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Treatment of intracranial mycotic aneurysm: surgery or not. A case report
Abstract:
Mycotic intracranial aneurysms are of infectious origin and, even nowadays, their treatment remains controversial with advocates for either surgical or medical treatment. We present the case of a 58-year-old patient who was admitted to the hospital with a left hemiparesis due to a large right parietal haematoma. An angiogram demonstrated a small vascular malformation localized on a distal parietal branch of the right Sylvian artery. The patient was operated on and recovered well. Nevertheless, a control angiogram demonstrated the disappearance of the previous malformation but showed a new saccular aneurysm localized on the right rolandic artery. At the same time the patient became septic and the diagnosis of endocarditis complicated by mycotic aneurysm was confirmed. The patient was then medically treated with antibiotics for two months and several angiograms showed the progressive disappearance of this aneurysm. Different treatments of intracranial mycotic aneurysms are finally reviewed and a therapeutic approach is discussed.
Insights
Treatment for mycotic intracranial aneurysms is debated. This case study shows successful medical management of a ruptured mycotic aneurysm with antibiotics, leading to its disappearance.
Area of Science:
- Neurology
- Infectious Diseases
- Vascular Surgery
Background:
- Mycotic intracranial aneurysms (MIAs) pose treatment challenges due to infectious origins.
- Surgical versus medical management remains a controversial topic in clinical practice.
Observation:
- A 58-year-old patient presented with hemiparesis from a right parietal hematoma, revealing a vascular malformation.
- Post-surgery, a new saccular aneurysm appeared on the right rolandic artery, coinciding with sepsis and confirmed endocarditis.
- The patient developed a mycotic aneurysm secondary to infective endocarditis.
Findings:
- Medical treatment with antibiotics for two months resulted in the progressive disappearance of the mycotic aneurysm.
- Initial surgical intervention addressed a presumed vascular malformation, but a secondary mycotic aneurysm developed.
Implications:
- This case highlights the potential efficacy of conservative medical management for mycotic intracranial aneurysms.
- Reviewing treatment options for MIAs is crucial for optimizing patient outcomes.
- Antibiotic therapy can be a viable primary treatment for certain mycotic aneurysms.