Republished: Intracranial vessel occlusion preceding the development of mycotic aneurysms in patients with endocarditis

2020 ◽  
Vol 12 (2) ◽  
pp. e1-e1
Author(s):  
Ezequiel Goldschmidt ◽  
Amir H Faraji ◽  
David Salvetti ◽  
Benjamin M Zussman ◽  
Ashutosh Jadhav
Keyword(s):  
Infectious Endocarditis ◽  
Intravenous Drug Use ◽  
Vessel Occlusion ◽  
Cerebral Angiogram ◽  
Septic Emboli ◽  
Intracranial Vessel ◽  
History Of ◽  
Mycotic Aneurysms ◽  
Vascular Occlusions

Mycotic aneurysms (MA) are an uncommon complication of infectious endocarditis. Septic emboli are thought to be the precipitating event in their development, but the evidence for this is sparse. We present three cases in which septic embolic occlusion preceded MA development at the occlusion site, suggesting that documented angiographic emboli in patients with infectious endocarditis and bacteremia constitute a risk factor for MA formation. Two adult patients with a history of intravenous drug use and one child with congenital heart disease are described. They were all diagnosed with infectious endocarditis and developed neurological symptoms during their hospital course. Initial catheter-based cerebral angiograms demonstrated vascular occlusions, which were followed by the development of MA at the same sites within 1 month. Septic emboli, documented on cerebral angiogram, in patients with infectious endocarditis may precede the appearance of MA. Patients with angiographic occlusions in the setting of endocarditis warrant close follow-up.

scholarly journals Intracranial vessel occlusion preceding the development of mycotic aneurysms in patients with endocarditis

2019 ◽  
Vol 12 (12) ◽  
pp. e015480 ◽  
Author(s):  
Ezequiel Goldschmidt ◽  
Amir H Faraji ◽  
David Salvetti ◽  
Benjamin M Zussman ◽  
Ashutosh Jadhav
Keyword(s):  
Infectious Endocarditis ◽  
Intravenous Drug Use ◽  
Vessel Occlusion ◽  
Cerebral Angiogram ◽  
Septic Emboli ◽  
Intracranial Vessel ◽  
History Of ◽  
Mycotic Aneurysms ◽  
Vascular Occlusions

Mycotic aneurysms (MA) are an uncommon complication of infectious endocarditis. Septic emboli are thought to be the precipitating event in their development, but the evidence for this is sparse. We present three cases in which septic embolic occlusion preceded MA development at the occlusion site, suggesting that documented angiographic emboli in patients with infectious endocarditis and bacteremia constitute a risk factor for MA formation. Two adult patients with a history of intravenous drug use and one child with congenital heart disease are described. They were all diagnosed with infectious endocarditis and developed neurological symptoms during their hospital course. Initial catheter-based cerebral angiograms demonstrated vascular occlusions, which were followed by the development of MA at the same sites within 1 month. Septic emboli, documented on cerebral angiogram, in patients with infectious endocarditis may precede the appearance of MA. Patients with angiographic occlusions in the setting of endocarditis warrant close follow-up.

scholarly journals An Unusual Association between Unilateral Intracranial Vessels Occlusion with Iron Deficiency Anaemia and Alpha-Thalassemia Trait: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Yeong Yeh Lee ◽  
Shalini Bhaskar
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anaemia ◽  
Vessel Occlusion ◽  
Cerebral Angiogram ◽  
Deficiency Anaemia ◽  
Intracranial Vessel ◽  
Unusual Association ◽  
Alpha Thalassemia ◽  
Thalassemia Trait ◽  
The Right

We report a 33-year-old Malay woman presented with acute left dense hemiparesis and an NIHSS score of 11/15. Computed tomography (CT) scan brain showed a massive right middle cerebral artery (MCA) territory infarct. The right internal carotid artery (ICA) and right proximal MCA were shown occluded from digital substraction angiography (DSA). Carotid dissection, carotid canal anomaly, and intercavernous communication were systematically ruled out. She had no risk factors for atherosclerosis. The connective tissue screening and thrombophilic markers were negative. However, she was anaemic on admission and subsequent investigations revealed that she had alpha-thalassemia and iron deficiency anaemia. The right ICA remained occluded from a repeat CT cerebral angiogram after one year, but otherwise she was neurologically stable. This case illustrates an unusual association between intracranial vessel occlusion with iron deficiency anaemia and alpha-thalassemia trait.

