Ruptured Intracranial Mycotic Aneurysm in Infective Endocarditis With Left Ventricular Assist Device and Implantable...

Area of Science:

• Cardiology
• Infectious Diseases
• Neurosurgery

Background:

• Mycotic aneurysms (MAs) are arterial wall degenerations caused by infection.
• Management guidelines for intracranial MAs are limited, based on small retrospective studies.
• Intracranial MAs in left ventricular assist device (LVAD) patients are rare, with few reported cases linked to specific pathogens.

Observation:

• A patient with a continuous flow left ventricular assist device (LVAD) developed Staphylococcus epidermidis bacteremia.
• This infection led to a ruptured intracranial aneurysm, a complication not previously documented with this specific organism in LVAD patients.
• Previous reports of intracranial MAs in LVAD patients primarily involved more virulent bacteria.

Findings:

• This case represents the first documented instance of a ruptured intracranial aneurysm associated with Staphylococcus epidermidis bacteremia in an LVAD recipient.
• The findings suggest that even less virulent organisms like Staphylococcus epidermidis can cause severe complications such as mycotic aneurysms in immunocompromised patients with cardiac devices.
• The study identifies a critical gap in current diagnostic and management protocols for LVAD-associated infections.

Implications:

• Routine screening for asymptomatic intracranial mycotic aneurysms should be strongly considered in patients with persistent LVAD- and implantable cardiac defibrillator pacemaker-associated infections.
• This case underscores the importance of vigilant monitoring and early detection of potential complications in patients with long-term cardiac support devices.
• Further research is warranted to establish comprehensive guidelines for the diagnosis and management of mycotic aneurysms in the context of cardiac device infections.