Múltiplos aneurismas micóticos intracranianos: registro de um caso

Valadares, João Batista; Souza, Mário T. Kroeff de; Hankinson, John; Hall, K.; Sengupta, R. P.

doi:10.1590/s0004-282x1979000300010

Cited by 2 publications

(1 citation statement)

References 19 publications

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“…In other anecdotal reports investigators described mycotic aneurysms that disappeared with appropriate antibiotic therapy [6,36,39,40,[53][54][55][56][57][58][59][60][61][62]. Salgado and colleagues [24) reported on 121 patients with endocarditis who survived hospitalization and were then followed for a mean of 40 months after discharge; none had evidence of aneurysm rupture.…”

Section: Discussionmentioning

confidence: 99%

The diagnosis and treatment of cerebral mycotic aneurysms

Brust

Dickinson

Hughes

et al. 1990

Annals of Neurology

127

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Seventeen patients were treated for 28 documented cerebral mycotic aneurysms. Initial neurological symptoms were attributable to aneurysm rupture in only 7 patients, and in 3 of them symptoms did not suggest subarachnoid hemorrhage. Six patients presented with embolic infarction and 1 with meningitis; in 3 patients it was uncertain if aneurysm rupture occurred. Four patients had rupture of at least one aneurysm while receiving appropriate antibiotic treatment and another had rupture at the conclusion of therapy. Of 20 aneurysms followed angiographically or with computed tomography during medical treatment, 10 became smaller or disappeared and 10 remained unchanged or enlarged, 1 with fatal rupture. Eight ruptured aneurysms were surgically excised; 2 of the patients with ruptured aneurysms died and 2 had residual aphasia or cognitive impairment. All 4 patients whose only surgery was for an unruptured aneurysm made uneventful recoveries. Recognizing the retrospective and anecdotal nature of our data and the differing views of previous investigators, we recommend: (1) that careful neurological examination, computed tomography, and (unless contraindicated) lumbar puncture be performed on any patient with endocarditis; (2) that those with neurological abnormalities not attributable to systemic toxicity, including pleocytosis in the cerebrospinal fluid or apparent infarction on computed tomographic scans, undergo four-vessel cerebral angiography; (3) that single accessible mycotic aneurysms in medically stable patients be promptly excised, with individualization of multiple or proximal aneurysms; and (4) that repeat angiography be performed at the conclusion of antibiotic therapy in patients requiring long-term anticoagulation.(ABSTRACT TRUNCATED AT 250 WORDS)

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