scholarly journals A Pilot Study of Tobacco Screening and Referral for Smoking Cessation Program among HIV-Infected Patients in France

2017 ◽  
Vol 16 (5) ◽  
pp. 467-474 ◽  
Author(s):  
Jean-Jacques Parienti ◽  
Zine Merzougui ◽  
Arnaud de la Blanchardière ◽  
Sylvie Dargère ◽  
Philippe Feret ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Tobacco Smoking ◽  
Smoking Cessation Program ◽  
Intravenous Drug Use ◽  
Active Smoking ◽  
Targeted Interventions ◽  
History Of ◽  
Living With Hiv ◽  
History Of Depression

Background: The prevalence of tobacco smoking is high among patients living with HIV, supporting the need for effective targeted interventions. Materials and Methods: All current smokers at our outpatient HIV clinic were invited to participate in a smoking cessation program. Results: Of the 716 patients living with HIV, 280 (39%) reported active smoking and were younger, more recently HIV infected and more frequently infected due to intravenous drug use (IDU). One hundred forty-seven (53%) smokers agreed to participate in the smoking cessation program and had a higher Fagerström score and were less likely IDU. During follow-up, 41 (28%) smokers withdrew from the program. After 6 months, 60 (57%) of the 106 smokers who completed the intervention had stopped tobacco smoking and were more likely to use varenicline, adjusting for a history of depression. Conclusion: Our smoking cessation program was feasible. However, strategies to reach and retain in smoking cessation program specific groups such as IDU are needed to improve the smoking cessation cascade.

scholarly journals BacillusPanophthalmitis with Posterior Extension to the Prechiasmatic Optic Nerve

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
James E. Kasenchak ◽  
Benjamin P. Hale ◽  
Thomas W. Wilson ◽  
Gregory M. Notz
Keyword(s):  
Optic Nerve ◽  
Drug Use ◽  
Intravenous Drug ◽  
Intravenous Drug Use ◽  
Eye Pain ◽  
Elevated Intraocular Pressure ◽  
History Of ◽  
Posterior Extension ◽  
Repeat Imaging

A rare case ofBacilluspanophthlamitis with extension to the prechiasmatic optic nerve secondary to hematogenous spreading after intravenous drug use is presented. A 27-year-old man with a recent history of trauma to the left eye presented with severe left eye pain following a binge of intravenous drug use. Visual acuity (VA) was LP. On examination he had chemosis, proptosis, elevated intraocular pressure, and a complete hyphema. CT-scan identified preseptal swelling, but no evidence of any posterior extension of the anterior process or orbital fractures. Topical and systemic therapy were initiated. On follow-up clinical examination less than 12 hours after presentation he had signs of a keratitis with worsening ophthalmoplegia and repeat imaging demonstrated posterior extension to the prechiasmatic optic nerve. Shortly after the cornea ruptured with cultures growingBacillus. The patient underwent enucleation and has had no further progression of infection. To the best of our knowledge, this is the first report ofBacilluspanophthalmitis presenting with signs of trauma with posterior extension to the prechiasmatic optic nerve.

scholarly journals A Rare Case of Botulism in an Adult Patient

2021 ◽  
Vol 3 (3) ◽  
pp. 276-279
Author(s):  
Deyna Montes-Velez ◽  
◽  
William Bautista ◽  
Samantha Brophy ◽  
Justin Chatten-Brown ◽  
...  
Keyword(s):  
Sudden Onset ◽  
Intravenous Drug Use ◽  
Facial Weakness ◽  
Wound Botulism ◽  
Patient Reports ◽  
Optimal Patient Outcome ◽  
History Of ◽  
Polysubstance Abuse ◽  
Guillain Barré

Presentation of botulism in adults is extremely rare and symptoms can be easily confused for symptoms of acute stroke, Guillain-Barre, or myasthenia gravis. The purpose of this clinical case report is to ensure adult botulism will be included in the differential diagnoses for a patient with this presentation so swift and accurate care can be provided to ensure optimal patient outcome. A 41-year-old-female presented with complaints of sudden onset of difficulty speaking. The patient reports a history of intravenous polysubstance abuse and symptoms progressed to bilateral facial weakness, ptosis, and external ophthalmoplegia. With no notable findings from a non-contrast computed tomography and magnetic resonance imaging and given the symptoms, a diagnosis of wound botulism from intravenous drug use was made. Botulism antitoxin was given and the patient was admitted into the intensive care unit for supportive follow-up care. A colony of Clostridium species was discovered in this patient’s arm and the patient showed significant improvement after a few days of care.

