Successful endovascular coiling of infectious cerebral aneurysm following Staphylococcus haemolyticus endocarditis

Recent reports suggest that Staphylococcus haemolyticus can cause infective endocarditis (IE). However, no data are available regarding infectious intracranial aneurysm (IIA) following S. haemolyticus endocarditis. Endovascular coiling is a challenging approach for the treatment of IIA. We describe the case of a 63-year-old woman who suddenly developed aphasia and dysarthria following an acute cerebral infarction in her left insular and temporal cortex. After a total hysterectomy at the age of 39, the patient had suffered from recurrent bacterial pyomyositis in her legs. At admission, there was no evidence of cerebral aneurysm, as assessed by magnetic resonance angiography, and no vegetation, as assessed by transesophageal echocardiography (TEE), resulting in an incorrect diagnosis. However, subarachnoid hemorrhage and development of cerebral aneurysm in the left middle cerebral artery occurred within 1 week of hospitalization. Continuous positive blood culture results and a second TEE finally revealed that IE was caused by S. haemolyticus. Coil embolization of the IIA was successful on day 26 after symptom onset; after this procedure, the patient began to recover. This case demonstrates that S. haemolyticus-induced endocarditis can cause IIA. Endovascular coiling is a potentially effective approach to treat IIA.

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Unusual Intracranial Manifestation of Infective Endocarditis

The Open Neuroimaging Journal ◽

10.2174/1874440002114010028 ◽

2021 ◽

Vol 14 (1) ◽

pp. 28-32

Author(s):

Keerthiraj Bele ◽

Sonali Ullal ◽

Ajit Mahale ◽

Sriti Rani

Keyword(s):

Infective Endocarditis ◽

Early Diagnosis ◽

Cerebral Artery ◽

Mycotic Aneurysm ◽

Parent Artery ◽

Left Middle Cerebral Artery ◽

Risk Of Rupture ◽

Complete Obliteration ◽

Glue Embolization ◽

Left Middle

Objective: The mycotic aneurysm is a rare intracranial pathology seen with pre-existing infective endocarditis. It has a high mortality rate due to its risk of rupture and needs early diagnosis and treatment. Methods: A 23-year male patient who presented with infective endocarditis subsequently developed a left parietal-temporal intracranial haemorrhage with suspicion of aneurysm after the course of antibiotic treatment as seen on Computed Tomography (CT) scan. Digital Subtraction Angiography (DSA) revealed a ruptured fusosaccular aneurysm in the distal parietal branches of the left Middle Cerebral Artery (MCA), for which glue embolization of the distal parent artery and aneurysm was done. Result: The interventional endovascular procedure was done with complete obliteration of the distal parent artery, mycotic aneurysm, and normal filling of the left internal cerebral artery (ICA) branches. Conclusion: Mycotic intracranial aneurysms (MIA) are a rare form of cerebrovascular pathology which needs early diagnosis with endovascular intervention when rupture occurs.

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Conus Perimedullary Arteriovenous Fistula with Intracranial Drainage: Case Report

Neurosurgery ◽

10.1097/00006123-200108000-00038 ◽

2001 ◽

Vol 49 (2) ◽

pp. 457-462 ◽

Cited By ~ 3

Author(s):

G. Edward Vates ◽

Alfredo Quiñones-Hinojosa ◽

Van V. Halbach ◽

Michael T. Lawton

Keyword(s):

Subarachnoid Hemorrhage ◽

Artery Aneurysm ◽

Venous Drainage ◽

Sudden Onset ◽

Clinical Findings ◽

Left Middle Cerebral Artery ◽

Lower Extremity Weakness ◽

Posterior Laminectomy ◽

Cerebral Artery Aneurysm ◽

Left Middle

Abstract OBJECTIVE AND IMPORTANCE Perimedullary arteriovenous fistulae (AVFs) do not commonly present with subarachnoid hemorrhage or intracranial venous drainage causing neurological symptoms. We present a case with both of these features. The patient was inadvertently treated for an unruptured intracranial aneurysm before his true problem was recognized. CLINICAL PRESENTATION A 65-year-old man presented with sudden-onset lower-extremity weakness, diplopia, nausea, and dysarthria on the day of admission. A lumbar puncture documented subarachnoid hemorrhage, and imaging studies revealed a left middle cerebral artery aneurysm. It was noted during surgery that this aneurysm was unruptured, and the patient did not exhibit improvement after surgery. INTERVENTION Spinal angiography demonstrated a spinal perimedullary AVF feeding from the left T12 radicular artery; venous drainage extended rostrally into the posterior fossa venous system. The AVF was surgically occluded via a posterior laminectomy at the level of the AVF. After surgery, the patient's symptoms began to abate. CONCLUSION Conus perimedullary AVFs can have venous drainage that extends as far as intracranial veins, which can lead to confusing clinical findings because the symptoms may suggest an intracranial process, although the lesion is in the spine. Surgeons must be aware of this confusing presentation.

