Ruptured Infectious Aneurysm of the Distal Middle Cerebral Artery Manifesting as Intracerebral Hemorrhage and Acute Subdural Hematoma-Case Report-

Abstract

A 21-year-old woman with severe mitral valve regurgitation due to infectious endocarditis was transferred to our institute in a deep coma with intracerebral hemorrhage and acute subdural hematoma. She had no history of head injury. Brain computed tomography revealed left frontoparietal intracerebral hematoma and adjacent acute subdural hematoma that were evacuated on the day of admission, but the distal middle cerebral artery (MCA) aneurysm remained undetected. Follow-up cerebral angiography demonstrated the distal MCA aneurysm, which had enlarged by 25% at 2 weeks following the first operation. The aneurysm originated from a branch of the angular artery and was successfully resected on Day 22. Histological examination of the aneurysm section showed no infectious nature, but the final diagnosis was infectious intracranial aneurysm based on the presence of infectious endocarditis.

Ruptured Mycotic Aneurysm of the Distal Middle Cerebral Artery Manifesting as Subacute Subdural Hematoma

“…A mycotic aneurysm associated with SDH is a rare case 16). Only 10 cases have been reported 2-4)14-16)20)26)31)34). In this case, his head trauma may have caused the rupture of the underlying mycotic aneurysm.…”

“…Their spontaneous rupture mostly results in subarachnoid and intracerebral hemorrhage, accompanied by morbidity and mortality as high as 60 ~ 90% in older case reports, and 12 ~ 32% in more recent reports 17)29). Ruptured mycotic aneurysm manifesting as subdural hematoma (SDH) is extremely rare; only 10 cases have been reported 2-4)13-15)20)26)31)34). We present a case of mycotic aneurysm associated with SDH, which was resolved with medical treatment.…”

“…Mycotic aneurysms account for approximately 2.5 ~ 4.5% of all intracranial aneurysms and are unique in their natural history, pathologic findings, location and common multiplicity 6)8)26)27)34). Their spontaneous rupture mostly results in subarachnoid and intracerebral hemorrhage, accompanied by morbidity and mortality as high as 60 ~ 90% in older case reports, and 12 ~ 32% in more recent reports 17)29).…”

Lactococcus garvieaeendocarditis presenting with subdural haematoma

“…Subarachnoidal haemorrhages (SAH) are seen in around 1% of IE-cases and the pathogenesis is believed to involve rupture of a mycotic aneurysm, although such an aneurysm is not always identified [18]. Rupture of mycotic aneurysms can also lead to SDH on rare occasions [19,20]. SDH as a feature of IE is extremely rare, and we have only found three reports of patients with IE complicated by SDH [19,21,22].…”

Non-traumatic subdural hematoma secondary to septic brain embolism: A rare cause of unexpected death in a drug addict suffering from undiagnosed bacterial endocarditis

“…The ensuing blood extravasation pours out either into the brain tissue or the subarachnoid space [27]. In contrast to intraparenchymal, subarachnoid and intraventricular hemorrhage, the occurrence of an acute subdural hematoma (SDH) is extremely rare in the context of IE [28,29,30,31,32,33,34].…”