Intracranial mycotic aneurysms of extravascular origin

126

Twenty-five cases (38%) of ischemic infarction occurred among 65 cases of tuberculous meningitis in patients <14 years of age. The male •' female ratio was 1.3:1. The most frequent clinical findings were meningeal signs, fever, alteration of consciousness, cranial nerve involvement, seizures, and focal neurologic deficit. Twenty-three patients had anterior circulation infarcts, and two more had infarcts in the vertebrobasilar territories. Distribution of infarcts in the anterior circulation was shown by computed tomography in the territories of the following arteries: lenticulostriate, 10 cases unilateral and 6 bilateral; middle cerebral, 3 cases; internal carotid, 1 case; multiple areas, 3 cases. Of the 25 ischemic infarction cases, 23 (92%) had hydrocephalus, 19 (76%) basal exudates, and 2 (8%) tuberculomas. Outcome was poor since no patient with infarction recovered completely. Six died and bilateral subcortical infarcts led to a considerably higher mortality than unilateral ones, whether cortical or subcortical. (Stroke 1988; 19:200-204)

mentioning

confidence: 99%

Ischemic infarction in 25 children with tuberculous meningitis.

Leiguarda

Starkstein

et al. 1988

126

“…14 Meningitis due to Mycobacterium and Aspergillus is infection occasionally forms aneurysms in this fashion; however, bacterial causes remain less well described. 7 ' 16 In 1966 Ojemann et al 16 first reported angiographic evidence of aneurysm formation in distal branches of major cerebral vessels in a case of bacterial meningitis. Such lesions have since become well known but notably involve distant vessels rather than the circle of Willis.…”

Section: Discussionmentioning

confidence: 99%

Fatal basilar vasculopathy complicating bacterial meningitis.

Perry

Bilbao

Gray

1992

Bacterial meningitis complicated by thrombosis, vasculitis, and aneurysm formation affecting both small and distal branches of cerebral vessels has been well described. Involvement of major cerebral vessels is rare and has only been documented late in the course of disease. We describe the clinical and pathological findings in a young man who presented with pontine infarction as an early manifestation of bacterial meningitis. Streptococcus milleri, an unusual organism in this setting, was cultured. Despite improvement with antibiotic therapy, the patient experienced fatal subarachnoid hemorrhage. A ruptured inflammatory aneurysm of the basilar artery, evidence of residual meningitis and vasculitis, and basilar thrombosis associated with pontine infarction were found. Bacterial meningitis, which may be associated with severe vasculopathy of the basilar artery and lead to cerebral infarction, aneurysm formation, and subarachnoid hemorrhage, should be considered in the differential diagnosis of these conditions. The role of S. milleri in meningitis and its vascular complications merits further study.

“…However, there are also extravascular sources of emboli following arterial wall infections by adjacent foci as well as cryptogenic origins of emboli that lack evidence of septic processes. 9 As a whole, bacterial aneurysms account for 2.5-6.2% of intracranial aneurysms. 10 ' 11 Although its course through the cavernous sinus would appear to render the carotid artery highly susceptible in the event of cavernous septic thrombosis, there have been only 22 7 -12 -23 documented cases of bacterial cavernous sinus aneurysms thus far, with approximately half of the cases occurring in children.…”

Section: Discussionmentioning

confidence: 99%

Bacterial cavernous sinus aneurysm treated by detachable balloon technique.

Micheli

Schteinschnaider

Plaghos

et al. 1989

We describe a patient who developed bilateral cavernous sinus septic thrombosis secondary to a suppurative lesion on the left cheek. Despite clinical improvement, left oculomotor symptoms recurred suddenly. A carotid artery aneurysm within the cavernous sinus was diagnosed by means of magnetic resonance imaging and confirmed by digital angiography. Follow-up angiograms showed an initial decrease in the aneurysm size, with subsequent enlargement. A latex contrast-filled balloon was successfully placed within the aneurysm, preserving the carotid parent artery blood flow. Our case illustrates the usefulness of the detachable balloon technique in the treatment of bacterial aneurysms of the cavernous sinus as an alternative treatment to carotid artery ligation. (Stroke 1989;20:1751-1754