scholarly journals Unusual Intracranial Manifestation of Infective Endocarditis

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.

Successful flow diversion treatment of ruptured infectious middle cerebral artery aneurysms with the use of Pipeline Flex with Shield technology

2021 ◽  
pp. 159101992199050
Author(s):  
Derek C Samples ◽  
Vijay M Ravindra ◽  
Dewey J Thoms ◽  
Izabela Tarasiewicz ◽  
Ramesh Grandhi
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Dual Antiplatelet Therapy ◽  
Flow Diverter ◽  
Flow Diversion ◽  
Parent Artery ◽  
Left Middle Cerebral Artery ◽  
Middle Cerebral Artery Aneurysms ◽  
Left Middle

Background Rupture of infectious intracranial aneurysms (IIAs) is associated with a high likelihood of mortality. Endovascular treatment of IIAs via parent artery sacrifice offers good efficacy and outcomes; however, depending on the lesion’s location, neurologic deficit may result. Case description We describe a pediatric patient with ruptured IIAs off the left middle cerebral artery (MCA) treated with coil embolization and endovascular flow diversion using the Pipeline Flex Embolization Device (PED) with Shield technology. We chose to place a flow diverter because 1) there was a second, more distal IIA not amenable to direct coil embolization, 2) there was significant potential for aneurysm regrowth and need for retreatment, and 3) we believed the diseased parent MCA needed to be reconstructed. Conclusions In the setting of previous hemicraniectomy, PED-Shield gave us the option to discontinue dual antiplatelet therapy should the patient require further neurosurgical intervention. Our case supports a role for PED-Shield to address ruptured pseudoaneurysms.

scholarly journals Post-stroke cognitive impairment on the Mini-Mental State Examination primarily relates to left middle cerebral artery infarcts

2021 ◽  
pp. 174749302098455
Author(s):  
Nick A Weaver ◽  
Angelina K Kancheva ◽  
Jae-Sung Lim ◽  
J Matthijs Biesbroek ◽  
Irene MC Huenges Wajer ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Cognitive Deficits ◽  
Mini Mental State Examination ◽  
Left Middle Cerebral Artery ◽  
Post Stroke ◽  
Lesion Symptom Mapping ◽  
State Examination ◽  
Left Middle

Background Post-stroke cognitive impairment can occur after damage to various brain regions, and cognitive deficits depend on infarct location. The Mini-Mental State Examination (MMSE) is still widely used to assess post-stroke cognition, but it has been criticized for capturing only certain cognitive deficits. Along these lines, it might be hypothesized that cognitive deficits as measured with the MMSE primarily involve certain infarct locations. Aims This comprehensive lesion-symptom mapping study aimed to determine which acute infarct locations are associated with post-stroke cognitive impairment on the MMSE. Methods We examined associations between impairment on the MMSE (<5th percentile; normative data) and infarct location in 1198 patients (age 67 ± 12 years, 43% female) with acute ischemic stroke using voxel-based lesion-symptom mapping. As a frame of reference, infarct patterns associated with impairments in individual cognitive domains were determined, based on a more detailed neuropsychological assessment. Results Impairment on the MMSE was present in 420 patients (35%). Large voxel clusters in the left middle cerebral artery territory and thalamus were significantly (p < 0.01) associated with cognitive impairment on the MMSE, with highest odds ratios (>15) in the thalamus and superior temporal gyrus. In comparison, domain-specific impairments were related to various infarct patterns across both hemispheres including the left medial temporal lobe (verbal memory) and right parietal lobe (visuospatial functioning). Conclusions Our findings indicate that post-stroke cognitive impairment on the MMSE primarily relates to infarct locations in the left middle cerebral artery territory. The MMSE is apparently less sensitive to cognitive deficits that specifically relate to other locations.

