Mycotic aneurysm of intracavernous internal carotid artery presenting as cavernous sinus syndrome

Abstract

Mycotic intracranial aneurysms are infectious aneurysms accounting for 0.7%–6.5% of all intracranial aneurysms and are most commonly located in distal branches of the middle cerebral arteries, particularly at the bifurcation area. They are caused by weakening of the vessel wall secondary to infection of a segment of the artery that can be endovascular as in infective endocarditis or extravascular as in meningitis or cavernous sinus thrombophlebitis. The rare occurrence of the mycotic cavernous internal carotid artery aneurysm, its variable clinical picture and limited knowledge of its natural course is a challenge for both diagnosis and management.

Disseminated Staphylococcal Disease Complicated with Intracranial Internal Carotid Artery Mycotic Pseudoaneurysm and Cerebral Infarcts—A Rare Presentation in a Malnourished Child

“…The only previously reported case was of a 3-year-old boy who developed an aneurysm of cavernous ICA 2 weeks following bilateral orbital cellulitis, necessitating ICA reconstructive procedure. 8 The four previously reported adult cases were: (1) a 46-year-old-man, presenting with sinusitis, orbital cellulitis complicated with cavernous sinus thrombosis and mycotic pseudoaneurysm in the cavernous part of the ICA, 9 (2) a 61-year-old man having end-stage renal disease and co-infected with Streptococcus group B and penicillium chrysogenum, (3 and 4) two cases following severe Staphylococcus aureus orbital cellulitis. 11 It is evident from ►Table 1, which shows the comprehensive list of ICA mycotic pseudoaneurysms among children <15 years of age, reported from India, that the index case is the only reported case affecting the intracranial petrous portion.…”

Nontraumatic Aneurysm—An Unusual Cause of Epistaxis

“…Trauma is the most common etiology for CCAs apart from infectious, iatrogenic, and idiopathic factors. [3][4][5] Reported predisposing factors for the condition include smoking, hypertension, female sex, and patient age more than 50. 2 Mycotic aneurysms could be sequelae of localized arteritis due to intravascular hematogenous spread of septic emboli from bacterial endocarditis or extravascular conditions such as meningitis, sinusitis, and cavernous sinus thrombophlebitis.…”

“…2 Mycotic aneurysms could be sequelae of localized arteritis due to intravascular hematogenous spread of septic emboli from bacterial endocarditis or extravascular conditions such as meningitis, sinusitis, and cavernous sinus thrombophlebitis. 5 Traumatic aneurysms follow accidental or iatrogenic trauma to the vessel. These are usually pseudoaneurysms consisting of a hematoma surrounded by a fibrous layer rather than a true arterial wall and is prone to rupture.…”

“…Trauma is the most common etiology for CCAs apart from infectious, iatrogenic, and idiopathic factors. 3-5 Reported predisposing factors for the condition include smoking, hypertension, female sex, and patient age more than 50. 2…”

“…Mycotic aneurysms could be sequelae of localized arteritis due to intravascular hematogenous spread of septic emboli from bacterial endocarditis or extravascular conditions such as meningitis, sinusitis, and cavernous sinus thrombophlebitis. 5…”