Clinicopathological Study of Bacterial Intracranial Aneurysms

Takeshita, Mikihiko; Kagawa, Mizuo; Kubo, Osami; Yato, Seiji; Satoh, Kazuei; Ujiié, Hiroshi; Kasuya, Hidetoshi; Izawa, Masahiro

doi:10.2176/nmc.31.508

Cited by 10 publications

(8 citation statements)

References 15 publications

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“…Infective aneurysms in children occur most often in individuals with infective endocarditis resulting from congenital or rheumatic heart disease. 327,328 Fortunately, these aneurysms have become less common with the decreased incidence of rheumatic heart disease and with earlier recognition and treatment of endocarditis. 329 Most infective aneurysms result from bacterial infection, but fungal aneurysms may occur in immunocompromised patients and occasionally in conjunction with sinusitis.…”

Section: Infective Aneurysmsmentioning

confidence: 99%

Management of Stroke in Infants and Children

Roach¹,

Golomb²,

Adams³

et al. 2008

Stroke

864

377

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Purpose— The purpose of this statement is to review the literature on childhood stroke and to provide recommendations for optimal diagnosis and treatment. This statement is intended for physicians who are responsible for diagnosing and treating infants, children, and adolescents with cerebrovascular disease. Methods— The Writing Group members were appointed by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee. The panel included members with several different areas of expertise. Each of the panel’s recommendations was weighted by applying the American Heart Association Stroke Council’s Levels of Evidence grading algorithm. After being reviewed by panel members, the manuscript was reviewed by 4 expert peer reviewers and by members of the Stroke Council Leadership Committee and was approved by the American Heart Association Science Advisory and Coordinating Committee. We anticipate that this statement will need to be updated in 4 years. Results— Evidence-based recommendations are provided for the prevention of ischemic stroke caused by sickle cell disease, moyamoya disease, cervicocephalic arterial dissection, and cardiogenic embolism. Recommendations on the evaluation and management of hemorrhagic stroke also are provided. Protocols for dosing of heparin and warfarin in children are suggested. Also included are recommendations on the evaluation and management of perinatal stroke and cerebral sinovenous thrombosis in children.

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Section: Infective Aneurysmsmentioning

confidence: 99%

Management of Stroke in Infants and Children

Roach¹,

Golomb²,

Adams³

et al. 2008

Stroke

864

377

View full text Add to dashboard Cite

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“…Some studies have reported an association between congenital heart diseases and the occurrence of mycotic aneurysms (bacterial intracranial aneurysm) caused by bacterial emboli that directly reach the cerebral circulation and reimplant on the arterial walls (20).…”

Section: Discussionmentioning

confidence: 99%

An unusual and complex congenital heart disease in a patient with a ruptured cerebral aneurysm

