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Hanabusa Y, Nakamura H, Aoki K, Makita K, Taguchi T, Arao K. Infective Arteritis Manifesting as an Acute Subdural Hematoma. Intern Med 2022; 62:1175-1179. [PMID: 36070949 PMCID: PMC10183287 DOI: 10.2169/internalmedicine.0320-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We encountered a 60-year-old man who had been diagnosed with heart failure of valvular disease and infective endocarditis; he was being treated with intravenous antibiotics and diuretics. On the 12th hospital day, he suddenly lost consciousness; computed tomography showed a right-sided huge subdural hematoma (SDH) with brain herniation. He died after invasive care was discontinued. A massive SDH was noted at autopsy, and microimaging demonstrated ruptured infective arteritis, without aneurysm, on the surface of the culprit lobe. Acute SDH usually occurs after head trauma, but an area of nonsaccular aneurysmal arteritis can also result in acute SDH.
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Affiliation(s)
- Yui Hanabusa
- Division of Cardiovascular Medicine, Nerima-Hikarigaoka Hospital, Japan
| | - Hironori Nakamura
- Division of Cardiovascular Medicine, Nerima-Hikarigaoka Hospital, Japan
| | - Kazuyasu Aoki
- Division of Neurosurgery, Nerima-Hikarigaoka Hospital, Japan
| | - Kohzoh Makita
- Division of Radiology, Nerima-Hikarigaoka Hospital, Japan
| | - Towako Taguchi
- Department of Comprehensive Pathology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Japan
| | - Kenshiro Arao
- Division of Cardiovascular Medicine, Nerima-Hikarigaoka Hospital, Japan
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Rice CJ, Kovi S, Wisco DR. Cerebrovascular Complication and Valve Surgery in Infective Endocarditis. Semin Neurol 2021; 41:437-446. [PMID: 33851397 DOI: 10.1055/s-0041-1726327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Infective endocarditis (IE) with neurologic complications is common in patients with active IE. The most common and feared neurological complication of left-sided IE is cerebrovascular, from septic emboli causing ischemic stroke, intracranial hemorrhage (ICH), or an infectious intracranial aneurysm with or without rupture. In patients with cerebrovascular complications, valve replacement surgery is often delayed for concern of further neurological worsening. However, in circumstances when an indication for valve surgery to treat IE is present, the benefits of early surgical treatment may outweigh the potential neurologic deterioration. Furthermore, valve surgery has been associated with lower in-hospital mortality than medical therapy with intravenous antibiotics alone. Early valve surgery can be performed within 7 days of transient ischemic attack or asymptomatic stroke when medically indicated. Timing of valve surgery for IE after symptomatic medium or large symptomatic ischemic stroke or ICH remains challenging, and current data in the literature are conflicting about the risks and benefits. A delay of 2 to 4 weeks from the time of the cerebrovascular event is often recommended, balancing the risks and benefits of surgery. The range of timing of valve surgery varies depending on the clinical scenario, and is best determined by a multidisciplinary decision between cardiothoracic surgeons, cardiologists, infectious disease experts, and vascular neurologists in an experienced referral center.
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Affiliation(s)
- Cory J Rice
- Erlanger Medical Center, University of Tennessee-Chattanooga College of Medicine, Chattanooga, Tennessee
| | - Shivakrishna Kovi
- Department of Neurology, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dolora R Wisco
- Department of Neurology, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Alawieh A, Chaudry MI, Turner RD, Turk AS, Spiotta AM. Infectious intracranial aneurysms: a systematic review of epidemiology, management, and outcomes. J Neurointerv Surg 2018; 10:708-716. [DOI: 10.1136/neurintsurg-2017-013603] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/16/2018] [Accepted: 01/24/2018] [Indexed: 12/27/2022]
Abstract
Infectious intracranial aneurysms (IIAs) are a rare cerebrovascular complication of systemic infections induced by microbial infiltration and degradation of the arterial vessel wall. Studies on the epidemiology and management of IIAs are limited to case reports and retrospective single-center studies, and report a large variability in epidemiological features, management, and outcomes due to the limited sample size. We conducted a systematic review of all published papers on IIAs in the English literature using MEDLINE and SCOPUS database from January 1950 to June 2017. A total of 288 publications describing 1191 patients with IIA (1398 aneurysms) were included and reviewed for epidemiological features, disease features, treatment and outcome. All patients were merged into a single cohort and summary data are presented. The majority of reported IIAs are distally located, relatively small (<5 mm), involve the anterior circulation, are associated with a relatively high rate of rupture, and demonstrate a propensity to multiplicity of aneurysms. Sensitive diagnosis of IIAs requires digital subtraction angiography and not CT angiography or MR angiography. Treatment of ruptured, symptomatic, or enlarging IIAs has evolved over the last 50 years. Endovascular therapy is associated with a high success rate and low morbidity compared with microsurgical and medical management. A treatment algorithm for the management of patients with IIA in various contexts is proposed and the need for prospective multicenter studies is emphasized.
