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Bacterial intracranial aneurysms
Abstract:
The treatment of 13 patients with bacterial intracranial aneurysms is reported. The incidence of bacterial intracranial aneurysms was 4% of all patients admitted with intracranial aneurysms and 3% of all patients admitted with bacterial endocarditis. Each patient had neurological signs or symptoms suggestive of intracranial disease prior to the diagnosis of an aneurysm. Alpha Streptococcus was the most common infecting organism. All patients were treated with specific, high-dose antibiotics, and five patients underwent surgery as well. There were no surgical deaths. Six of eight nonsurgically treated patients died. A review of the literature confirms a high mortality for patients treated with only antibiotics, and a low mortality for elective surgery. The authors conclude that 1) patients with bacterial endocarditis, who develop sudden severe headache, focal neurological signs or symptoms, or seizures, should undergo serial cerebral angiography every 7 to 10 days throughout their hospitalization; 2) if an aneurysm is identified it should be excised whenever possible; and 3) patients with proximal or multiple aneurysms should be considered for surgery.
Insights
Bacterial intracranial aneurysms are rare but serious. Early diagnosis via serial cerebral angiography and surgical excision significantly improve survival rates compared to antibiotic treatment alone.
Area of Science:
- Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Bacterial intracranial aneurysms (BIAs) are a rare but life-threatening complication of bacterial endocarditis.
- This study reports on the treatment and outcomes of 13 patients diagnosed with BIAs.
Observation:
- BIAs constituted 4% of intracranial aneurysms and 3% of bacterial endocarditis cases.
- Neurological symptoms preceded aneurysm diagnosis in all patients.
- Alpha Streptococcus was the predominant causative organism.
Findings:
- High-dose antibiotics and surgery led to better outcomes.
- No deaths occurred among the five surgically treated patients.
- Six of eight patients treated with antibiotics alone died, highlighting a high mortality rate.
Implications:
- Serial cerebral angiography is recommended for bacterial endocarditis patients with neurological changes.
- Surgical excision of identified BIAs is crucial for improving patient survival.
- Consideration for surgery in cases of proximal or multiple aneurysms is advised.