Mycotic Aneurysm of Internal Carotid Artery Secondary to Livestock-associated Methicillin-resistant Staphylococcus Aureus Clonal Complex CC398.

The aim of this article is to present a case of mycotic aneurysm of internal carotid artery secondary to livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) treated with resection and common-to-internal carotid artery bypass with autologous vein graft in a male pig farmer. A 69-year-old man, pig farmer, with recent dental extraction was admitted with a right cervical pulsatile mass, dysphonia, pain, leukocytosis and elevated C-reactive protein (CRP). Ultrasonography (US) and computed tomography angiography (CTA) showed a 3.9 × 4.5 cm mycotic aneurysm of right internal carotid artery with hypermetabolic uptake in positron emission tomography (PET) scan. Resection of the mycotic aneurysm and a common-to-internal carotid artery bypass with major saphenous vein graft were performed. LA-MRSA clonal complex (CC) 398 was detected in intraoperative samples and antibiotic therapy was changed according to antibiogram. Patient was discharged at the seventh postoperative day and received antibiotic therapy for 6 weeks. US 12 months later showed patency of the bypass without collections. Mycotic aneurysms of internal carotid artery are very infrequent. MRSA isolation is rare, and to the best of our knowledge this is the first case caused by multi-drug resistant LA-MRSA CC398. The treatment includes mycotic aneurysm resection and reconstruction with venous graft bypass plus intensive antibiotic therapy.

[A fungus in a thrombus by mechanical thrombectomy in acute cerebral infarction: a case report].

A 88-year-old man suddenly presented with aphasia and right hemiparesis. The diffusion-weighted image of MRI showed ischemic lesions on the left middle cerebral artery area, and MRA showed the left intracranial artery (ICA) occlusion. Therefore, we diagnosed him as having acute ischemic stroke and treated with mechanical thrombectomy (MT). The DWI of MRI showed ischemic lesions on the left middle cerebral artery area, and MRA showed the left ICA occlusion. Therefore, we performed MT and continued best medical treatment, but ICA was reoccluded. Six day later, aspergillus was found in the thrombus from ICA. Then, we considered that ICA occlusion was caused by aspergillus. We experienced a patient specified the cause by thrombus pathology. The pathological diagnosis of the thrombus getting by MT is usefulness for stroke etiology.

Endovascular Treatment of Infectious Pseudoaneurysm of Internal Carotid Artery.

BACKGROUND: Infectious pseudoaneurysm of the intracavernous carotid artery is rare, often caused by sphenoid sinusitis or transsphenoidal surgery. Management of intracranial infectious aneurysms (IIAs) remains a controversial topic lacking randomized controlled trials to guide clinical decision making. CASE DESCRIPTION: For this case, we used an antibiotic to treat the patient in the initial stage. Because IIAs enlarge rapidly, endovascular treatment was performed in the emergency department. CONCLUSIONS: Unfortunately, the patient died because the IIA recurred and ruptured. Therefore we speculated that stent-assisted coil placement for the treatment of ruptured infectious pseudoaneurysms of the internal carotid artery may not be safe.

Mycotic Pseudoaneurysm of Internal Carotid Artery Secondary to Lemierre's Syndrome, How to Do It.

We report the case of a patient with internal carotid artery (ICA) mycotic pseudoaneurysm secondary to Lemierre's syndrome, urgently treated. A 75-year-old man presented to E.R. with a left swelling lesion of the neck and complaining left visions lost since that morning, fever, hypotension, and dyspnea. Since 15 days before developing symptoms, he had sore throat and odynophagia treated with a broad coverage of antibiotic therapy for presumed streptococcal pharyngitis. Preoperative computed tomography angiography images revealed a circular lesion, involving the common carotid artery, carotid bulb, and the proximal part of the internal and external carotid arteries. A pseudoaneurysm of the ICA was detected, and the jugular vein was compressed. A Cormier carotid vein graft bypass was performed. Lemierre's syndrome is a rare syndrome, but it is rarer the carotid artery pseudoaneurysm secondary to Lemierre's syndrome. Surgical treatment is safe and durable in patients with severe infection involving the neck.

Lemierre's Syndrome Associated Mycotic Aneurysm of the External Carotid Artery with Primary Internal Carotid Artery Occlusion in a Previously Healthy 18-Year-Old Female.

