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[Cerebral hemorrhage due to a ruptured mycotic aneurysm. Two cases]
A le Bayon1, O Lebourg, J M Blard
1Service de neurologie A, centre Gui-de-Chauliac, 80, avenue Fliche, 34295 Montpellier, France.
Introduction:
Cerebral hemorrhages due to rupture of mycotic aneurysms are rare but severe complications of infective endocarditis. We report two cases with a good outcome.
Exegesis:
The first patient presented with a parieto-occipital hematoma which occurred in the course of a relapsing infective endocarditis due to Streptococcus mitis. She fully recovered after neurosurgical treatment. In the second case, a right frontal hematoma revealed two mycotic aneurysms and an infective endocarditis due to Streptococcus gordonii. Motor weakness partially recovered after antibiotic therapy and angiography demonstrated complete resolution of aneurysms.
Conclusion:
Ruptured mycotic aneurysms are poor prognosis factors in infective endocarditis. Adapted antibiotic therapy is the first-intent treatment. Neurosurgery is indicated when hematomas are poorly tolerated and in cases requiring anticoagulant therapy.
Insights
Ruptured mycotic aneurysms, a severe complication of infective endocarditis, can be successfully treated. Early antibiotic therapy and neurosurgery for cerebral hemorrhages offer good patient outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Cardiology
Background:
- Mycotic aneurysms are rare but serious complications of infective endocarditis.
- Cerebral hemorrhages resulting from ruptured mycotic aneurysms carry a significant risk.
Observation:
- Two cases of infective endocarditis presenting with cerebral hemorrhages due to ruptured mycotic aneurysms are detailed.
- Case 1: Parieto-occipital hematoma in relapsing infective endocarditis (Streptococcus mitis) resolved after neurosurgery.
- Case 2: Frontal hematoma revealed mycotic aneurysms (Streptococcus gordonii); antibiotic therapy led to aneurysm resolution.
Findings:
- Despite poor prognosis factors associated with ruptured mycotic aneurysms, good outcomes are achievable.
- Antibiotic therapy is the primary treatment for infective endocarditis and associated mycotic aneurysms.
- Neurosurgery is crucial for managing poorly tolerated hematomas and in cases requiring anticoagulation.
Implications:
- This study highlights the importance of prompt diagnosis and multidisciplinary management for ruptured mycotic aneurysms.
- Successful treatment strategies involve tailored antibiotic regimens and timely neurosurgical intervention when indicated.
- Early recognition and management can significantly improve patient prognosis in infective endocarditis complicated by cerebral hemorrhage.