Pulmonary artery aneurysms (PAAs) are rare vascular anomalies, most commonly associated with pulmonary hypertension, congenital heart disease, vasculitis, or infection. Idiopathic PAAs, lacking an identifiable underlying cause, are exceptionally rare and often discovered incidentally. This case illustrates the diagnostic approach and rationale for conservative management of idiopathic PAAs in the absence of high-risk features.

The incidence of silent brain infarction (SBI) and perioperative neurocognitive disorders (PND) is higher in cardiac surgery. However, standard preventive strategies remain unknown due to limited evidence.

To report a case of carbamazepine-induced neurotoxicity presenting as paroxysmal dysarthria with ataxia, and to highlight clinical risk factors and diagnostic challenges. This case mimicked a transient ischemic attack (TIA), representing a significant diagnostic pitfall. We present the case of a 71-year-old woman who developed acute paroxysmal dysarthria and ataxia after initiating carbamazepine for otoneuralgia. Differential diagnoses considered included TIA, seizure, drug-induced neurotoxicity, and vestibular disorders. Diagnosis was established through medication review, temporal correlation, and a positive rechallenge test. The Naranjo Adverse Drug Reaction Probability Scale was applied. Symptoms resolved completely upon drug withdrawal and recurred immediately after re-exposure (the patient self-administered a single 100 mg dose on day 4, with immediate symptom recurrence, confirming causality). Serum drug levels were not measured due to limitations of our hospital's laboratory facilities; the Naranjo score was 5 (probable ADR). This case illustrates that carbamazepine may induce specific neurotoxicity even at standard doses in susceptible elderly patients. Paroxysmal dysarthria is a rare but underrecognized adverse reaction. Key clinical take-home points include vigilant clinical assessment, caution with potential drug-drug interactions, therapeutic drug monitoring, and pharmacogenetic profiling when indicated- all of which may aid in prevention and risk reduction.