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[Valve replacement in infective endocarditis with mycotic cerebral aneurysm. Report of a case with successful
1Second Department of Surgery, Kurume University, School of Medicine, Japan.
Abstract:
A 49 year-old woman was hospitalized with headache and left-sided weakness. Computed tomographic scan and carotid angiogram revealed mycotic aneurysms of the bilateral middle cerebral artery with intracranial bleeding. Although all blood cultures were sterile, her physical examination suspected mitral regurgitation due to infective endocarditis and mycotic cerebral aneurysms. Severe congestive heart failure developed immediately after successful clipping for ruptured mycotic aneurysm of the right middle cerebral artery and then mitral valve replacement with prosthetic valve was performed 3 months after craniotomy. At operation, infective endocarditis on the mitral valve was confirmed. Her postoperative course was uneventful and the second craniotomy for aneurysm of the left middle cerebral artery has been planning.
Insights
A woman experienced headache and weakness due to mycotic aneurysms and infective endocarditis. Treatment involved surgery for the brain aneurysm and later mitral valve replacement for heart failure.
Area of Science:
- Neurology
- Cardiology
- Infectious Diseases
Background:
- Mycotic cerebral aneurysms are rare but serious complications of infective endocarditis.
- This case highlights the diagnostic challenges and complex management of coexisting neurological and cardiac conditions.
Observation:
- A 49-year-old woman presented with neurological deficits suggestive of stroke.
- Imaging revealed bilateral middle cerebral artery mycotic aneurysms with intracranial hemorrhage.
- Clinical suspicion of infective endocarditis was raised due to mitral regurgitation, despite negative blood cultures.
Findings:
- Successful surgical clipping of a ruptured right middle cerebral artery mycotic aneurysm was performed.
- The patient developed severe congestive heart failure post-operatively, necessitating mitral valve replacement.
- Infective endocarditis of the mitral valve was confirmed during valve replacement surgery.
Implications:
- This case underscores the critical link between infective endocarditis and cerebrovascular complications like mycotic aneurysms.
- Multidisciplinary management is essential for patients with complex presentations involving the brain and heart.
- Prompt surgical intervention for ruptured aneurysms and subsequent cardiac valve management can lead to favorable outcomes.