The diagnosis and treatment of cerebral mycotic aneurysms

Abstract

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)

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

“…The use of such therapy alone for the treatment of ICMA has variable success rates. 127,135,162,169,170,172 There are no controlled studies, but there are numerous anecdotal case reports on the natural history of unruptured ICMA treated with antibiotic drugs alone. 162,169,[173][174][175] Several studies reported successful healing of ICMA with antibiotic drugs alo ne.…”

“…127,135,162,169,170,172 There are no controlled studies, but there are numerous anecdotal case reports on the natural history of unruptured ICMA treated with antibiotic drugs alone. 162,169,[173][174][175] Several studies reported successful healing of ICMA with antibiotic drugs alo ne. 127,135,162,[175][176][177] Corr et al 178 reported 18 patients with ICMA treated with antibiotic drugs alone.…”

“…In another study among 20 patients with ICMA, ICMA either resolved or disappeared in 50%, and 50% showed no change or enlargement in size during antibiotic therapy. 169 Ducruet et al 127 published a comprehensive review of 27 studies comprising 287 patients with ICMA in the English language literature. In this review, ≈30% of ICMAs resolved on antimicrobial therapy alone, 20% decreased in size, 20% increased in size, and 15% were unchanged.…”

Retrospective Review of Cerebral Mycotic Aneurysms in 26 Patients: Focus on Treatment in Strongly Immunocompromised Patients with a Brief Literature Review

“…2 A second study reported CMAs (10/20, 50%) that either resolved or disappeared and 10/20 (50%) demonstrated no change or enlargement while the patient was on antibiotic therapy. 17 A third study found that approximately 30%…”

Endovascular treatment for intracranial infectious aneurysms

“…IIAs can be treated with antibiotic therapy alone, with an unpredictable evolution: they can regress, enlarge, stabilize or even rupture 6 . In patients treated with surgery or, more recently, endovascular techniques (EvT), occlusion of the IIAs can be achieved 7,8 . We report five cases of IIAs associated with endocarditis, which were treated with endovascular techniques.…”