Lemierre's syndrome is a rare life-threatening condition characterized by internal jugular vein thrombosis and is typically associated with a gram-negative infection with septic metastasis secondary to a retropharyngeal abscess that involves the vasculature of the head and neck. We report a case of Lemierre's syndrome in an 18-year-old female adolescent who developed an internal carotid artery occlusion and ipsilateral external carotid artery (ECA) mycotic aneurysm complicated by fulminant pseudomonal sepsis. The patient was managed with open ligation of the ECA with essentially complete recovery.

Mycotic Aneurysm of the Extracranial Internal Carotid Artery, Resect and Ligate or Reconstruct?

Mycotic aneurysmal disease of the extracranial carotid arteries (ECA) is a rare entity associated with a high morbidity, including rupture, hemorrhage, airway obstruction, and stroke. Surgical management is challenging due to difficult dissection through infected or inflamed tissue. This report highlights a case of ECA-aneurysm infection presenting with stroke and an occluded internal carotid artery, likely due to microbial arteritis on a background of osteomyelitis. Operative intervention was performed to definitively treat the infection and prevent the potential associated complications. In this case, the incident vessel was 100% occluded at presentation, allowing vessel ligation and resection without carotid complex reconstruction.

Fungal Internal Carotid Artery Aneurysm Treated by Trapping and High-Flow Bypass: A Case Report and Literature Review.

We report a case of unruptured fungal internal carotid artery (ICA) aneurysm and review the pertinent literature. A 79-year-old man presented with decreased visual acuity on the right side, and he was diagnosed with retrobulbar optic neuritis. Medical treatment with steroids resulted in Aspergillus meningoencephalitis spreading to the bottom of bilateral frontal lobes, caused by an intracranial extension of sphenoid sinusitis. Magnetic resonance imaging (MRI) performed 26 days after the start of antifungal therapy showed a denovo right ICA aneurysm projecting anteriorly into the sphenoid sinus. As the aneurysm grew rapidly, it was trapped surgically after establishing a high-flow bypass from the external carotid artery to the middle cerebral artery. The patient's postoperative course was uneventful. Anti-fungal medication was continued until plasma concentrations of beta-D-glucan decreased to within normal limits. Although fungal ICA aneurysm carries a high mortality rate, early detection and prompt treatment by trapping and high-flow bypass can lead to good clinical outcome.

Infectious arteritis of the internal carotid artery complicating retropharyngeal abscess.

INTRODUCTION: Retropharyngeal abscess is a well-known entity in children, but can also occur in adults. The two main vascular complications are vascular compression and pseudoaneurysm, while infectious arteritis of the internal carotid artery is exceptional. CASE REPORT: The authors describe a case of a retropharyngeal abscess in an adult woman complicated by infectious arteritis of the internal carotid artery. This rare complication was treated by endovascular occlusion of the internal carotid artery and incision and drainage of the abscess in combination with antibiotic and anticoagulant therapy. The patient did not present any neurological sequelae and follow-up MRI did not reveal any signs of vascular or neurological complications. DISCUSSION: This case highlights the importance of thorough examination of imaging performed in the context of deep neck space abscess to detect signs of vascular involvement. Treatment must be aggressive in view of the life-threatening risk of arterial rupture or septic embolism. This is the first reported case of infectious arteritis involving the internal carotid artery complicating retropharyngeal abscess.

Rapidly Fatal Internal Carotid Artery Mycotic Aneurysm Rupture in a Rheumatoid Patient Taking a TNF-α Inhibitor: Case Report and Literature Review.

