RESUMEN
INTRODUCTION: The etiology of brain aneurysms remains poorly understood. Finnish research suggests that oral bacteria might contribute to the development and rupture of brain aneurysms. Previous studies by our team have not confirmed these findings, likely due to methodological differences. We aimed to replicate the Finnish study with a French population, using the same primers and comparing the results to internal controls. METHODS: We used RT-qPCR to retrospectively analyze the expression of oral bacterial genes in eight patients. During surgical procedures, four tissue types were consistently sampled from each patient: the aneurysmal wall, the superficial temporal artery (STA), the middle meningeal artery (MMA), and the dura mater (DM). Results were expressed as fold differences employing the 2-∆∆Ct method, and statistical analyses were performed accordingly. RESULTS: Our cohort included eight patients, evenly split into ruptured and unruptured groups. The sex distribution was balanced (4 females, 4 males). We observed DNA expression from oral bacteria in all sampled tissues; however, there were no significant differences between the ruptured and unruptured groups. CONCLUSION: We detected oral bacterial gene expression in the aneurysmal wall, STA, MMA, and DM in a sample of French patients. Although limited by the small sample size, our results suggest a potential role for bacterial involvement in vascular invasiveness related to bacteremia. These findings do not definitively link oral bacteria to the pathogenesis of aneurysm development and rupture.
Asunto(s)
Aneurisma Intracraneal , Humanos , Femenino , Masculino , Aneurisma Intracraneal/microbiología , Persona de Mediana Edad , Francia , Anciano , Estudios Retrospectivos , Boca/microbiología , Adulto , Aneurisma Roto/microbiología , Arterias Temporales , Duramadre , Bacterias/genética , Bacterias/aislamiento & purificación , Arterias MeníngeasRESUMEN
BACKGROUND AND PURPOSE: Environmental factors are important with respect to the rupture of cerebral aneurysms. However, the relationship between the gut microbiome, an environmental factor, and aneurysm rupture is unclear. Therefore, we compared the gut microbiome in patients with unruptured intracranial aneurysms (UIAs) and ruptured aneurysms (RAs) to identify the specific bacteria causing the rupture of cerebral aneurysms. METHODS: A multicenter, prospective case-control study was conducted over one year from 2019 to 2020. The fecal samples of patients with stable UIAs and RAs immediately after onset were collected. Their gut microbiomes were analyzed using 16S rRNA sequencing. Subsequently, a phylogenetic tree was constructed, and polymerase chain reaction was performed to identify the specific species. RESULTS: A total of 28 RAs and 33 UIAs were included in this study. There was no difference in patient characteristics between RAs and UIAs: age, sex, hypertension, dyslipidemia, diabetes status, body mass index, and smoking. No difference was observed in alpha diversity; however, beta diversity was significantly different in the unweighted UniFrac distances. At the phylum level, the relative abundance of Campylobacter in the RA group was larger than that in the UIA group. Furthermore, the gut microbiome in the RA and UIA groups exhibited significantly different taxonomies. However, Campylobacter was focused on because it is widely known as pathogenic among these bacteria. Then, a phylogenetic tree of operational taxonomic units related to Campylobacter was constructed and 4 species were identified. Polymerase chain reaction for these species identified that the abundance of the genus Campylobacter and Campylobacter ureolyticus was significantly higher in the RA group. CONCLUSIONS: The gut microbiome profile of patients with stable UIAs and RAs were significantly different. The genus Campylobacter and Campylobacter ureolyticus may be associated with the rupture of cerebral aneurysms.
Asunto(s)
Aneurisma Roto/microbiología , Campylobacter , Disbiosis/microbiología , Microbioma Gastrointestinal , Aneurisma Intracraneal/microbiología , Anciano , Campylobacter/clasificación , Campylobacter/crecimiento & desarrollo , Campylobacter/aislamiento & purificación , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
In a patient with infective endocarditis (IE), susceptibility-weighted angiography (SWAN) sequence revealed 2 intracranial infectious aneurysms (IIAs) as bright signal lesion, related to the high-velocity arterial flow within the IIAs. In addition, SWAN revealed a convexal subarachnoid hemorrhage-related to distal IIA rupture-as a dark signal. The risk of IIA rupture emphasizes the need for serial imaging follow-up in patients with IE receiving antibiotic therapy after endovascular treatment and after valve surgery. Considering its specific risks, particularly in patients with IE who may be on anticoagulation, digital subtraction angiography is not used routinely in this context. Therefore, SWAN might be an alternative method for selecting patients with IE who need conventional angiography and might be useful for serial follow-up and monitoring after treatment. Future studies should investigate the role of SWAN for the detection of IIAs.