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Glenn J, Strecker-McGraw M, McGraw I, Jabbar K, James NA, Stone CK. Rupture of an Occult Intracranial Mycotic Aneurysm after Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator for Acute Ischemic Stroke. J Emerg Med 2017; 53:717-721. [DOI: 10.1016/j.jemermed.2017.08.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/18/2017] [Accepted: 08/11/2017] [Indexed: 11/28/2022]
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Initial Treatment Strategy for Intracranial Mycotic Aneurysms: 2 Case Reports and Literature Review. World Neurosurg 2017; 106:1051.e9-1051.e16. [DOI: 10.1016/j.wneu.2017.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 11/19/2022]
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Yuan SM, Wang GF. Cerebral mycotic aneurysm as a consequence of infective endocarditis: A literature review. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Piccirilli M, Prizio E, Cannizzaro D, Tropeano MP, Guidetti G, Santoro A. The only case of mycotic aneurysm of the PICA: Clinical-radiological remarks and review of literature. J Clin Neurosci 2017; 38:62-66. [DOI: 10.1016/j.jocn.2016.12.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 12/26/2016] [Indexed: 11/30/2022]
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Wilson WR, Bower TC, Creager MA, Amin-Hanjani S, O’Gara PT, Lockhart PB, Darouiche RO, Ramlawi B, Derdeyn CP, Bolger AF, Levison ME, Taubert KA, Baltimore RS, Baddour LM. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e412-e460. [DOI: 10.1161/cir.0000000000000457] [Citation(s) in RCA: 215] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Safety and efficacy of endovascular treatment for intracranial infectious aneurysms: A systematic review and meta-analysis. J Neuroradiol 2016; 43:309-16. [DOI: 10.1016/j.neurad.2016.03.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 12/14/2022]
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Hamisch CA, Mpotsaris A, Timmer M, Reiner M, Stavrinou P, Brinker G, Goldbrunner R, Krischek B. Interdisciplinary Treatment of Intracranial Infectious Aneurysms. Cerebrovasc Dis 2016; 42:493-505. [PMID: 27598469 DOI: 10.1159/000448406] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/11/2016] [Indexed: 11/19/2022] Open
Abstract
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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Affiliation(s)
- Christina A Hamisch
- Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany
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A Singular Case of Neurosyphilis Manifesting Through a Meningovascular Chronic Inflammatory Process in Association with the Occurrence of Two Aneurysms Involving the Distal A2 Segment of Both Anterior Cerebral Arteries: A Case Report and Review of the Literature. World Neurosurg 2016; 87:662.e13-8. [DOI: 10.1016/j.wneu.2015.10.085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/23/2015] [Accepted: 10/24/2015] [Indexed: 11/18/2022]
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Endovascular treatment of intracranial infectious aneurysms. Neuroradiology 2015; 58:277-84. [DOI: 10.1007/s00234-015-1633-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/14/2015] [Indexed: 12/19/2022]
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Fusco MR, Stapleton CJ, Griessenauer CJ, Thomas AJ, Ogilvy CS. Endovascular treatment of intracranial infectious aneurysms in eloquent cortex with super-selective provocative testing: Case series and literature review. Interv Neuroradiol 2015; 22:148-52. [PMID: 26672110 DOI: 10.1177/1591019915617326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 11/02/2015] [Indexed: 11/15/2022] Open
Abstract
Intracranial infectious aneurysms (IIAs) are a rare subgroup of intracranial aneurysms. Often erroneously termed mycotic aneurysms, these lesions most often result from infectious endocarditis and involve the distal anterior cortical circulation. Diagnosis typically follows headaches or septic infarcts, although increasing numbers of lesions are found incidentally, during screening protocols for infectious endocarditis. Open surgical treatment was previously the mainstay of treatment; however, these IIAs are often fusiform and quite fragile, making open surgical obliteration difficult and typically requiring lesion trapping. Current treatment techniques more commonly involve endovascular coil embolization or parent vessel occlusion. Many of these lesions occur distally, in or around the eloquent cortex, making embolization potentially dangerous. We present cases that highlight the use of super-selective provocative testing with sodium amobarbital and lidocaine, to help clarify and predict the risk of parent vessel occlusion in IIAs located in the eloquent cortex.
