Bloodstream infection is associated with subarachnoid hemorrhage and infectious intracranial aneurysm in left ventricular assist device

Abstract

Bloodstream infection is the leading cause of mortality in left ventricular assist device. Bloodstream infection is a risk factor for intracranial hemorrhage. We report three left ventricular assist device recipients who presented with bloodstream infection and developed subarachnoid hemorrhage. Case 1, a 37-year-old male with non-ischemic cardiomyopathy with HeartMate II, presented with confusion and found to have serratia bloodstream infection and left frontal lobe subarachnoid hemorrhage. Cerebral angiogram showed a right M3/M4 branch infectious intracranial aneurysm. He was treated with coil embolization and underwent device exchange. Case 2, a 41-year-old male with non-ischemic cardiomyopathy with HeartMate II presented with confusion and found to have methicillin-resistant staphylococcus aureus bloodstream infection and bilateral frontal convexity subarachnoid hemorrhage. Cerebral angiogram showed left M3 and left A3 infectious intracranial aneurysms, which were treated with antibiotics alone. Case 3, a 58-year-old female with ischemic cardiomyopathy with HeartMate II presented with fever, found to have candida albicans bloodstream infection and a parieto-occipital enhancing lesion concerning for cerebral abscess. Repeat computed tomography brain a week later showed a new right frontal subarachnoid hemorrhage. Cerebral angiogram showed a M4/M5 junction infectious intracranial aneurysm; patient was not a surgical candidate and was transitioned to hospice. This case series emphasizes that left ventricular assist device–associated subarachnoid hemorrhage may be caused by infectious intracranial aneurysms when acute bloodstream infections are present.

RETRACTED ARTICLE: The risk factors of intracranial infection in patients with intracerebral hemorrhage undergone hematoma puncture: what should we care

“…The postoperative infections in patients with neurosurgical craniocerebral surgery are mostly happens in the body cavity or intracranial parts [ 14 ]. It’s been reported that postoperative infection in patients with cerebrovascular diseases, craniocerebral trauma and craniocerebral tumors is relatively high, and its possible causes are closely related to the types of surgery, surgical methods and the characteristics of surgery in patients with this disease [ 15 , 16 ]. Patients with cerebrovascular diseases and craniocerebral injuries mainly undergo emergency surgery in clinical settings, and there are often insufficient pre-operative preparations and incomplete debridement during surgery [ 17 ].…”

Ruptured cerebral mycotic aneurysm in a left ventricular assist device patient with bacteremia

“…Lee and colleagues reported an LVAD patient who developed a second CMA, following rupture of their initial CMA, which was successfully detected with CTA and treated with endovascular coiling. 5 As evidenced by the different types of organisms that have been described in our case report and others, the virulence of the organism itself appears irrelevant, and the mere presence of bacteremia in an LVAD patient should be a consideration for neurological imaging. In conclusion, clinicians should have a low threshold for neurological screening in bacteremic LVAD patients, regardless of the source of sepsis and infectious organism, as preventive interventions of CMAs can reduce the likelihood of rupture and fatal cerebral hemorrhage in this at-risk population.…”

Intracranial Mycotic Aneurysm in a Left Ventricular Assist Device Patient: A Complication to Avoid

“…IIA is rare, only comprising 0.7%-5.4% of all intracranial aneurysms and usually associated with infective endocarditis [4]. It is interesting that S. epidermidis being less virulent still causes mycotic aneurysm formation in LVAD patients [5][6][7][8][9][10][11]. In this case, the patient did not present with signs or symptoms of systemic inflammatory response syndrome (SIRS).…”