[Intracranial bacterial aneurysms--report of two cases with special reference to operative indications]

Two cases of intracranial bacterial aneurysms caused by bacterial endocarditis are reported. Case 1 was a 20-year-old male who underwent mitral valve annuloplasty because of mitral regurgitation due to mitral valve prolapse syndrome 3 year prior to this admission. He was referred when a large intracerebral hemorrhage of the right frontal lobe ruptured into the lateral ventricle was seen in computed tomography (CT) scan on admission. An aneurysm at the distal portion of precentral artery of the middle cerebral artery (MCA) was found by right carotid angiography. Emergency evacuation of the hematoma and trapping of the aneurysm were performed. Another three aneurysms, located at the distal portion of contralateral left precentral artery of MCA, the left posterior cerebral artery (PCA) and the right anterior falx artery were found in the subsequent angiogram. The latter two aneurysms developed while receiving antibiotics. The aneurysms of PCA and MCA were trapped surgically. However, the aneurysm of anterior falx artery disappeared spontaneously under antibiotic therapy without surgery. Case 2 was a 21-year-old female who underwent cardiac surgery one month prior to presentation for aortic insufficiency and coarctation of the aorta. She was referred to our clinic because of sudden loss of consciousness, aphasia and right hemiparesis. CT scan and left carotid angiography showed a large hematoma in the left frontal lobe and an aneurysm at the distal portion of the opercular-frontal artery. Emergency ventricular drainage was performed. The operation for evacuation of the hematoma and clipping of aneurysm was performed 10 days later. However, at the operation the aneurysm neck was only partially clipped in order to prevent the obstruction of efferent vessels.(ABSTRACT TRUNCATED AT 250 WORDS)