[A case of multiple septic intracranial aneurysms--successful treatment with surgical and conservative therapy in the...

Here reported is a case of multiple septic intracranial aneurysms which were successfully treated with surgical and conservative therapy. A 44-year-old man was admitted to our hospital because of headache, vomiting and visual disturbance. He had had a fever and had been under treatment for a respiratory tract infection during the preceding 3 months. Physical examination on admission revealed pansystolic heart murmur over the cardiac apex. Neurological examination revealed neck stiffness, papilledema and right homonymous hemianopsia. Laboratory data showed the presence of inflammatory process. A CT scan showed a high density area in the left occipital region, and vertebral angiography showed a saccular aneurysm on a distal branch of the left occipitotemporal artery. Fourteen days after admission, the operation of clipping the neck of the aneurysmal artery was performed and the hematoma evacuated to lower the increased intracranial pressure. He had been well after the operation until 3 weeks later when a follow-up angiography showed a new unruptured aneurysm on a distal branch of the right middle cerebral artery with a relapse of the infection. Then, he was treated with appropriate antibiotics and antifibrinolytic agents. A repeated angiography 1 month later showed resolution of the aneurysm. The mechanism of resolution of septic aneurysm and its treatment are discussed.