A rare case of Streptococcus anginosus infectious intracranial aneurysm: Proper management of a poor prognosis

Abstract

Background: Infectious intracranial aneurysms (IIAs), sometimes referred to as cerebral mycotic aneurysms, are an uncommon but feared compilation of bacterial endocarditis, occurring in up to 5% of all bacterial endocarditis cases. While IIAs carry a low risk of rupture, a ruptured mycotic aneurysm carries devastating neurologic consequences with up to an 80% mortality rate secondary to subarachnoid and intracerebral hemorrhage. Case Description: A 69-year-old man undergoing antibacterial therapy for Streptococcus anginosus endocarditis with aortic insufficiency and root abscess presented to the ED with multiple seizures and left-sided weakness. MRI of the head revealed right frontal and temporal abscesses with evidence of scattered septic emboli and subarachnoid hemorrhage. CTA of the head revealed a ruptured 1 mm distal middle cerebral artery mycotic aneurysm. Prior to undergoing surgery, the patient began to decline, becoming lethargic, and failing to respond to commands. The patient underwent endovascular Onyx embolization. After the procedure, the patient remained with partial status epilepticus and was discharged to rehabilitation. Over the following months, the patient made a great recovery and was able to undergo aortic and mitral valve replacement 5 months after neurosurgical intervention. Conclusion: This favorable outcome is the result of a tremendous deal of long-term coordination and efficient communication between neurosurgery, cardiology, neurology, physical medicine and rehabilitation, and primary care.

Complex networks approach to study comorbidities in patients with unruptured intracranial aneurysms

“…Co-morbidities of group C are primarily detected in women. Specifically, they are diseases like Streptococcal pharyngitis (ICD J02.0) 11 , 12 , chronic obstructive pulmonary disease (ICD J44.8) 13 , hypothyroidism (ICD E03.9) 14 , 15 and panic disorder (ICD F41.0). In men, group C comorbidity is limited to depression (ICD F32.9).…”

Intracranial infectious aneurysm caused by infective endocarditis resulting in intracerebral rebleeding following previous surgery for intracerebral hemorrhage: A case report and literature review

“…An analysis of the pooled cohort of patients from the literature revealed that 65% of patients with IIAs presented with bacterial IE ( 5 ). In the pre-antibiotic era, this ratio commonly arises in patients with prosthetic valves, nosocomial-acquired blood stream infections, or a history of intravenous drug use ( 6 , 7 ). Less commonly, IIA can also result from the direct extension of intracranial bacterial infections, such as meningitis, cavernous sinus thrombophlebitis and orbital cellulitis, often in patients who are immunosuppressed ( 8 ).…”

Mycotic Cerebral Aneurysm: A Rare Complication of Infective Endocarditis

“…The terminology «mycotic aneurysm» was used for the first time by William Osler in Gulstonian Lectures of 1885, it refers to a dilatation of an arterial wall caused by any infectious etiology [2]. It is a serious clinical condition that carries a significant morbidity with up to 80% mortality rates when reptured [3]. Therefore, an early and rapid diagnosis is critical for timely treatment to optimize patient outcome.…”