A rare case of Streptococcus anginosus infectious intracranial aneurysm: Proper management of a poor prognosis

Background: Infectious intracranial aneurysms (IIAs), sometimes referred to as cerebral mycotic aneurysms, are an uncommon but feared compilation of bacterial endocarditis, occurring in up to 5% of all bacterial endocarditis cases. While IIAs carry a low risk of rupture, a ruptured mycotic aneurysm carries devastating neurologic consequences with up to an 80% mortality rate secondary to subarachnoid and intracerebral hemorrhage. Case Description: A 69-year-old man undergoing antibacterial therapy for Streptococcus anginosus endocarditis with aortic insufficiency and root abscess presented to the ED with multiple seizures and left-sided weakness. MRI of the head revealed right frontal and temporal abscesses with evidence of scattered septic emboli and subarachnoid hemorrhage. CTA of the head revealed a ruptured 1 mm distal middle cerebral artery mycotic aneurysm. Prior to undergoing surgery, the patient began to decline, becoming lethargic, and failing to respond to commands. The patient underwent endovascular Onyx embolization. After the procedure, the patient remained with partial status epilepticus and was discharged to rehabilitation. Over the following months, the patient made a great recovery and was able to undergo aortic and mitral valve replacement 5 months after neurosurgical intervention. Conclusion: This favorable outcome is the result of a tremendous deal of long-term coordination and efficient communication between neurosurgery, cardiology, neurology, physical medicine and rehabilitation, and primary care.

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Rothia dentocariosa causing intracranial mycotic aneurysm and ischaemic stroke

BMJ Case Reports ◽

10.1136/bcr-2020-240349 ◽

2021 ◽

Vol 14 (3) ◽

pp. e240349

Author(s):

Eli Kisilevsky ◽

Nataly Pesin ◽

Daniel Mandell ◽

Edward A Margolin

Keyword(s):

Intracranial Aneurysms ◽

Mycotic Aneurysm ◽

Systemic Infection ◽

Bacterial Endocarditis ◽

Medical Assessment ◽

Subacute Bacterial Endocarditis ◽

Brain Aneurysm ◽

High Incidence ◽

Mycotic Aneurysms ◽

Untreated Dental Caries

We describe a case of subacute bacterial endocarditis and mycotic brain aneurysm caused by Rothia dentocariosa due to untreated dental caries. R. dentocariosa is a rare cause of endocarditis that has a high incidence of aneurysmal and haemorrhagic complications. All patients with intracranial aneurysms who have signs of systemic infection should be considered to have mycotic aneurysms until proven otherwise. Dental habits should be included in regular medical assessment and dental care should be considered for patients presenting with infectious symptoms.

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Mycotic aneurysm of the superior gluteal artery in a patient with bacterial endocarditis: case report and review of the literature

Vascular ◽

10.1258/vasc.2010.cr0225 ◽

2011 ◽

Vol 19 (1) ◽

pp. 47-50 ◽

Cited By ~ 6

Author(s):

Naoki Fujimura ◽

Hideaki Obara ◽

Kenji Matsumoto ◽

Yuko Kitagawa

Keyword(s):

Mycotic Aneurysm ◽

Preoperative Evaluation ◽

Ct Scanning ◽

Bacterial Endocarditis ◽

Review Of The Literature ◽

Safe Alternative ◽

Selective Embolization ◽

Superior Gluteal Artery ◽

Mitral Valve Plasty ◽

Mycotic Aneurysms

Mycotic aneurysm of the superior gluteal artery (SGA) is extremely rare. The review of the literature revealed only five cases of mycotic SGA aneurysms reported to date and none had a concomitant superior mesenteric artery (SMA) aneurysm. We describe a 64-year-old man with mycotic aneurysms of both the SGA and the SMA. The patient was referred to our hospital because of SMA embolism caused by bacterial endocarditis following mitral valve plasty. He was treated conservatively, but monitoring using computerized tomography (CT) scanning showed the development and growth of the SGA and the SMA aneurysms. The SMA aneurysm was resected surgically, and the SGA lesion was treated by means of selective embolization. For the treatment of SGA aneurysms, prompt and precise preoperative evaluation is important. When the anatomical feature and size of the aneurysm is suitable, endovascular treatment may be the first-line treatment, providing an efficacious and safe alternative to traditional surgical repair.

