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Published on: October 20, 2017
Mycotic Pseudoaneurysm Associated with Skull Base Osteomyelitis Treated with Endovascular Embolization
Ali S Haider1, Brandon I Esianor2, Mrigank S Shail3
1Neurosurgery, Texas A&M College of Medicine.
Abstract:
Pseudoaneurysms occur due to malformations in arterial wall uniformity, leading to blood collection between the outer arterial layers and resultant outpouching of the vessel. Unlike true aneurysms, pseudoaneurysms do not involve all layers of the blood vessel. Mycotic pseudoaneurysms can occur after associated vessel adventitia infection, leading to transmural dissection. Here we present a case of a 78-year-old man with a history of chronic otitis externa and osteomyelitis who presented with increasing right ear pain with bloody discharge and associated headache. Catheter angiography demonstrated a large pseudoaneurysm in the right middle meningeal artery (MMA) at the base of the skull. Based on the clinical findings and the patient's history, the patient was ultimately diagnosed with mycotic pseudoaneurysms of the MMA. The patient was subsequently treated with antibiotics as well as endovascular embolization and recovered without any complications.
Insights
This case report details a mycotic pseudoaneurysm of the middle meningeal artery in an elderly male. Prompt diagnosis and combined antibiotic and endovascular treatment led to a successful recovery.
Area of Science:
- Vascular Surgery
- Neurology
- Infectious Diseases
Background:
- Pseudoaneurysms are arterial defects involving incomplete vessel wall layers.
- Mycotic pseudoaneurysms arise from arterial adventitia infection, potentially causing transmural dissection.
Observation:
- A 78-year-old male with chronic otitis externa and osteomyelitis presented with right ear pain, bloody discharge, and headache.
- Catheter angiography revealed a large pseudoaneurysm in the right middle meningeal artery (MMA).
Findings:
- The patient was diagnosed with a mycotic pseudoaneurysm of the MMA, linked to his history of infection.
- Combined treatment with antibiotics and endovascular embolization was initiated.
Implications:
- This case highlights the importance of considering mycotic pseudoaneurysms in patients with cranial infections and vascular symptoms.
- Successful management underscores the efficacy of a multimodal treatment approach for complex vascular pathologies.
