3), p.363-365
• Main Authors: Al-Aghbari , Said, Memon , Imran K, Al-Shamakhi , Ahmed, Jamkhandikar , Rakesh M, Al-Saadi , Tahra, Al-Muqaimi , Majed, Ahmad , Asifa, Ansari , Misbahuddin, Michael , Philips G
• Format: Article
• Language: English
• Subjects: Aged; Aneurysms; Armed forces; BLOOD; CRANIAL NERVES; DIAGNOSIS; Diagnostic Errors; Fatal Outcome; Humans; Interesting Medical Image; Intracranial Aneurysm - diagnostic imaging; INTRACRANIAL DISORDERS; Male; Mastoidectomy; Medical imaging; MENINGITIS; Meningitis - diagnostic imaging; Middle Cerebral Artery - diagnostic imaging; NMR; Nuclear magnetic resonance; Postoperative Complications - diagnostic imaging; Tomography; Tomography, X-Ray Computed; إلتهاب السحايا; الأعصاب القحفية; الإضطرابات داخل الجمجمة; التشخيص; الدم
• ISSN: 2075-051X; 2075-0528
• DOI: 10.18295/squmj.2017.17.03.020

Comment Despite significant improvements in imaging technology, diagnostic radiological errors can still occur due to poor imaging techniques or failure of perception, lack of knowledge or misjudgment on the part of the radiologist.1 As such, both diagnostic radiologists and referring physicians should be aware of potential sources of error when interpreting imaging scans. Errors in which an abnormality is detected on imaging but its true pathological nature and significance are not recognised are classified as cognitive errors; these include false-positive cases as well as the inaccurate classification of abnormal findings.1 Erroneous conclusions drawn from improper clinical information, a paucity of knowledge or the consideration of only a restricted number of differential diagnoses have been previously implicated in misdiagnoses.1 In the current case, although the abnormality was correctly identified on the initial CT scan, it was falsely attributed to focal basal meningitis rather than a ruptured aneurysm; this represents a rare instance of cognitive error. Malatt et al. identified several factors contributing to false-negative interpretations of emergency head CT scans, including inadequate or inaccurate clinical information, failure to compare recent images with those from prior scans, use of improper windowing and leveling settings and lack of use of multiplanar reconstruction technology to provide various anatomical views.2 Lawson et al. also reported that excessive reliance on previous experience, the inclination to find and/or exaggerate supporting evidence to favour a specific diagnosis while neglecting or failing to obtain opposing evidence and the penchant to make a diagnosis without sufficient testing could all contribute to bias and result in an erroneous diagnosis.3 It is therefore essential to keep an open mind and consider relevant alternative diagnoses when interpreting a specific imaging finding.