scholarly journals Causes of death among crack cocaine users

2006 ◽  
Vol 28 (3) ◽  
pp. 196-202 ◽  
Author(s):  
Marcelo Ribeiro ◽  
John Dunn ◽  
Ricardo Sesso ◽  
Andréa Costa Dias ◽  
Ronaldo Laranjeira
Keyword(s):  
General Population ◽  
Mortality Risk ◽  
Causes Of Death ◽  
Crack Cocaine ◽  
Study Endpoint ◽  
Intravenous Drug Use ◽  
Common Causes ◽  
History Of ◽  
Cocaine Users

OBJECTIVE: The study accompanied 131 crack-cocaine users over a 5-year period, and examined mortality patterns, as well as the causes of death among them. METHOD: All patients admitted to a detoxification unit in Sao Paulo between 1992 and 1994 were interviewed during two follow-up periods: 1995-1996 and 1998-1999. RESULTS: After 5 years, 124 patients were localized (95%). By the study endpoint (1999), 23 patients (17.6%) had died. Homicide was the most prevalent cause of death (n = 13). Almost one third of the deaths were due to the HIV infection, especially among those with a history of intravenous drug use. Less than 10% died from overdose. CONCLUSIONS: The study suggests that the mortality risk among crack cocaine users is greater than that seen in the general population, being homicide and AIDS the most common causes of death among such individuals.

scholarly journals Cavernous Thrombophlebitis Secondary to Cavernous Internal Carotid Mycotic Aneurysm

2019 ◽  
Vol 10 (3) ◽  
pp. 221-223
Author(s):  
Devin J. Burke ◽  
Ashutosh Jadhav
Keyword(s):  
Mycotic Aneurysm ◽  
Internal Carotid ◽  
Case Reports ◽  
Case Series ◽  
Intravenous Drug Use ◽  
Cavernous Sinus Syndrome ◽  
Full Resolution ◽  
Fungal Endocarditis ◽  
History Of ◽  
Mycotic Aneurysms

We report a case of a 22-year-old male with a history of intravenous drug use presenting with cavernous sinus syndrome secondary to cavernous thrombophlebitis. The source of the thrombophlebitis was from a mycotic aneurysm in the setting of fungal endocarditis. With antifungal therapy and aortic valve replacement, the patient had full resolution of cranial nerve deficits. Descriptions of mycotic aneurysms of the cavernous portion of the internal carotid artery are limited to case reports and case series. Most have been nonendocarditic in etiology with poor prognosis. We present a unique case with endocarditic etiology and an excellent prognosis.

Selective endovascular techniques in the treatment of cerebral mycotic aneurysms

1993 ◽  
Vol 78 (4) ◽  
pp. 661-665 ◽  
Author(s):  
Mazen H. Khayata ◽  
Armand Aymard ◽  
Alfredo Casasco ◽  
Denis Herbreteau ◽  
France Woimant ◽  
...  
Keyword(s):  
Standard Procedure ◽  
Endovascular Embolization ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Content Type ◽  
Mycotic Aneurysms ◽  
Distal Localization ◽  
Risk Of Hemorrhage

✓ The aim of this study was to evaluate the role of endovascular treatment for intracranial mycotic aneurysms. The clinical and angiographic features of three patients with endocarditic vegetation (two with Streptococcus viridans and one with Staphylococcus) were reviewed retrospectively. Patients were selected for this treatment according to the clinical setting and aneurysm location. In two cases, selective catheterization of a distal middle cerebral and posterior cerebral artery branch with a microcatheter followed by superselective amobarbital testing of the parent vessel was preliminary to the occlusion of that vessel with autologous clot or glue. The third patient was treated by selective occlusion of the aneurysm by intra-aneurysmal placement of platinum minicoils. Two patients presented with intracranial hemorrhage and in one the lesion was found on computerized tomography. All three aneurysms had been excluded from the circulation at the 6-month follow-up review. The only complication from the procedure, despite the septic nature and distal localization, was balloon deflation in one patient, who was successfully retreated with coils. Endovascular embolization is indicated in patients who are at risk of hemorrhage and cannot undergo the standard procedure. The superselective amobarbital test allows selection of patients who will tolerate distal vessel occlusion. This endovascular procedure represents a safe and effective treatment for these lesions.