Asunto(s)
Aneurisma Infectado/diagnóstico por imagen , Aneurisma Roto/diagnóstico por imagen , Angiografía de Substracción Digital/métodos , Endocarditis Bacteriana/diagnóstico por imagen , Aneurisma Intracraneal/diagnóstico por imagen , Angiografía por Resonancia Magnética/métodos , Aneurisma Roto/microbiología , Humanos , Aneurisma Intracraneal/microbiología , Masculino , Persona de Mediana EdadRESUMEN
Degeneration of intracranial aneurysm wall is under active research and recent studies indicate an increased risk of rupture of intracranial aneurysm among patients with periodontal diseases. In addition, oral bacterial DNA has been identified from wall samples of ruptured and unruptured aneurysms. These novel findings led us to evaluate if oral diseases could predispose to pathological changes seen on intracranial aneurysm walls eventually leading to subarachnoid hemorrhage. The aim of this review is to consider mechanisms on the relationship between periodontitis and aneurysm rupture, focusing on recent evidence.
Asunto(s)
Aneurisma Intracraneal/etiología , Aneurisma Intracraneal/microbiología , Boca/microbiología , Enfermedades Periodontales/complicaciones , Enfermedades Periodontales/microbiología , Aneurisma Roto/etiología , Aneurisma Roto/microbiología , Humanos , Hemorragia Subaracnoidea/etiología , Hemorragia Subaracnoidea/microbiologíaRESUMEN
Infective endocardites are associated with both ischemic and hemorrhagic neurological complications and also with cerebral abscesses and the development of "mycotic" aneurysms, which are detected in about 5 % of patients in the acute and sub-acute phase of the infection. Data about their natural history and their hemorrhagic risk are scarce and fragmented. The therapeutic management is represented by the medical treatment of the infection with interventional abstention, the surgical treatment and the endovascular approach by selective embolization of the aneurysm. No evidence is provided concerning the superiority of a specific approach. Mycotic aneurysms remain a diagnostic and therapeutic challenge and their management is necessarily based on a multidiscplinary approach.
Asunto(s)
Aneurisma Infectado/terapia , Aneurisma Intracraneal/terapia , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiología , Hemorragia Cerebral/cirugía , Procedimientos Endovasculares/métodos , Humanos , Hallazgos Incidentales , Aneurisma Intracraneal/diagnóstico , Aneurisma Intracraneal/microbiologíaRESUMEN
We present an unusual case of acute ischaemic stroke secondary to thrombosed mycotic aneurysm with subsequent early aneurysmal rupture and subarachnoid haemorrhage, successfully treated with endovascular coil embolisation of the thrombosed segment. Imaging correlates are presented demonstrating successful endovascular management despite vessel occlusion precluding angiographic visualisation of the aneurysmal segment. Imaging and clinical follow-up is provided demonstrating durable occlusion and excellent clinical outcome with full functional recovery.
Asunto(s)
Aneurisma Infectado/diagnóstico , Aneurisma Roto/diagnóstico , Infarto de la Arteria Cerebral Media/diagnóstico , Aneurisma Intracraneal/diagnóstico , Accidente Cerebrovascular Isquémico/etiología , Hemorragia Subaracnoidea/etiología , Aneurisma Infectado/complicaciones , Aneurisma Infectado/microbiología , Aneurisma Roto/etiología , Angiografía por Tomografía Computarizada , Embolización Terapéutica , Humanos , Infarto de la Arteria Cerebral Media/complicaciones , Infarto de la Arteria Cerebral Media/microbiología , Aneurisma Intracraneal/complicaciones , Aneurisma Intracraneal/microbiología , Accidente Cerebrovascular Isquémico/diagnóstico , Accidente Cerebrovascular Isquémico/terapia , Masculino , Persona de Mediana Edad , Arteria Cerebral Media/diagnóstico por imagen , Arteria Cerebral Media/microbiología , Hemorragia Subaracnoidea/diagnóstico , Hemorragia Subaracnoidea/terapia , Resultado del TratamientoRESUMEN
Unruptured intracranial aneurysm (UIA) is a life-threatening cerebrovascular condition. Whether changes in gut microbial composition participate in the development of UIAs remains largely unknown. We perform a case-control metagenome-wide association study in two cohorts of Chinese UIA patients and control individuals and mice that receive fecal transplants from human donors. After fecal transplantation, the UIA microbiota is sufficient to induce UIAs in mice. We identify UIA-associated gut microbial species link to changes in circulating taurine. Specifically, the abundance of Hungatella hathewayi is markedly decreased and positively correlated with the circulating taurine concentration in both humans and mice. Consistently, gavage with H. hathewayi normalizes the taurine levels in serum and protects mice against the formation and rupture of intracranial aneurysms. Taurine supplementation also reverses the progression of intracranial aneurysms. Our findings provide insights into a potential role of H. hathewayi-associated taurine depletion as a key factor in the pathogenesis of UIAs.