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Stroke in young secondary to infective endocarditis complicating hypertrophic cardiomyopathy – A case report

Nepalese Heart Journal ◽

10.3126/njh.v16i1.23904 ◽

2019 ◽

Vol 16 (1) ◽

pp. 57-59

Author(s):

Abhishek Bhandari ◽

Bhupendra Shah ◽

Aditya Mahaseth ◽

Sanjib Kumar Sharma

Keyword(s):

Infective Endocarditis ◽

Hypertrophic Cardiomyopathy ◽

Clinical Presentation ◽

Normal Sinus Rhythm ◽

Left Middle Cerebral Artery ◽

Normal Sinus ◽

Dominant Disease ◽

The Common ◽

Left Middle ◽

Stroke In Young

Hypertrophic cardiomyopathy is an autosomal dominant disease of cardiac sarcomere with the varied clinical presentation. The common manifestations are heart failure (dyspnea), palpitations, chest pain, stroke and even sudden death. Majority of patients are not recognized because of being asymptomatic. Stroke is one of the complications of hypertrophic cardiomyopathy and usually occurs in the setting of atrial fibrillation, advanced age and congestive cardiac failure. Although infective endocarditis is known, but relatively uncommon, complication of hypertrophic cardiomyopathy, it is not reported from Nepal. We report here a case of 42-year male patient with hypertrophic cardiomyopathy in normal sinus rhythm with infective endocarditis who developed malignant cardioembolic stroke involving left middle cerebral artery territory.

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Subarachnoid Hemorrhage from a Peripheral Intracranial Aneurysm Associated with Malignant Glioma: Report of a Case

Neurosurgery ◽

10.1227/00006123-198510000-00019 ◽

1985 ◽

Vol 17 (4) ◽

pp. 645-649 ◽

Cited By ~ 24

Author(s):

Brian T. Andrews ◽

Corey Raffel ◽

Harold Rosegay

Keyword(s):

Subarachnoid Hemorrhage ◽

Intracranial Aneurysm ◽

Malignant Glioma ◽

Middle Cerebral Artery ◽

Causal Relationship ◽

Cerebral Artery ◽

Histological Analysis ◽

Left Middle Cerebral Artery ◽

Left Middle

Abstract The case of a patient who initially presented with a subarachnoid hemorrhage from an aneurysm of the distal left middle cerebral artery is reported. The aneurysm was later found to have occurred within a malignant glioma. Histological analysis showed tumor infiltrating the wall of the aneurysm. A causal relationship between growth of the tumor and development and rupture of the aneurysm is postulated.

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Neurofibromatosis type 1 with subarachnoid hemorrhage due to multiple and de novo aneurysms: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02967-3 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Tatsuya Uchida ◽

Kenichi Amagasaki ◽

Atsushi Hosono ◽

Hiroshi Nakaguchi

Keyword(s):

Computed Tomography ◽

Subarachnoid Hemorrhage ◽

Neurofibromatosis Type 1 ◽

Intracranial Aneurysms ◽

De Novo ◽

Neurofibromatosis Type ◽

Left Middle Cerebral Artery ◽

Short Period ◽

Left Middle

Abstract Background Neurofibromatosis type 1 causes various lesions in many organs including the skin, and the incidence of complications with intracranial aneurysms is 9–11%. Here we report a case of neurofibromatosis type 1 with subarachnoid hemorrhage due to multiple and de novo aneurysms. Case presentation The patient was a 49-year-old Japanese woman with a history of neurofibromatosis type 1. She was transported to our hospital owing to disturbance of consciousness and was diagnosed with subarachnoid hemorrhage by computed tomography. Computed tomography angiography revealed multiple, small intracranial aneurysms, and we suspected that one of them in the peripheral branch of the left middle cerebral artery was the source of hemorrhage based on the distribution of hematoma. The patient underwent emergency surgery. Because it was difficult to identify an aneurysm in the most peripheral part of the left middle cerebral artery in the initial surgery, only one aneurysm was clipped. Later, a peripheral aneurysm was clipped using the navigation system. Because both aneurysms were small intracranial aneurysms (< 2 mm), either of them could be the source of hemorrhage. The postoperative course was good, and the patient was discharged in healthy condition. Because brain magnetic resonance imaging performed in the previous year did not find aneurysms at the same site, she was diagnosed with rupture of a de novo aneurysm. Neurofibromatosis type 1 might have caused the rupture of multiple intracranial aneurysms in a short period in this patient. Conclusion Neurofibromatosis type 1 may be complicated by the formation of multiple intracranial aneurysms in a short period.

