A Diagnostic and Therapeutic Alert for Vertebral Artery Pseudoaneurysm: Lessons From a Case Initially Misdiagnosed as Schwannoma

Pseudoaneurysm of the vertebral artery is a rare vascular lesion characterized by localized pulsatile hematomas formed in surrounding tissues following vertebral artery wall rupture, presenting with nonspecific clinical manifestations. This report describes a 57-year-old male patient presenting with "dizziness." Initial MRI suggested a mass in the right C3/4 intervertebral foramen, initially suspected as a schwannoma, but digital subtraction angiography ultimately confirmed a pseudoaneurysm of the vertebral artery rather than a schwannoma. This case highlights the imaging mimicry of vertebral artery pseudoaneurysms with neurogenic tumors, underscoring their importance in differential diagnosis of intervertebral foramen masses. Although the patient underwent successful endovascular embolization, postoperative complications including spinal cord ischemia occurred. Through this misdiagnosis and treatment experience, the report aims to enhance clinical awareness of vertebral artery pseudoaneurysms, emphasize the significance of multimodal imaging evaluation, and discuss associated treatment risks.