Asunto(s)
Clostridiaceae/metabolismo , Microbioma Gastrointestinal , Aneurisma Intracraneal , Taurina/metabolismo , Animales , Estudios de Casos y Controles , Estudios de Cohortes , Progresión de la Enfermedad , Trasplante de Microbiota Fecal , Femenino , Humanos , Aneurisma Intracraneal/microbiología , Aneurisma Intracraneal/patología , Masculino , Ratones , Pronóstico , Factores de RiesgoRESUMEN
PURPOSE: Infected (mycotic) intracranial aneurysms (IIA) are a prevalent source of morbidity in patients with systemic infection. Unlike saccular aneurysms, ruptured IIA frequently presents with intracerebral hemorrhage (ICH), and the appearance of ruptured IIA on CTA overlaps with the CTA "Spot Sign" (SS), an imaging finding in non-infectious, spontaneous ICH. The purpose of this study was to investigate the imaging and clinical features which may differentiate these two entities on CTA for which treatment strategies differ substantially. METHODS: In an IRB-approved, retrospective case series, we compared 14 patients with confirmed IIA and 14 patients with positive SS due to other non-infectious etiology (SS(+) ICH). Clinical history, laboratory studies, and CTA reports and images were reviewed to define imaging characteristics of IIA and SS(+) ICH, including the diagnostic criteria for SS used in clinical trials. RESULTS: A total of 7/14 patients (50.0%) diagnosed with IIA had ICH at presentation. Of these, 3/7 patients (42.9%) with ruptured IIA and ICH met diagnostic imaging criteria of SS. The remaining 4/7 patients did not meet criteria due to presence of a connecting vessel. Compared with SS(+) ICH of non-infectious etiology, patients with ruptured IIA were younger (40.7 vs. 66.4 years) and had higher rates of IVDU and bacteremia (p < 0.01) and lower rates of hypertension (p < 0.01). Hematoma volume was similar in both groups, but lobar location was more frequent in ruptured IIA (p = 0.06). Mortality at 1 year from diagnosis was equally high in both groups (42.9%). CONCLUSION: This study characterizes ruptured IIA as an imaging mimic of SS and provides a framework for differentiating these lesions, allowing prompt diagnosis and appropriate treatment.
Asunto(s)
Aneurisma Infectado/diagnóstico por imagen , Aneurisma Roto/diagnóstico por imagen , Angiografía Cerebral , Angiografía por Tomografía Computarizada , Aneurisma Intracraneal/diagnóstico por imagen , Adulto , Anciano , Aneurisma Infectado/microbiología , Aneurisma Roto/microbiología , Biomarcadores , Diagnóstico Diferencial , Femenino , Humanos , Aneurisma Intracraneal/microbiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoAsunto(s)
Isquemia Encefálica/diagnóstico por imagen , Neoplasias del Colon/diagnóstico por imagen , Endocarditis Bacteriana/diagnóstico por imagen , Aneurisma Intracraneal/diagnóstico por imagen , Infecciones Estreptocócicas/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Adenocarcinoma/complicaciones , Adenocarcinoma/diagnóstico por imagen , Adulto , Isquemia Encefálica/etiología , Neoplasias del Colon/complicaciones , Diagnóstico Diferencial , Endocarditis Bacteriana/etiología , Humanos , Aneurisma Intracraneal/etiología , Aneurisma Intracraneal/microbiología , Masculino , Infecciones Estreptocócicas/complicaciones , Streptococcus gallolyticus/aislamiento & purificación , Accidente Cerebrovascular/etiologíaRESUMEN
This is the first reported case in which a mycotic aneurysm refractory to the first medical treatment was treated with a Pipeline embolization device (PED), and the first case of a mycotic aneurysm from Brucella treated by endovascular therapy. A 35-year-old man presented with left eye pain and ptosis, and fever for 2 weeks. Before symptom onset, he visited Vietnam where he developed a flu-like illness; however, antibiotics were ineffective. We suspected Brucella as the most likely infectious etiology for the patient's intracavernous aneurysm. Since the aneurysm did not reduce in size following 2 weeks of antibiotic therapy, we placed a PED in the left internal carotid artery. Follow-up angiogram 4 months later showed no residual aneurysm, and cranial nerve palsies had completely resolved. From the results of this case, it appears that flow diverter stenting may be a safe and effective treatment of mycotic aneurysms of the cavernous segment of ICA.
