Clinical Analysis of Misdiagnosis of Internal Carotid Artery Aneurysms in Patients with Systemic Lupus Erythematosus

ZHANG Lixia; LUO Huan; SUN Mingxia; HU Taichun; LIU Xiaomin

doi:10.3969/j.issn.1002-3429.2025.10.003

Abstract：Objective To investigate the causes and preventive measures of internal carotid artery aneurysm misdiag-nosed as neuropsychiatric systemic lupus erythematosus(NPSLE)in patients with systemic lupus erythematosus(SLE).Methods The clinical data of 4 SLE patients with internal carotid artery aneurysm misdiagnosed as NPSLE from January 2020 to September 2024 were retrospectively analyzed.Results All 4 patients diagnosed with SLE were treated with long-term low-dose corticosteroids and immunosuppressive agents,but were misdiagnosed as NPSLE because of headache.The misdiagnosis lasted 3 d to 1 year.One patient developed epinasal hemorrhage due to recurrent headache,intermittent fever,nausea,vomi-ting,and poor efficacy of adequate glucocorticoids.After excluding nasal diseases,head magnetic resonance angiography was performed in time and found that the patient had internal carotid aneurysm,which was ruptured,and the patient died on the same day.One patient with transient consciousness disorder underwent head CT scan,the result of which was negative.Sup-plemented corticosteroids was far from satisfactory.The patient had unclear consciousness again,and a follow-up head CT scan showed subarachnoid hemorrhage.The patient was diagnosed with internal carotid artery aneurysm by digital subtraction angi-ography,and the condition was stable after the operation of intracranial aneurysm coil embolization.One patient with a history of intracranial aneurysm surgery had headache again,which was not severe,and the head CT showed no abnormality.CT an-giography showed that the patient had internal carotid artery aneurysm.One patient received head CT because of dizziness and headache,showing no abnormality,and was found to have small internal carotid artery aneurysm by digital subtraction angiog-raphy.Both patients did not undergo surgery and improved after conservative treatment.Conclusion Intracranial aneurysms are uncommon in SLE patients,especially in patients with internal carotid artery aneurysms.Headache is the most common clinical symptom,and it is more likely to be misdiagnosed as NPSLE in the diagnosis and treatment process.Cranial magnetic resonance angiography and whole brain digital subtraction angiography should be performed timely according to the condition of the patient to reduce the misdiagnosis rate.