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A RARE CASE OF RUPTURED ANEURYSM AT THE ORIGIN OF INFERIOR PART OF DUPLICATED MIDDLE CEREBRAL ARTERY

MNJ (Malang Neurology Journal) ◽

10.21776/ub.mnj.2021.007.02.13 ◽

2021 ◽

Vol 7 (2) ◽

pp. 146-148

Author(s):

Achmad Firdaus Sani ◽

Dedy Kurniawan

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Anatomical Variation ◽

Ruptured Aneurysm ◽

Endovascular Coiling ◽

Left Middle Cerebral Artery ◽

History Of ◽

Head Computed Tomography ◽

Left Middle

Duplicated middle cerebral artery (DMCA) is an anomalous vessel arises from the internal carotid artery (ICA). This anatomical variation is rare. Aneurysm with this anatomical variation and unusual form was very rare. Even though this kind of aneurysm is rare, it was often ruptured. In this paper, we report a case of 40-years old female with abrupt decreased of consciousness as a chief complaint, along with severe headache one day earlier, no history of head trauma, and there was nuchal rigidity. She didn’t had history of hypertension before. Head computed tomography showed subarachnoid hemmorrhage (SAH) mostly on the left sylvian fissure with Hunt and Hess scale was 3 and Fisher scale was 2, while the cerebral angiography showed duplication of the left middle cerebral artery in which the inferior part of the MCA duplication has ruptured aneurysm at the origin. Treatment option for this aneurysm is endovascular coiling with preserved of the inferior part of duplicated MCA. Result of this treatment shows a good outcome.

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Abstract 1122‐000202: Two World Wars, Two Pandemics and Then Stroke:Thrombectomy, Angioplasty and Stenting in a 110‐Year‐Old Patient

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000202 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Pouria Moshayedi ◽

Emily Chapman ◽

Mais Al‐Kawaz ◽

Jacopo Scaggiante ◽

Halima Tabani ◽

...

Keyword(s):

Acute Stroke ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Brain Mri ◽

Temporal Cortex ◽

Left Middle Cerebral Artery ◽

Infarct Core ◽

Vessel Occlusion ◽

Stent Deployment ◽

Left Middle

Introduction : Endovascular thrombectomy (EVT) is the standard of care in patients with acute stroke due to large vessel occlusion. In an aging population it is important to know EVT outcomes in old age, despite patients over 80 years are mostly excluded from major trial. While the oldest reported patients undergoing EVT was 102 years old, we report a 110 years old patient as the oldest patient undergoing EVT for stroke reported in the literature, and discuss the technical details and outcome. Methods : n/a Results : A 110‐ year‐old patient presented with right side weakness and slurred speech and found to have left middle cerebral artery occlusion. She received tenecteplase and transferred to angio‐suite 1 hour and 35 minutes after onset of symptoms. Left middle cerebral artery underwent two passes with stentriever, balloon angioplasty and stent deployment resulting in thrombolysis in cerebral infarction (TICI) 3 reperfusion. Brain MRI showed infarction in the left basal ganglia and left temporal cortex. After thrombectomy she was able to hold right arm and leg against gravity and follow commands. However, patient developed aspiration pneumonia and passed away after family chose to focus care on her comfort and refused tracheostomy and gastric tube. Conclusions : Despite poor clinical outcome, this case presents technical success in good recanalization, resulting in small infarct core and immediate neurological improvement in the oldest reported acute stroke patient undergoing thrombectomy.

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Republished: Remote multifocal bleeding points producing a Sylvian subpial hematoma during endovascular coiling of an acutely ruptured cerebral aneurysm

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012715.rep ◽

2016 ◽

Vol 9 (7) ◽

pp. e25-e25 ◽

Cited By ~ 1

Author(s):

Christopher Alan Hilditch ◽

Hemant Sonwalkar ◽

Siddhartha Wuppalapati

Keyword(s):

Poor Prognosis ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Artery Aneurysm ◽

Endovascular Coiling ◽

Left Middle Cerebral Artery ◽

Conventional Angiography ◽

Rare Type ◽

Hematoma Formation ◽

Posterior Communicating Artery Aneurysm ◽

Left Middle

Subpial hematoma is a rare type of intracranial hemorrhage with a poor prognosis. A new mechanism to explain subpial Sylvian hematoma formation in acute post-aneurysmal subarachnoid hemorrhage (SAH) was observed during coiling of a posterior communicating artery aneurysm. Multiple small bleeding points from pial branches of the left middle cerebral artery, which were remote from the ruptured aneurysm, were observed on conventional angiography. This bleeding led to the formation of a large expanding subpial Sylvian hematoma. Similar observations have been recently demonstrated on 4D CT angiography (4D CTA). We present a case that adds evidence to the literature in support of a new mechanism of subpial hematoma formation in the setting of acute SAH. This may advocate the early use of 4D CTA and conveys a poor prognosis, which might influence treatment decisions.

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