Asunto(s)
Aneurisma Infectado/cirugía , Brucelosis/cirugía , Enfermedades de las Arterias Carótidas/cirugía , Procedimientos Endovasculares/instrumentación , Aneurisma Intracraneal/cirugía , Stents , Adulto , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/microbiología , Aneurisma Infectado/fisiopatología , Angiografía de Substracción Digital , Antibacterianos/uso terapéutico , Brucelosis/diagnóstico por imagen , Brucelosis/microbiología , Brucelosis/fisiopatología , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/microbiología , Enfermedades de las Arterias Carótidas/fisiopatología , Angiografía Cerebral/métodos , Circulación Cerebrovascular , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/microbiología , Aneurisma Intracraneal/fisiopatología , Imagen por Resonancia Magnética , Masculino , Diseño de Prótesis , Resultado del TratamientoRESUMEN
Acute subdural hematoma (ASDH) revealing mycotic aneurysm (MA) is an exceptional occurrence. We report 2 cases of MA-related pure ASDH in the course of infective endocarditis (IE) without history of head trauma, hypertension or coagulopathy. Case 1: A 54-year-old man presented with a 10-day history of headache, fever. At admission neurologic examination and Brain-CT were normal. Blood cultures showed Streptococcus bovis. MRI 5â¯days later revealed ischemic spots and minime ASDH over the right convexity. Cerebral angiography, revealed a 3â¯mm saccular aneurysm at the bifurcation of a distal branch of the right posterior cerebral artery (PCA). Case 2: A 42-year-old man presented with a 8-day history of fever, and worsening headache. Mitral regurgitation was evidenced. A methicillin-sensitive staphylococcus aureus left-sided IE was diagnosed. Pre- and post-contrast Brain-CT were normal. He presented 15â¯days later a secondarily generalized status epilepticus. Brain CT showed an ASDH over the convexity with falco-tentorial extension, midline shift and temporal herniation. It was removed in emergency. Cerebral angiography revealed a MA of a peripheral branch of the left PCA. The 2 patients were successfully treated by endovascular glue embolization and recovered without complications. Even rare, ruptured MA should be considered as a cause of pure ASDH of unknown origin. As MA can be missed on CT- and MR-Angiography because of mass effect, cerebral angiography may be mandatory.
Asunto(s)
Aneurisma Infectado/etiología , Endocarditis Bacteriana/complicaciones , Hematoma Subdural Agudo/microbiología , Aneurisma Intracraneal/microbiología , Adulto , Aneurisma Infectado/terapia , Aneurisma Roto/microbiología , Aneurisma Roto/terapia , Angiografía Cerebral , Embolización Terapéutica , Hematoma Subdural Agudo/terapia , Humanos , Aneurisma Intracraneal/terapia , Imagen por Resonancia Magnética , Masculino , Persona de Mediana EdadRESUMEN
Gut microbiota modulates metabolic and immunoregulatory axes and contributes to the pathophysiology of diseases with inflammatory components, such as atherosclerosis, diabetes mellitus, and ischemic stroke. Inflammation is emerging as a critical player in the pathophysiology of an intracranial aneurysm. Therefore, we hypothesized that the gut microbiota affects aneurysm formation by modulating inflammation. We induced intracranial aneurysms in mice by combining systemic hypertension and a single injection of elastase into the cerebrospinal fluid. Depletion of the gut microbiota was achieved via an oral antibiotic cocktail of vancomycin, metronidazole, ampicillin, and neomycin. Antibiotics were given 3 weeks before aneurysm induction and either continued until the end of the experiment or stopped 1 day before aneurysm induction. We also assessed the effects of the gut microbiota depletion on macrophage infiltration and mRNA levels of inflammatory cytokines. Gut microbiota depletion by antibiotics reduced the incidence when antibiotics were started 3 weeks before aneurysm induction and continued until the end of the experiment (83% versus 6%, P<0.001). Even when antibiotics were stopped 1 day before aneurysm induction, the gut microbiota depletion significantly reduced the incidence of aneurysms (86% versus 28%, P<0.05). Both macrophage infiltration and mRNA levels of inflammatory cytokines were reduced with gut microbiota depletion. These findings suggest that the gut microbiota contributes to the pathophysiology of aneurysms by modulating inflammation. Human studies are needed to determine the exact contribution of the gut microbiota to the pathophysiology of aneurysm formation and disease course in humans.
