1157. Neoplastic Cerebral Aneurysm from Metastatic Lung Adenocarcinoma with Neuroendocrine Features

Authors: Jennifer D. Sokolowski, MD; Evin Guilliams; Maria Diaz; Miriam Wildeman; James Nguyen; David Gish; Jason Sheehan; Yashar Kalani; Min Park (Charlottesville, VA)

Introduction: Neoplastic cerebral aneurysms are exceedingly rare. Methods: We describe a case of a ruptured, distal middle cerebral artery aneurysm as the presenting symptom leading to the identification of metastatic lung cancer. Results: The patient underwent an uncomplicated surgical trapping and ligation of the aneurysm. Histopathologic examination of the aneurysm confirmed the neoplastic cerebral aneurysm was due to a metastatic lung adenocarcinoma with neuroendocrine features.His lesion was treated as a metastatic brain tumor and he underwent Gamma Knife radiosurgery to the operative bed. He was also started on chemotherapy including pembrolizumab for oligometastatic disease.He has the longest reported survival of a patient with an neoplastic cerebral aneurysm of lung origin, currently at greater than 4 months with modified Rankin Score of 1. Conclusion: Neoplastic cerebral aneurysms are rare, and there is insufficient data to support specific guidelines for management. This case is novel due to the good functional status of the patient on discharge and subsequent adjuvant therapy he received.