Pediatric intracranial internal carotid artery aneurysm masquerading as meningitis: a case report.

Introduction and importance: Intracranial aneurysms in children are very rare vascular lesions that often have atypical clinical features that differ from those of adult cases. Pediatric intracranial internal carotid artery aneurysm (PIICAA) is particularly uncommon and may be confused with other neurological or infectious conditions, delaying timely diagnosis. Case presentation: This report describes a case of a dissecting PIICAA in a 10-year-old boy who initially presented with fever, seizures, headache, and meningeal signs, leading to a misdiagnosis of meningitis. The infectious etiology was not confirmed with conventional imaging or cerebrospinal fluid analysis, and finally, a diagnosis was made via magnetic resonance imaging and angiography. Clinical discussion: The diagnostic complexity of pediatric internal carotid artery aneurysms is highlighted in this case, especially when symptoms are suggestive of central nervous system infection. Conclusion: The rarity of such cases, coupled with their nonspecific presentation, highlights the importance of keeping cerebral aneurysm in mind as a life-threatening differential diagnosis for neurological syndromes.