Diagnostic and Therapeutic Considerations for “Mycotic” Cerebral Aneurysms – 2 Case Reports and Review of the Literature

Regelsberger, Jan; Elsayed, A.; Matschke, Jakob; Lindop, G. B. M.; Grzyska, Ulrich; Boom, Louisa van den; Venne, Dominic

doi:10.1055/s-0031-1279756

Cited by 15 publications

(13 citation statements)

References 25 publications

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“…In general, MA occurs in the following order of frequency: intracavitary, peripheral, and intracranial arteries, respectively. 117 Previous studies reported the frequency of atherosclerotic aortic aneurysms and intracavitary MA but did not address MAs located elsewhere. In 22 000 autopsies performed at Boston City Hospital from 1902 through 1951, aortic aneurysms were detected in 1% to 5% of autopsies, but MAs were reported in only 1.5% of these.…”

Section: Frequencymentioning

confidence: 99%

“…127 Among cases associated with IE or prosthetic valve endocarditis, 55% to 77% occur in the middle cerebral artery and 18% in the posterior cerebral artery; they occur less commonly in the anterior cerebral artery. 112,117,119 Multiple ICMAs occur in up to 25% of cases. 112,127,128 Pathogenesis ICMA most often occurs as a result of hematogenous spread or, less likely, as a result of contiguous spread.…”

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

“…Because ICMA can develop during antimicrobial therapy, in selected patients, especially those with focal neurological findings or CNS bleeding, repeat imaging in 2 to 4 weeks after an initial negative procedure may be considered. 112,117,126,135,162 The role of imaging to monitor patients with a diagnosis of ICMA to guide medical and surgical therapy is discussed in Diagnosis and Treatment. ¶References …”

Section: Imaging Modalitiesmentioning

confidence: 99%

“…Reported mortality rates have ranged widely from 12% to 90% depending on rupture, underlying condition, virulence of the underlying infection, and other factors. 112,117,125,127,135,162 There are certain factors that have consistently influenced outcome. Patients who have rupture of an ICMA have worse outcomes than those who do not.…”

Section: Prognosismentioning

confidence: 99%

“…Patients who have rupture of an ICMA have worse outcomes than those who do not. 112,117,125,135,162,184 Patients with multiple ICMAs have worse outcomes than those with a single ICMA. 135,174 Mortality was significantly higher for older people and for those with meningitis and ICMA located in the vertebrobasilar territory.…”

Section: Prognosismentioning

confidence: 99%

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

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

373

307

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The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax. frequencyThe frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin. [1][2][3][4][5][6][7][8][9] For intracavitary grafts, the infection rate is ≈1% to 5%. 1-6 Graft infection is most common after emergency procedures and after reoperation. [1][2][3][4]10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction. 11,12 MicrobiologyThe microbiological cause of VGI has evolved over the years. 1 In early published studies, Staphylococcus aureus was the predominant microorganism recovered. 1,13 Improvements in surgical technique, administration of prophylactic antistaphylococcal antimicrobial therapy, and other factors have resulted in a changing microbiological epidemiology. Vascular graft surgery performed on patients with multiple underlying comorbidities and the increased frequency of emergency procedures have contributed to the changing spectrum of infection. Other factors such as changes in hospital flora, surgery in patients with complicated vascular anatomy, and multiple revisions of previous vascular surgery have resulted in a more diverse microbio- clInIcal stateMents anD GuIDelInes logical spectrum of infection, which includes multidrugresistant strains, polymicrobial infection, and Candida species. Gram-positive cocci accounts for at least two thirds of VGIs. 1,13 Infections caused by coagulase-negative staphylococ...

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Section: Frequencymentioning

confidence: 99%