Infective endocarditis complicated by rupture of intracranial mycotic aneurysm during pregnancy

Trivedi, Mihir; Carroll, Craig; Rutherford, Scott A.

doi:10.1016/j.ijoa.2007.07.007

Cited by 14 publications

(5 citation statements)

References 22 publications

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“…After screening of the titles and abstracts, 63 studies were selected for full review [1,3,4,7,10,11,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71]. Thirty studies with 2 or more patients and 33 case reports with a total number of 814 patients were identified.…”

Section: Resultsmentioning

confidence: 99%

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Interdisciplinary Treatment of Intracranial Infectious Aneurysms

Hamisch¹,

Mpotsaris

Timmer³

et al. 2016

Cerebrovasc Dis

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Objective: Intracranial infectious aneurysms (IIAs) are a rare clinical entity without a definitive treatment guideline. In this study, we evaluate the treatment options of these lesions based on our own clinical experience and review the current knowledge of therapy as portrayed in the literature. Methods: We conducted a single-center retrospective analysis of all patients with an IIA and performed a systematic review of the literature using the MEDLINE database. We undertook a comprehensive literature search using the OVID gateway of the MEDLINE database (1950-October 2015) using the following keywords (in combination): ‘infectious', ‘mycotic', ‘cerebral aneurysm', ‘intracranial aneurysm'. 1,721 potentially relevant abstracts were identified and 63 studies were selected for full review. The studies were analysed regarding ruptured versus unruptured aneurysms, aneurysm localization and treatment, as well as clinical and radiological outcome. Results: Our institutional series consisted of 6 patients (median age 57 [32-76]) treated between 2011 and 2015. All patients presented with ruptured IIAs located on the middle cerebral artery (MCA, 5 patients) and anterior cerebral artery (ACA, 1 patient). Five patients were treated by clipping and resecting the aneurysm, 1 patient underwent coiling. All patients received antibiotic therapy and 1 patient died. We further identified 814 patients (median age 35.5 [0-81]) in 63 studies. Locations of the aneurysms were mentioned in 55 studies. The most frequent locations of the aneurysms were: MCA (63.5%), posterior cerebral artery (14%), ACA (9.0%) and others (13.5%). Treatment for IIAs was described in 62 studies: antibiotic treatment (56.1%), a combination of antibiotics and surgery (20.9%) or antibiotics and endovascular treatment (23.0%). Outcome was mentioned in 82.4% of the patients with a mortality rate of 16.8%. An evaluation of treatment outcome was limited due to the heterogeneity of patients in the published case series. Conclusion: Antibiotic therapy of patients with IIA is mandatory. However, due to the complexity of the disease and its accompanying comorbidities, a general treatment algorithm could not be defined. Analogous to non-mycotic aneurysms, further treatment decisions require an interdisciplinary approach involving neurosurgeons, interventionists and infectious disease specialists.

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Section: Resultsmentioning

confidence: 99%

“…Five publications ([60,67,68,69,70]; table 4) report a combined surgical and endovascular treatment of 5 patients with IIAs. Four patients had a good outcome with mild or without neurological symptoms and one patient died.…”

Section: Resultsmentioning

confidence: 99%

Interdisciplinary Treatment of Intracranial Infectious Aneurysms

Hamisch¹,

Mpotsaris

Timmer³

et al. 2016

Cerebrovasc Dis

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“…At 29 weeks, a ruptured intracranial IAA caused neurologic deterioration. After coil embolization of a 2-mm middle cerebral artery IAA, cardiac and brain surgery, and a cesarean section, mother and son were both doing well 6 months after the acute insult [9].…”

Section: Presentationmentioning

confidence: 99%

“…Physicians should have a high index of suspicion for mycotic aneurysms when virulent valvular infection and/ or previous clinical evidence of an embolus are combined with unexplained neurologic deterioration. Wide-ranging presentations of intracranial IAAs are reported: meningitis in children [5]; endocarditis with subsequent brain infarcts [6]; ruptured IAAs in pregnant and nonpregnant patients [7][8][9]; and intracranial hemorrhages and ocular symptoms [10]. Among seven pediatric patients with endocarditis who subsequently developed clinically evident brain infarcts, three were later found to have IAAs; all were successfully repaired.…”

Section: Presentationmentioning

confidence: 99%

Diagnosis and management of mycotic aneurysms

León

Mills²

2009

Curr Infect Dis Rep

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We reviewed all papers most recently reported in the literature related to infected arterial aneurysms (IAAs) affecting the aorta and vascular beds other than the aorta. In this article, we report on vascular beds other than the aorta. As is the case for aortic IAAs, infected non-aortic aneurysms are rarely encountered. The majority of recent studies are limited to case reports and small series of unusual infected aneurysms. A comprehensive review of this entity was performed based on the available literature from January through December 2008 in all languages. Available reports were analyzed with respect to demographic features, type of presentation, methods of diagnosis and therapy, follow-up, and outcome (morbidity and mortality).

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“…The bleeding can be subarachnoid, intraparenchymal, or intraventricular [5]. Other signs and symptoms of IIAs are due to the underlying etiology [19], such as septic emboli, fever, and chills, or to the mass effect of the aneurysm. Silent IIAs are not uncommon and can represent up to 10% of autopsy cases [20].…”

Section: Clinical Manifestations and Diagnosismentioning

confidence: 99%