OBJECT: Tumor necrosis factor (TNF)-α inhibitors are effective at treating certain inflammatory and autoimmune disorders. They are generally safe; potential adverse events include infections (bacterial, fungal, and viral), congestive heart failure exacerbations, and the potential for demyelinating diseases and possibly certain malignancies. We present the first documented case of fungal internal carotid artery (ICA) mycotic aneurysm in a patient being treated with a TNF-α inhibitor. We also review the literature on infections with TNF-α inhibition and the management of previously reported fungal ICA mycotic aneurysm cases. CASE DESCRIPTION: A 76-year-old woman with rheumatoid arthritis, treated with etanercept and methotrexate, presented with a 2-week history of left temporal headaches. She was treated empirically for giant cell arteritis (GCA) with oral prednisone, which provided no symptom relief. She was subsequently hospitalized for a superficial temporal artery biopsy, which was negative for GCA. She returned 2 weeks later after experiencing a left thromboembolic ischemic stroke. She had an acute neurologic decline, and a head computed tomography scan showed diffuse subarachnoid hemorrhage from a ruptured left fusiform paraclinoid ICA aneurysm. She was taken emergently for a craniotomy for clip-wrapping of the aneurysm, but intraoperative ultrasound revealed poor flow in the left anterior cerebral circulation and a complete infarct of the left-sided anterior circulation. The family withdrew care and the patient died. Postmortem analysis demonstrated fungi consistent with Aspergillus invading the necrotic left ICA. CONCLUSIONS: Although fungal mycotic aneurysms of the ICA are rare, their incidence may increase with the expanded use of immunosuppressive medications. Patients with rheumatoid arthritis who take potent immunosuppression regimens may be prime candidates for mycotic aneurysms because they often have two favoring conditions: atherosclerosis and immunosuppression. These ICA aneurysms carry a high mortality rate, so early diagnosis and aggressive therapy, potentially by endovascular trapping/vessel occlusion coupled with long-term antifungal therapy, is essential.

Carotid stent infection: a rare but potentially fatal complication of carotid artery stenting.

Infections involving endovascular devices are rare and, to our knowledge, only three cases of infection with an inserted carotid stent have ever been reported. A 68-year-old man underwent carotid artery stenting (CAS) of the left proximal internal carotid artery. Two days after CAS the patient developed a high fever and investigation showed that the inserted carotid stent was infected. The infection could not be controlled despite adequate antibiotic therapy. Eventually a rupture of the carotid artery occurred and the patient underwent emergency resection of the left carotid bifurcation in addition to stent removal and reconstruction with a saphenous vein interposition graft. The patient recovered fully without any neurological sequelae.

Mycotic aneurysm of the internal carotid artery.

Mycotic aneurysms of the extracranial carotid artery are rare. We describe a case of a patient with an aneurysm of extracranial internal carotid artery, presented as a swelling at the right submandibular triangle. Carotid angiography revealed a saccular aneurysm. During the operation, an abscess, due to Salmonella, was found around the aneurysm. Ten days later, after the drainage of the pus, new carotid angiography revealed thrombosis of the right internal carotid artery. Two months later, the physical condition of our patient improved.Atherosclerosis, trauma, and many microbial agents are common causes of the aneurysm. The symptoms of the aneurysm may vary according to its size and location. Pain over the aneurysm is a common symptom. Rupture of the aneurysm is the most dramatic complication. Clinical examination, color Doppler ultrasonography, angiography, and computed tomography are the most common diagnostic modalities. Differential diagnosis must be done from other expansive pathologies. Resection of the aneurysmatic sac with restoration of flow is the preferred method of treatment.

Syphilitic arteritis involving the origin of the cervical internal carotid artery.

We report a case of meningovascular syphilis in a young adult woman presenting with left hemiparesis due to near occlusion of proximal cervical internal carotid with subacute middle cerebral artery territory infarction. Diagnosis was made on the basis of positive serum, and spinal fluid serology for syphilis, carotid Doppler, and magnetic resonance angiography, as well as improvement after intravenous penicillin therapy. In this case report, the imaging findings were described and related literature was reviewed.

Fatal hemorrhage following trans--sphenoidal resection of a pituitary adenoma: a case report and review of the literature.

A 58-year-old woman with acromegaly developed massive epistaxis 7 days following trans-sphenoidal resection of a growth hormone-secreting pituitary adenoma. At autopsy, it was determined that the source of the hemorrhage was a rupture of the intracavernous segment of the internal carotid artery secondary to a bacterial arteritis. We describe the gross dissection and histologic examination undertaken in this unusual case, discuss the possible etiology of the infection and review the potential complications of this surgical approach with a view to improving forensic examination of these patients.

Vernet's syndrome caused by large mycotic aneurysm of the extracranial internal carotid artery after acute otitis media--case report.

An 85-year-old man presented with a rare large aneurysm of the extracranial internal carotid artery (ICA) due to acute otitis media manifesting as Vernet's syndrome 2 weeks after the diagnosis of right acute otitis media. Angiography of the right extracranial ICA demonstrated an irregularly shaped large aneurysm with partial thrombosis. The aneurysm was treated by proximal ICA occlusion using endovascular coils. The ICA mycotic aneurysm was triggered by acute otitis media, and induced Vernet's syndrome as a result of direct compression to the jugular foramen. Extracranial ICA aneurysms due to focal infection should be considered in the differential diagnosis of lower cranial nerve palsy, although the incidence is thought to be very low.