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Brucella-Induced Ruptured Infrarenal Dissecting Abdominal Aortic Aneurysm

Aorta ◽

10.1055/s-0039-1688449 ◽

2019 ◽

Vol 07 (02) ◽

pp. 056-058

Author(s):

Harishankar Ramachandran Nair ◽

Prakash Goura ◽

Shivanesan Pitchai ◽

Unnikrishnan Madathipat

Keyword(s):

Mycotic Aneurysm ◽

Open Repair ◽

Brucella Melitensis ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

High Morbidity ◽

Abdominal Aortic ◽

Increased Risk ◽

Risk Of Rupture ◽

Mycotic Aneurysms

AbstractMycotic aneurysms, often saccular, accounting for approximately 2.5% of all abdominal aortic aneurysms, possess increased risk of rupture, uncontrolled sepsis, and protracted hospital stay and are associated with high morbidity and mortality. The authors report the case of a 49-year-old female with no known comorbidities who presented with free rupture of an infrarenal dissecting mycotic aneurysm and underwent emergent open repair successfully. The etiological agent, Brucella melitensis, a Gram-negative zoonotic coccobacillus, is rarely reported to cause mycotic aneurysm.

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IV Levetiracetam in the management of refractory complex-partial status epilepticus

Neuropediatrics ◽

10.1055/s-0029-1215826 ◽

2008 ◽

Vol 39 (05) ◽

Author(s):

HO Nomayo

Keyword(s):

Status Epilepticus ◽

Partial Status Epilepticus ◽

Complex Partial Status Epilepticus ◽

Partial Status

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Management of a Mycotic Aneurysm in a Patient with COVID-19: A Case Report

Medicina ◽

10.3390/medicina57060620 ◽

2021 ◽

Vol 57 (6) ◽

pp. 620

Author(s):

Muzammil H. Syed ◽

Mark Wheatcroft ◽

Danny Marcuzzi ◽

Hooman Hennessey ◽

Mohammad Qadura

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Stent Graft ◽

Mycotic Aneurysm ◽

Neurological Deficits ◽

Endovascular Stent ◽

Endovascular Stents ◽

Abdominal Aortic ◽

Short Period

The aim of this paper is to share our experience in managing a patient with Klebsiella pneumoniae mycotic abdominal aortic aneurysm who was also infected with COVID-19. A 69-year-old male was transferred to our hospital for the management of an infra-renal mycotic abdominal aortic aneurysm. During his hospital course, the patient contracted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He was intubated due to respiratory distress. Over a short period, his mycotic aneurysm increased in size from 2.5 cm to 3.9 cm. An emergency repair of his expanding aneurysm was achieved using our previously described protocol of coating endovascular stents with rifampin. The patient was managed with a rifampin-coated endovascular stent graft without any major complications. Postoperatively, the patient did not demonstrate any neurological deficits nor any vascular compromise. He remained afebrile during his postoperative course and was extubated sometime thereafter. He was then transferred to the ward for additional monitoring prior to his discharge to a rehab hospital while being on long-term antibiotics. During his hospital stay, he was monitored with serial ultrasounds to ensure the absence of abscess formation, aortic aneurysm growth or graft endoleak. At 6 weeks after stent graft placement, he underwent a CT scan, which showed a patent stent graft, with a residual sac size of 2.5 cm without any evidence of abscess or endoleak. Over a follow-up period of 180 days, the patient remained asymptomatic while remaining on long-term antibiotics. Thus, in patients whose surgical risk is prohibitive, endovascular stent grafts can be used as a bridge to definitive surgical management.

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