Asunto(s)
Microbioma Gastrointestinal/fisiología , Aneurisma Intracraneal/etiología , Animales , Anticuerpos/farmacología , Microbioma Gastrointestinal/efectos de los fármacos , Humanos , Aneurisma Intracraneal/microbiología , Ratones , Ratones Endogámicos C57BLAsunto(s)
Aneurisma Infectado/cirugía , Aneurisma de la Aorta/cirugía , Implantación de Prótesis Vascular , Endocarditis Bacteriana/cirugía , Procedimientos Endovasculares , Enterococcus faecalis/aislamiento & purificación , Infecciones por Bacterias Grampositivas/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Aneurisma Ilíaco/cirugía , Aneurisma Intracraneal/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiología , Antibacterianos/administración & dosificación , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/microbiología , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Aneurisma Ilíaco/diagnóstico , Aneurisma Ilíaco/microbiología , Aneurisma Intracraneal/diagnóstico , Aneurisma Intracraneal/microbiología , Masculino , Persona de Mediana Edad , Válvula Mitral/microbiología , Insuficiencia de la Válvula Mitral/diagnóstico , Insuficiencia de la Válvula Mitral/microbiología , Resultado del TratamientoRESUMEN
INTRODUCTION: With rising rates of intravenous drug use, Infectious Intracranial aneurysms (IIAs) are a relevant topic for investigation. We performed a systematic review to better understand current practice patterns and limits of current published literature. METHOD: 131 publications with a total of 499 patients (665 aneurysms) were included. Of the 499 patients, 83 were single case reports, and 20.5% of the total had multiple aneurysms. 35.8% of all aneurysms were ruptured. Of those reporting treatment, options included conservative antibiotic therapy (30.0%), open surgical intervention (31.1%), and endovascular occlusion (31.8%). Chronologically, publication of IIAs has increased. Usage of endovascular therapies has grown, while conservative and surgical management have declined in the literature. Overall, 56.2% of aneurysms for which conservative therapy was initiated eventually either underwent intervention or death of patient occurred. RESULTS: The issue of cardiac valve surgery in relationship to aneurysm therapy was discussed in 20.8% (80 patients) of all 384 infectious endocarditis patients; of which 15.0% (12) underwent valve surgery before aneurysm treatment and 85.0 patients (68)% underwent valve surgery after aneurysm treatment. For 51 of the patients where valve surgery followed aneurysm management, the corresponding aneurysm treatment modality could be determined; 58.8% (30) of whom were managed endovascularly. 32.7% (26) of all cases reporting cardiac surgery details underwent cardiac surgery during their admission with the IIA. CONCLUSIONS: Overall, increasing trend of endovascular management of IIAs is evident, and a strong temporal preference exhibited by providers to perform cardiac surgery subsequently to IIA management.
Asunto(s)
Aneurisma Infectado/terapia , Aneurisma Roto/terapia , Antibacterianos/uso terapéutico , Procedimientos Quirúrgicos Cardíacos , Tratamiento Conservador/métodos , Endocarditis Bacteriana/cirugía , Procedimientos Endovasculares , Aneurisma Intracraneal/terapia , Procedimientos Neuroquirúrgicos , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/epidemiología , Aneurisma Infectado/microbiología , Aneurisma Roto/diagnóstico , Aneurisma Roto/epidemiología , Aneurisma Roto/microbiología , Antibacterianos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Tratamiento Conservador/efectos adversos , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/microbiología , Procedimientos Endovasculares/efectos adversos , Humanos , Aneurisma Intracraneal/diagnóstico , Aneurisma Intracraneal/epidemiología , Aneurisma Intracraneal/microbiología , Procedimientos Neuroquirúrgicos/efectos adversos , Factores de Riesgo , Abuso de Sustancias por Vía Intravenosa/epidemiología , Resultado del TratamientoRESUMEN
Some authors have reported the association between CMC and brain aneurysms. In this paper it is reported a fusiform brain aneurysm associated to CMC and the vessel wall MRI findings.