Abstract WMP16: Radiographic Characteristics of Mild Ischemic Stroke Patients With Visible Intracranial Occlusion; Data From the INTERRSeCT Multi-Center Prospective Imaging Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Hsien Lee Lau ◽  
Hannah Gardener ◽  
Vasu A Saini ◽  
Nastajjia Krementz ◽  
Thalia Field ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Symptom Onset ◽  
Imaging Study ◽  
Collateral Flow ◽  
Residual Flow ◽  
Vessel Occlusion ◽  
Cerebral Angiogram ◽  
Intracranial Vessel ◽  
Stroke Group ◽  
Mild Stroke

Background: Early neurological deterioration occurs in one third of mild ischemic strokes primarily due to the presence of a visible intracranial vessel occlusion. We studied the clinical and vascular occlusive patterns, thrombus characteristics and recanalization rates in patients with mild ischemic stroke and a visible intracranial vessel occlusion. Methods: We studied patients enrolled in the INTERRSeCT multi-center prospective study of acute ischemic strokes with visible intracranial occlusions. We compared the clinical, thrombus characteristics and recanalization rates between two groups, 1) mild ischemic NIHSS≤5 and 2) moderate/severe strokes NIHSS >5, with or without IV alteplase treatment. Vessel imaging with CT angiography (CTA) was initiated within 12 hrs of symptom onset followed by repeat imaging with CTA or cerebral angiogram (before endovascular therapy; EVT) within 4 +/- 2 hrs. Results: Among 575 patients with a visible intracranial occlusion, 12.9% had mild strokes with similar patient characteristics compared to the moderate/severe stroke group. Residual flow grades were similar between the two groups (residual flow grades I-II, 21% vs 19%). The mild stroke group had longer symptom-onset-to -CT (240 vs 167 min, p=0.02) and -CTA (246 vs 172 min, p=0.02) times, longer CT to needle time (35 vs 26 min, p<0.01), more distal occlusions (49% in M2 of the middle cerebral artery), lower clot burden scores 9 (6-9) vs 6 (4-9) (p<0.001), better collateral flow (9.1 vs 7.6, p=0.001) and no association between residual flow grade and recanalization. The mild stroke group was less likely to receive IV alteplase (62% vs 84%), but more likely to recanalize (rAOL2b and 3) with (46% vs 29%) and without (38% vs 26%) IV alteplase. Conclusion: Some thrombus characteristics that predict recanalization in more severe strokes do not predict recanalization in mild strokes, such as residual blood flow through intracranial occlusions, though they have similar cardiovascular risk factors. Less than half of patients with mild strokes recanalized with IV alteplase which was associated with longer decision-making times suggesting that more aggressive use of thrombolytics and/or EVT may be viable treatment options in this population.

scholarly journals Malignant clinical course of mycotic intracranial aneurysms in children: A review

2020 ◽  
Vol 11 ◽  
pp. 71
Author(s):  
Yahya H Khormi ◽  
Ronette Goodluck Tyndall ◽  
Mandeep Tamber
Keyword(s):  
Clinical Course ◽  
Pediatric Population ◽  
Management Strategies ◽  
Sudden Onset ◽  
New Right ◽  
Unruptured Aneurysms ◽  
History Of ◽  
Mycotic Aneurysms ◽  
Imminent Risk

Background: Mycotic aneurysms are a rare in the pediatric population. The natural history of these lesions and their appropriate management strategies is controversial. Case Description: A 13-year-old male presented with the sudden onset of a headache, vomiting, and fever. Inflammatory markers were elevated, and the blood culture was positive for Streptococcus viridans. When the computed tomography angiography (CTA) showed a ruptured mycotic aneurysm accompanied by multiple small unruptured aneurysms, he was started on antibiotics and underwent an urgent craniotomy. Despite negative blood cultures, the follow-up CTA showed further enlargement of the previously diagnosed aneurysms and a new right frontal aneurysm. The second and third craniotomies were, respectively, performed to resect the additional aneurysms. Pathologically, both aneurysmal walls were markedly inflamed and attenuated, suggesting the imminent risk of aneurysmal rupture. Following the total of three craniotomies, the patient had an uneventful postoperative course. Within 2 weeks, he regained baseline neurological function. Conclusion: Mycotic aneurysms in children may follow a very malignant course. Aneurysms may grow, new ones may form, and repeated CTAs are required to direct further follow-up treatment.

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