• Yan Feng, MingJun Ji, Yufeng Ren, Ziqian Liu, Zhenxue Xin, and Liqun Wang.
• Department of Neurosurgery, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Shi Jiazhuang, Hebei, China.
• Medicine (Baltimore). 2022 Apr 29; 101 (17): e29223e29223.

RationaleDistal middle cerebral artery aneurysms are very rare in the clinic, and craniotomy clipping is the better treatment after diagnosis. However, patients can also have repeated acute intracerebral hemorrhage after craniotomy for aneurysm, which has not been previously reported.Patient ConcernsA 24-year-old male patient was admitted to our hospital with headache, nausea, and vomiting. He was well before, had no family history of cerebrovascular disease or hypertension, and had no history of trauma.DiagnosesComputer tomography and digital subtraction angiography of the brain revealed intracranial hematoma and an aneurysm located at the M4 segment of the left middle cerebral artery.InterventionsThe patient underwent 2 surgeries to treat the aneurysm, followed by 2 operations for acute cerebral hemorrhage.OutcomesDespite repeated surgical treatments, the patient had a poor prognosis and eventually died of respiratory and circulatory failure after repeated brain bleeding.LessonsBriefly, it is of great importance to consider the risk factors of cerebral hemorrhage, and provide individualized treatment and psychological counseling for patients with intracerebral hemorrhage.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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