De Novo Aneurysm of the Distal Middle Cerebral Artery and Subarachnoid Hemorrhage After Nasogastric Tube Insertion: A Case Report

Distal middle cerebral artery aneurysm is rare and can develop from trauma, infection, atherosclerosis, or surgery. Nasogastric (NG) tube insertion is a common and safe procedure for stroke patients with dysphagia. In this case, the patient showed right internal border-zone infarction without major arterial occlusion. Magnetic resonance angiography of the brain showed no intracranial aneurysm. On the tenth day of hospitalization, we inserted an NG tube for feeding; insertion was difficult. Four hours later, the patients showed sudden mental deterioration. Computed tomography and computed tomographic angiography of the brain showed diffuse subarachnoid hemorrhage and ruptured de novo aneurysm at the right distal middle cerebral artery. Herein, we report a case of de novo aneurysm and subarachnoid hemorrhage that occurred after NG tube insertion.