Multiple middle cerebral artery aneurysms in an infant

1990 ◽  
Vol 72 (5) ◽  
pp. 806-809 ◽  
Author(s):  
Cornelia Cedzich ◽  
J. Schramm ◽  
G. Röckelein
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Systemic Disease ◽  
Intracerebral Hematoma ◽  
Left Middle Cerebral Artery ◽  
Content Type ◽  
Middle Cerebral Artery Aneurysms ◽  
Subarachnoid Blood ◽  
Left Middle ◽  
Control Angiography

✓ An 11-month-old boy was admitted for evaluation of drowsiness, vomiting, and convulsions. Computerized tomography showed subarachnoid blood in the left sylvian fissure and a small intracerebral hematoma in the temporal lobe. Angiography revealed several aneurysms of the left middle cerebral artery (MCA). During surgery, 13 aneurysms were found arising from one main branch of the left MCA, and this segment of the MCA was trapped. Somatosensory evoked potentials did not show any change during surgery. The diseased arterial segment was examined histologically and the pathogenetic aspects of the case are discussed. Control angiography 6 months later excluded systemic disease or other aneurysms. The rarity of such lesions in childhood and their successful surgical treatment are discussed briefly.

Delayed breaking of a Heifetz aneurysm clip

1977 ◽  
Vol 47 (3) ◽  
pp. 463-465 ◽  
Author(s):  
Antti Servo ◽  
Matti Puranen
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Left Middle Cerebral Artery ◽  
Carotid Angiography ◽  
Content Type ◽  
Aneurysm Clip ◽  
Correct Placement ◽  
Left Middle ◽  
Fine Print

✓ An aneurysm of the left middle cerebral artery was treated by clipping with a Heifetz clip. The correct placement was confirmed angiographically immediately after the operation. At carotid angiography 1 year later the clip was found to have broken, and the aneurysm had increased in size.

scholarly journals A Rare Case ofStreptococcus alactolyticusInfective Endocarditis Complicated by Septic Emboli and Mycotic Left Middle Cerebral Artery Aneurysm

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Patricia Almeida ◽  
Jaclyn Railsback ◽  
James Benjamin Gleason
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Left Middle Cerebral Artery ◽  
Middle Cerebral Artery Aneurysm ◽  
Microsurgical Clipping ◽  
Cerebral Artery Aneurysm ◽  
Left Middle

To date,S. alactolyticusendocarditis complicated by middle cerebral artery aneurysm has not been reported. We describe the case of a 65-year-old female with a history of hypertrophic cardiomyopathy with left ventricular outflow tract obstruction presenting with confusion and a apical holosystolic murmur. Angiography of the brain identified new bilobed left middle cerebral artery aneurysm. Serial blood cultures grewS. alactolyticus, and aortic and mitral valve vegetation were discovered on transesophageal echocardiography. The patient was treated with antimicrobial therapy, mitral and aortic valve replacements, and microsurgical clipping of cerebral aneurysm. This case serves to highlight the pathogenicity of a sparsely described bacterium belonging to the heterogenousS. boviscomplex.

scholarly journals Adverse Outcome of Early Recurrent Ischemic Stroke Secondary to Atrial Fibrillation after Repeated Systemic Thrombolysis

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Luciano A. Sposato ◽  
Valeria Salutto ◽  
Diego E. Beratti ◽  
Paula Monti ◽  
Patricia M. Riccio ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Neurological Outcome ◽  
Left Middle Cerebral Artery ◽  
Cerebrovascular Event ◽  
Middle Cerebral Artery Infarction ◽  
Systemic Thrombolysis ◽  
Left Middle

Background. Recurrent ischemic stroke is associated with adverse neurological outcome in patients with atrial fibrillation. There is very scarce information regarding the neurological outcome of atrial fibrillation patients undergoing repeated systemic thrombolysis after early recurrent ischemic stroke.Clinical Case and Discussion. We describe a case of a 76-year-old woman with known paroxysmal atrial fibrillation who was admitted because of an acute right middle cerebral artery ischemic stroke and who underwent repeated systemic thrombolysis within 110 hours. The patient underwent systemic thrombolysis after the first ischemic stroke with almost complete neurological recovery. On the fourth day after treatment, an acute left middle cerebral artery ischemic stroke was diagnosed and she was treated with full-dose intravenous recombinant tissue plasminogen activator. A hemorrhagic transformation of the left middle cerebral artery infarction was noted on follow-up cranial computed tomographic scans. The patient did not recover from the second cerebrovascular event and died 25 days after admission.Conclusion. To the best of our knowledge, this is the second case reporting the adverse neurological outcome of a patient with diagnosis of atrial fibrillation undergoing repeated systemic thrombolysis after early recurrent ischemic stroke. Our report represents a contribution to the scarce available evidence suggesting that repeated systemic thrombolysis for recurrent ischemic stroke should be avoided.

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