Necrobacillosis resulting in isolated carotid thrombosis and massive stroke: a unique Lemierre variant?

We describe a healthy, young adult male patient who developed isolated carotid artery thrombosis and occlusion following acute pharyngitis due to Fusobacterium necrophorum. We believe this is the first case of isolated occlusion of internal carotid artery (ICA) with F.necrophorum without associated internal jugular vein (IJV) thrombosis. Lemierre's syndrome (LS) is characterized by a history of recent oropharyngeal infection in previously healthy individuals, clinical or radiological evidence of internal jugular vein thrombosis, and isolation of anaerobic pathogens, mainly F.necrophorum. We discuss literature on this rare, previously unreported, variant of LS.

Extracranial infected carotid artery aneurysm.

Infected aneurysms of the extracranial carotid arteries are rare. This is a case report of a 63-year-old female who developed an infected internal carotid artery aneurysm due to group B Streptococcus ten days after a dental procedure. She was successfully treated with excision of the aneurysm and common to internal carotid artery bypass with greater saphenous vein.

Extracranial internal carotid artery mycotic aneurysm: case report and review.

Mycotic aneurysms of the internal carotid artery (ICA) are rare and often difficult to diagnose. They can have nonspecific signs and symptoms, an unclear etiology, and can lead to severe morbidity and mortality if left untreated. We present a case of a 47-year-old woman with an apparent mycotic aneurysm of the extracranial ICA associated with Klebsiella pneumonia. We discuss the various clinical findings and radiographic imaging that lead to this unusual diagnosis and the details of our surgical treatment, which included excision of the mycotic aneurysm and reconstruction with a greater saphenous vein interposition graft. We also review the literature on mycotic aneurysms of the ICA, including the radiologic modalities available to diagnose this condition, epidemiology, pathophysiology, and treatment options.

An aspergillotic aneurysm of the internal carotid artery following allogeneic bone marrow transplantation: successful management with catheter coil embolization and long-term antifungal agents.

We report a case of a mycotic aneurysm of the internal carotid artery and cerebral hemorrhagic infarction resulting from Aspergillus middle ear infection in a patient with severe aplastic anemia who received unrelated bone marrow transplantation. Although a mycotic aneurysm is a rare complication, and most often fatal, the patient was successfully treated with catheter coil embolization of the internal carotid artery and long-term systemic antifungal therapy. This case emphasizes the need for the rapid diagnosis of potential fungal involvement of the vascular system and suggests the necessity for aggressive treatment, such as with the modality illustrated in this case.

Fungal internal carotid artery aneurysms: successful embolization of an Aspergillus-associated case and review.

BACKGROUND: Fungal aneurysms of the carotid artery are rare. We report here a case of Aspergillus fumigatus invasive sphenoidal sinusitis complicated by carotid artery aneurysms in a severely neutropenic patient who was successfully treated with a combination of antifungal therapy and embolization of all aneurysms. METHODS AND RESULTS: Carotid aneurysms were suspected when severe epistaxis occurred during follow-up for sinusitis. MRI angiograph and cerebral angiograph revealed 5 aneurysms involving the right intracavernous carotid artery. Coil endovascular embolization was successfully used for the first time in this context, and the patient is alive 2 years later. We also reviewed the literature and identified 10 cases of fungal carotid artery aneurysms. Aspergillus species was the most common fungal organism. All patients were immunocompromised and had to be treated surgically. CONCLUSIONS: Internal carotid arterial involvement is a rare but life-threatening complication of invasive fungal sinusitis. Fungal aneurysms should be diagnosed early, so that the embolization procedure can be performed before the occurrence of severe bleeding.

Ultrasound diagnosis of an internal carotid artery pseudoaneurysm in a young child.

Pseudoaneurysm of the carotid artery is a rare complication of deep neck space infection. It carries a high mortality rate even when treated appropriately. We report a case of a pseudoaneurysm of the internal carotid artery in a 2-year-old child who had a neck infection without an associated abscess. The diagnosis was not obvious on MRI but was confirmed by ultrasonography. This was successfully managed by angiographic embolization, followed by antibiotic and anticoagulant treatment. The combination of MRI and ultrasonography, without the use of invasive or radiation techniques, was sufficient for the diagnosis of pseudoaneurysm of the internal carotid artery.