Chen

Chen²,

Lu³

2014

Turkish Neurosurgery

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A 38-year-old woman had complex, congenital heart anomalies, including double-outlet right ventricle with mitral atresia, severe left ventricle hypoplasia, atrial septal defect, and severe pulmonary stenosis, for which she had not received appropriate treatment. She presented to our institution with an intense sudden-onset headache that had initiated while sleeping. Brain computed tomography indicated the presence of spontaneous subarachnoid hemorrhage. Cerebral angiography revealed a left middle cerebral artery aneurysm. Two days later, she underwent a craniotomy for aneurysm clipping. According to the pathological analysis, culture, and clinical presentation, the aneurysm was not mycotic. The patient regained consciousness after a few days postoperatively.Despite the complex and rare congenital heart disease, it is especially notable that the patient survived 38 years without treatment and later had a ruptured cerebral aneurysm that was successfully managed operatively. Our literature review indicated that some congenital heart diseases such as aortic coarctation may correlate with the presence of intracranial aneurysms. Our case is novel because there are no similar cases of complex congenital heart disease combined with a ruptured intracranial aneurysm successfully resolved operatively. We believe that this case would help clinicians deal with such complicated cases of congenital heart disease combined with intracranial aneurysms. KEywoRds:Congenital heart disease, Double-outlet right ventricle, Aneurysm ÖZOtuz sekiz yaşında bir kadında mitral atrezi, şiddetli sol ventrikül hipoplazisi, atriyal septal defekt ve şiddetli pulmoner stenozla birlikte çift çıkışlı sağ ventrikül dahil konjenital kalp anomalileri vardı ve bunlar için uygun tedavi almamıştı. Kurumumuza uyurken aniden başlayan şiddetli başağrısı ile geldi. Bilgisayarlı beyin tomografisi spontan subaraknoid kanama varlığını işaret etti. Serebral anjiyografi bir sol orta serebral arter anevrizmasını ortaya koydu. İki gün sonra anevrizmayı kliplemek için kraniyotomi yapıldı. Patoloji analizi, kültür ve klinik sunuma göre anevrizma mikotik değildi. Hastanın bilinci ameliyattan birkaç gün sonra açıldı.Karmaşık ve alışılmadık konjenital kalp hastalığına rağmen hastanın tedavi almadan 38 yıl yaşaması ve daha sonra operatif olarak başarıyla tedavi edilen bir rüptüre serebral anevrizması olması özellikle ilginçtir. Literatür derlememiz aort koarktasyonu gibi bazı konjenital kalp hastalıklarının intrakraniyal anevrizma varlığıyla ilişkili olabileceğine işaret etti. Olgumuz ameliyatla başarıyla tedavi edilen rüptüre bir intrakraniyal anevrizma ile kombine benzer bir karmaşık konjenital kalp hastalığı olgusu literatürde olmadığı için ilginçtir. Bu olgunun klinisyenlerin intrakraniyal anevrizmalarla kombine olan karmaşık konjenital kalp hastalığı olguları gibi durumlarla başa çıkmasına yardımcı olacağına inanıyoruz.ANAhTAR sÖZCÜKlER: Konjenital kalp hastalığı, Çift çıkışlı sağ ventrikül, Anevrizma

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“…Occasionally, only a congenital defect in the muscularis layer of the media with a normal internal elastic lamina is seen. They are also known to occur in children with cyanotic congenital heart disease and bacterial endocarditis secondary to infected emboli traversing the intracranial circulation following a right-to-left shunt [35,36,37,38,39]. The bacteria escape through the occluded origins of the thin-walled penetrating vessels to the Virchow-Robin space and then to the adventitia of the parent vessel.…”

Section: Discussionmentioning

confidence: 99%

“…The frequently encountered bacteria in children with bacterial intracerebral aneurysms are α-streptococcus, Staphylococcus, Pseudomonas and Haemophilus spp. [37, 38]. The infectious aneurysms due to bacterial infections are commonly observed in distal cortical vessels whereas those related to viremia and immune suppression (HIV infection and familial immunodeficiency state) are seen more proximally in the supraclinoid ICA and MCA segments and are often fusiform and multifocal [1].…”

Section: Discussionmentioning

confidence: 99%

“…Giant aneurysms frequently present with mass symptoms, hydrocephalus or cranial nerve palsies [1]. Aneurysms occur in perhaps 1.7% of patients with bacterial endocarditis and are multiple in 20% [35,36,37,38,39]. The presence of a right-to-left pulmonary shunt for a prolonged duration of time and the pyogenic meningitis also raise the possibility of an infectious etiology.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Multiple Intracranial Aneurysms in a Child with Congenital Cyanotic Heart Disease

2006

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A 10-year-old child with transposition of the great arteries had multiple intracranial aneurysms. The child presented with pyogenic meningitis, and the investigations incidentally revealed numerous aneurysms involving both anterior and posterior circulation arteries. Angiography also revealed multiple fistulae between the internal and external carotid arteries. The child is under observation. The pathogenesis and management strategy of multiple intracranial aneurysms are discussed and the relevant literature is briefly reviewed.

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Clinicopathological Study of Bacterial Intracranial Aneurysms

Cited by 10 publications

References 15 publications

Management of Stroke in Infants and Children

Management of Stroke in Infants and Children

An unusual and complex congenital heart disease in a patient with a ruptured cerebral aneurysm

Multiple Intracranial Aneurysms in a Child with Congenital Cyanotic Heart Disease

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