Infectious intracranial aneurysms: a systematic review of epidemiology, management, and outcomes

Abstract

Infectious intracranial aneurysms (IIAs) are a rare cerebrovascular complication of systemic infections induced by microbial infiltration and degradation of the arterial vessel wall. Studies on the epidemiology and management of IIAs are limited to case reports and retrospective single-center studies, and report a large variability in epidemiological features, management, and outcomes due to the limited sample size. We conducted a systematic review of all published papers on IIAs in the English literature using MEDLINE and SCOPUS database from January 1950 to June 2017. A total of 288 publications describing 1191 patients with IIA (1398 aneurysms) were included and reviewed for epidemiological features, disease features, treatment and outcome. All patients were merged into a single cohort and summary data are presented. The majority of reported IIAs are distally located, relatively small (<5 mm), involve the anterior circulation, are associated with a relatively high rate of rupture, and demonstrate a propensity to multiplicity of aneurysms. Sensitive diagnosis of IIAs requires digital subtraction angiography and not CT angiography or MR angiography. Treatment of ruptured, symptomatic, or enlarging IIAs has evolved over the last 50 years. Endovascular therapy is associated with a high success rate and low morbidity compared with microsurgical and medical management. A treatment algorithm for the management of patients with IIA in various contexts is proposed and the need for prospective multicenter studies is emphasized.

Rapid formation and rupture of an infectious basilar artery aneurysm from meningitis following suprasellar region meningioma removal: a case report

“…On the other hand, intracranial infection following craniocerebral operations is another important source of IIAs [1,7,[12][13][14]. Other more rare reasons of IIAs include orbital cellulitis, bacterial pneumonia, osteomyelitis of the skull and sinus infections [6,15]. According to literature reports, viridans group streptococci and Staphylococcus aureus is the most common pathogenic bacteria, which is responsible for 57 to 91% of all IIAs [15][16][17].…”

“…As a peculiar type of aneurysm, infectious intracranial aneurysms (IIAs) account for only about 1-6% of all intracranial aneurysms [1,2], most of which are secondary to infectious endocarditis [3][4][5]. According to the systematic review conducted by Ali Alawieh et al, nearly 70% of all IIAs are resulted from infectious endocarditis [6]. Occasionally, some other infectious factors such as bacterial meningitis and cavernous thrombophlebitis can also lead to IIAs [4][5][6][7].…”

“…According to the systematic review conducted by Ali Alawieh et al, nearly 70% of all IIAs are resulted from infectious endocarditis [6]. Occasionally, some other infectious factors such as bacterial meningitis and cavernous thrombophlebitis can also lead to IIAs [4][5][6][7]. Compared with other conventional intracranial aneurysms, IIAs usually predict worse prognosis because of higher aneurysmal rupture rate [5].…”

First Case of Intracranial Mycotic Aneurysm Caused by <b><i>Prevotella intermedia</i></b> Associated with Chronic Sinusitis in a Korean Adult

“…IMA is associated with significant morbidity and mortality because of spontaneous rupture [4]. The majority of IMAs are caused by viridans group streptococci and Staphylococcus aureus [2,3]; there are a few reports of IMA caused by anaerobes, which are rare pathogens, after dental treatment [5]. This report describes a previously healthy adult who had an IMA caused by anaerobic Prevotella species, which was identified by 16S rRNA sequencing.…”

“…A mycotic aneurysm is an abnormal focal arterial dilatation [1,2], and an intracranial mycotic aneurysm (IMA) is a mycotic aneurysm within the cerebral arteries, caused predominantly by bacterial infections [3]. IMA is associated with significant morbidity and mortality because of spontaneous rupture [4].…”