Asunto(s)
Candidiasis Mucocutánea Crónica/diagnóstico , Encefalitis/microbiología , Aneurisma Intracraneal/microbiología , Adolescente , Enfermedades de las Arterias Carótidas/diagnóstico , Enfermedades de las Arterias Carótidas/microbiología , Arteria Carótida Interna , Angiografía Cerebral/métodos , Angiografía por Tomografía Computarizada/métodos , Encefalitis/diagnóstico , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico , Angiografía por Resonancia Magnética/métodos , Imagen Multimodal/métodosRESUMEN
Subarachnoid and intraparenchymal haemorrhages due to cerebral mycotic aneurysms are rare and associated with high mortality. Streptococcus agalactiae, is a rare cause of endocarditis and there are no reported cases of cerebral mycotic aneurysms secondary to this organism. We report a rare case of streptococcus agalctiae induced intracranial mycotic aneurysm.
Asunto(s)
Aneurisma Infectado/microbiología , Endocarditis Bacteriana/complicaciones , Aneurisma Intracraneal/microbiología , Infecciones Estreptocócicas , Streptococcus agalactiae , Adulto , Humanos , Masculino , Tomografía Computarizada por Rayos XAsunto(s)
Aneurisma Infectado/etiología , Cardiobacterium/patogenicidad , Endocarditis Bacteriana/complicaciones , Enfermedades de las Válvulas Cardíacas/etiología , Aneurisma Intracraneal/etiología , Adulto , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/microbiología , Endocarditis Bacteriana/microbiología , Enfermedades de las Válvulas Cardíacas/microbiología , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/microbiología , MasculinoRESUMEN
Mycotic aneurysms (MA) are an uncommon complication of infectious endocarditis. Septic emboli are thought to be the precipitating event in their development, but the evidence for this is sparse. We present three cases in which septic embolic occlusion preceded MA development at the occlusion site, suggesting that documented angiographic emboli in patients with infectious endocarditis and bacteremia constitute a risk factor for MA formation. Two adult patients with a history of intravenous drug use and one child with congenital heart disease are described. They were all diagnosed with infectious endocarditis and developed neurological symptoms during their hospital course. Initial catheter-based cerebral angiograms demonstrated vascular occlusions, which were followed by the development of MA at the same sites within 1 month. Septic emboli, documented on cerebral angiogram, in patients with infectious endocarditis may precede the appearance of MA. Patients with angiographic occlusions in the setting of endocarditis warrant close follow-up.
Asunto(s)
Aneurisma Infectado/diagnóstico , Bacteriemia , Endocarditis Bacteriana , Aneurisma Intracraneal/diagnóstico , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/microbiología , Aneurisma Infectado/cirugía , Antibacterianos/uso terapéutico , Terapia Combinada , Angiografía por Tomografía Computarizada , Diagnóstico Diferencial , Embolización Terapéutica , Femenino , Humanos , Lactante , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/microbiología , Aneurisma Intracraneal/cirugía , Masculino , Adulto JovenRESUMEN
We report the first case of a ruptured intracranial aneurysm-related Staphylococcus epidermidis bacteremia in a patient supported by a continuous flow left ventricular assist device (LVAD). Mycotic aneurysms (MAs) are aneurysmal degeneration of the arterial wall as a result of infection. Current recommendations for management of intracranial mycotic aneurysms are based on a few retrospective case studies. There are only a few cases of intracranial MA reported in patients with LVAD infections caused by Pseudomonas aeruginosa and Klebsiella rhinos. Here, we describe the first case of a ruptured intracranial aneurysm caused by a less virulent organism (Staphylococcus epidermidis) and conclude that screening for asymptomatic MA should be strongly considered in patients with persistent LVAD- and implantable cardiac defibrillator pacemaker-associated infections.