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Affiliation(s)
- Matthew R Fusco
- Department of Neurosurgery, Vanderbilt University, Nashville, USA Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Christopher J Stapleton
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Christoph J Griessenauer
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Ajith J Thomas
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Christopher S Ogilvy
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
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Endovascular treatment of cerebral mycotic aneurysm: a review of the literature and single center experience. BIOMED RESEARCH INTERNATIONAL 2013; 2013:151643. [PMID: 24383049 PMCID: PMC3872026 DOI: 10.1155/2013/151643] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 11/18/2013] [Indexed: 12/03/2022]
Abstract
The management of mycotic aneurysm has always been subject to controversy. The aim of this paper is to review the literature on the intracranial infected aneurysm from pathogenesis till management while focusing mainly on the endovascular interventions. This novel solution seems to provide additional benefits and long-term favorable outcomes.
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Lee SM, Park HS, Choi JH, Huh JT. Ruptured mycotic aneurysm of the distal middle cerebral artery manifesting as subacute subdural hematoma. J Cerebrovasc Endovasc Neurosurg 2013; 15:235-40. [PMID: 24167806 PMCID: PMC3804664 DOI: 10.7461/jcen.2013.15.3.235] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 05/27/2013] [Accepted: 07/24/2013] [Indexed: 01/16/2023] Open
Abstract
Mycotic aneurysms are rare inflammatory neurovascular lesions. Ruptured mycotic aneurysm manifesting as subdural hematoma is extremely rare. A 72-year-old male patient was admitted to our hospital with headache and drowsiness. Computer tomography (CT) of brain and CT angiography revealed subdural hematoma and an aneurysm located at the M4 segment of the left middle cerebral artery (MCA). Cerebral angiogram revealed 2 aneurysms; one located at the left distal MCA and the other at the bifurcation of left MCA. Laboratory studies showed leukocytosis and elevated inflammatory factors. The patent was treated with antibiotic therapy for 4 weeks. The follow-up CT and cerebral angiography showed that the mycotic aneurysm was completely resolved, and the patient was nearly free of symptoms.
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Affiliation(s)
- Sang-Min Lee
- Department of Neurosurgery, Busan-Ulsan Regional Cardiocerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University, Busan, Korea
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Intracranial infectious aneurysms: a comprehensive review. Neurosurg Rev 2009; 33:37-46. [PMID: 19838745 DOI: 10.1007/s10143-009-0233-1] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 09/20/2009] [Accepted: 09/23/2009] [Indexed: 10/20/2022]
Abstract
Intracranial infectious aneurysms, or mycotic aneurysms, are rare infectious cerebrovascular lesions which arise through microbial infection of the cerebral arterial wall. Due to the rarity of these lesions, the variability in their clinical presentations, and the lack of population-based epidemiological data, there is no widely accepted management methodology. We undertook a comprehensive literature search using the OVID gateway of the MEDLINE database (1950-2009) using the following keywords (singly and in combination): "infectious," "mycotic," "cerebral aneurysm," and "intracranial aneurysm." We identified 27 published clinical series describing a total of 287 patients in the English literature that presented demographic and clinical data regarding presentation, treatment, and outcome of patients with mycotic aneurysms. We then synthesized the available data into a combined cohort to more closely estimate the true demographic and clinical characteristics of this disease. We follow by presenting a comprehensive review of mycotic aneurysms, highlighting current treatment paradigms. The literature supports the administration of antibiotics in conjunction with surgical or endovascular intervention depending on the character and location of the aneurysm, as well as the clinical status of the patient. Mycotic aneurysms comprise an important subtype of potentially life-threatening cerebrovascular lesions, and further prospective studies are warranted to define outcome following both conservative and surgical or endovascular treatment.
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Ligon BL. Biography: history of developments in imaging techniques: Egas Moniz and angiography. SEMINARS IN PEDIATRIC INFECTIOUS DISEASES 2003; 14:173-81. [PMID: 12881804 DOI: 10.1053/spid.2003.127232] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Angiography, the primary imaging technique used for visualizing the brain's blood vessels and any accompanying abnormalities, also is used for imaging aneurysms and other lesions having an infectious cause. A Nobel laureate who later was recognized for his radical treatment for mental illness, Antonio Caetano de Abreu Freire Egas Moniz, has been credited with discovering angiography. However, despite the tremendous impact it has had on the field of medicine, angiography did not receive the recognition that the researcher's later work in psychosurgery did. For many years, the reason for this seeming oversight remained a mystery, especially considering that leucotomy subsequently was superseded by psychopharmaceutical drugs and other management modalities, whereas angiography continues to play a vital role in medicine. This article looks at the various achievements of Egas Moniz, who excelled in many disciplines, as well as at the circumstances surrounding his being denied the Nobel Prize for the discovery of angiography.
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Affiliation(s)
- B Lee Ligon
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
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