Bacterial intracranial aneurysm

Abstract

The authors tabulate and analyze cases of bacterial intracranial aneurysm documented since 1954, and add four of their own. In 85 cases the overall mortality was 46%. Elimination of patients dying before reaching the hospital makes this figure spuriously low. Figures for patients hospitalized for endocarditis before neurological symptoms occurred suggest a true mortality of 80% from aneurysms that rupture and 30% if the aneurysm remains intact. Multiple reports of spontaneously resolving, enlarging, diminishing, multiple, and sequentially appearing aneurysms, all of which occurred in our fourth case, clarify the need for complete and sequential angiography. Computerized tomographic (CT) scanning in this disease has not been reported, but our experience with these scans demonstrates considerable potential value.A protocol of complete cerebral angiography and CT scanning of these neurologically asymptomatic patients is proposed, in order to assess the true incidence of bacterial intracranial aneurysm, to learn more of its natural history, and to prevent some neurological catastrophes. KEY WORDS9 bacterial endocarditis 9 cerebral aneurysm 9 cerebral angiography 9 cerebral hemorrhage 9 infectious aneurysm mycotic aneurysm 9 subarachnoid hemorrhage

Diagnosis and Management of Infective Endocarditis and Its Complications

“…126 The reported occurrence of ICMAs in 1.2% to 5% of cases [127][128][129][130][131] is probably an underestimate because some ICMAs remain asymptomatic and resolve with antimicrobial therapy. Streptococci and S aureus account for Ϸ50% and Ϸ10% of cases, respectively, 124,126,131 and are seen with increased frequency among IVDA patients with IE. 131 The distal middle cerebral artery branches are most often involved, especially the bifurcations.…”

“…The mortality rate for patients with proximal ICMAs exceeds 50%. 126 The clinical presentation of patients with ICMAs is highly variable. Patients may develop severe localized headache, altered sensorium, or focal neurological deficits such as hemianopsia or cranial neuropathies; the neurological signs and symptoms may suggest a mass lesion or an embolic event.…”

History of surgery for cerebrovascular disease in children. Part I. Intracranial arterial aneurysms

“…7,50,51 Besides a few small series, 13 the majority of publications have been individual case reports. 9,40,74 Children are disproportionately represented, which is probably due to the higher incidence of infectious diseases in this group. The exception to this finding is in infants, who have a high incidence of septic illness but a very low incidence of mycotic aneurysms.…”

Múltiplos aneurismas micóticos intracranianos: registro de um caso

“…A paciente teve alta, sendo readimitida 7 semanas após para novo estudo angio- O aneurisma micótico intracraniano localiza-se preferencialmente nos ramos periféricos da artéria cerebral média 11.13,20^ sendo múltiplos em aproximadamente 17.5% dos casos 3 .…”