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Infectious intracranial aneurysms
1Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.
Abstract:
Infectious cerebral aneurysms are uncommon, accounting for only 2.6% to 6% of all intracranial aneurysms according to autopsy studies. These aneurysms may arise from an intravascular or extravascular source of infection. The vast majority occur in the setting of bacterial endocarditis with an intravascular source of infection due to embolization of fragments of infected cardiac valve emboli. Infectious aneurysms are usually discovered after a devastating intracranial hemorrhage that carries a 60% to 90% mortality. More recently, fungal infectious aneurysms, which carry an even graver prognosis, have become more common. A high index of suspicion and early diagnosis of infectious aneurysms prior to hemorrhage is an important factor in reducing morbidity and mortality. Some lesions are effectively treated with antibiotics alone, but other require surgical intervention.
Insights
Infectious cerebral aneurysms, though rare, pose a high mortality risk, often diagnosed after hemorrhage. Early detection and treatment, including antibiotics or surgery, are crucial for better outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Vascular Surgery
Background:
- Infectious cerebral aneurysms are rare, comprising 2.6%–6% of all intracranial aneurysms.
- They originate from intravascular (e.g., bacterial endocarditis) or extravascular infection sources.
- Fungal infectious aneurysms are increasing and carry a worse prognosis.
Purpose of the Study:
- To highlight the importance of early diagnosis and management of infectious cerebral aneurysms.
- To review the etiology, presentation, and treatment strategies for these uncommon vascular lesions.
Main Methods:
- Review of autopsy studies and clinical case series on infectious cerebral aneurysms.
- Analysis of etiological factors, particularly bacterial endocarditis and fungal infections.
- Evaluation of diagnostic challenges and treatment outcomes.
Main Results:
- High mortality rates (60%–90%) associated with infectious cerebral aneurysms, typically discovered post-hemorrhage.
- Bacterial endocarditis is the most common cause, leading to embolization.
- Fungal aneurysms present a graver prognosis.
Conclusions:
- A high index of suspicion is vital for early diagnosis before rupture.
- Treatment may involve antibiotics alone or necessitate surgical intervention.
- Prompt diagnosis and management significantly impact patient morbidity and mortality.