Related Experiment Videos
[A case of septic aneurysm complicated with simultaneous subdural and intracerebral hematoma]
Insights
This case report describes a rare instance of septic aneurysms causing simultaneous subdural and intracerebral hematomas in a young patient. The study highlights the diagnostic challenges and transient nature of these aneurysms.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Medicine
Background:
- Septic aneurysms are rare but serious complications, often associated with infectious endocarditis.
- Simultaneous subdural and intracerebral hematomas present a complex diagnostic and management challenge.
Observation:
- A 13-year-old girl with a history of cardiac surgery presented with sudden neurological decline, including altered consciousness and focal deficits.
- Initial CT scans revealed subdural and intracerebral hematomas; however, the source of bleeding was not immediately apparent.
- Cerebral angiography identified a transient aneurysm on a peripheral branch of the calcarine artery, presumed to be the source of the intracerebral hematoma.
Findings:
- The identified aneurysm on the calcarine artery branch was likely septic in origin, leading to the intracerebral hemorrhage.
- The subdural hematoma was surgically evacuated, and the patient initially improved.
- The aneurysm was not visualized on follow-up angiography, suggesting potential resolution or thrombosis.
Implications:
- This case underscores the importance of considering septic aneurysms in patients with unexplained intracranial hemorrhages, especially those with a history of cardiac conditions or infections.
- The transient nature of the aneurysm highlights the challenges in diagnosis and the potential for spontaneous resolution.
- Early recognition and appropriate management are crucial for improving outcomes in such complex neurological emergencies.
Abstract:
A case of septic aneurysms complicated with simultaneous subdural and intracerebral hematoma is presented. A 13-year-old girl had been operated on for endocardial cushion defect when she was 5 years old, and residual mitral regurgitation was followed up. She suddenly complained of headache, vomited and lost consciousness. She was brought to the Tokyo Women's Medical College Hospital by an ambulance. On arrival, she was semicomatose. Her left pupil was mydriatic and did not react to light. Right hemiparesis was noted. Systolic murmur was audible in the apical region of the heart. Laboratory data showed a mild anemia and a white cell count of 23,000. CT scan showed a subdural hematoma in the left frontotemporoparietal region and a small subcortical hematoma in the left occipital lobe. An emergency operation was carried out for the subdural hematoma. When the dura was opened, about 10 ml bloody CSF flowed out. A hematoma weighing about 50 g was removed. A bleeding point or an aneurysm could not be discovered on the dura, arachnoid membrane or surface of the brain at the operation. On the 15th day after the operation, when the fever was decreased, cerebral angiography was done. The left vertebral angiogram showed an aneurysm on a peripheral branch of the calcarine artery, which was considered the origin of the subcortical hematoma in the left occipital lobe. The left carotid angiogram showed no aneurysm. On the seventh day after that study, the aneurysm did not appear by left vertebral angiography. She was discharged with no neurological deficit. One month later, she was admitted again with a high fever.(ABSTRACT TRUNCATED AT 250 WORDS)