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Hemorrhagic Stroke
Case report
Republished: Intracranial vessel occlusion preceding the development of mycotic aneurysms in patients with endocarditis
  1. Ezequiel Goldschmidt1,
  2. Amir H Faraji1,
  3. David Salvetti1,
  4. Benjamin M Zussman1,
  5. Ashutosh Jadhav2
  1. 1Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Ashutosh Jadhav; jadhavap{at}upmc.edu

Abstract

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.

  • aneurysm
  • embolic
  • hemorrhage
  • infection
  • inflammation

https://doi.org/10.1136/neurintsurg-2019-015480.rep

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    Footnotes

    • Republishing Republished with permission from BMJ Case Reports. Published 31 December 2019; doi:10.1136/bcr-2019-015480

    • Contributors EG, AHF, DS, and BMZ were involved in the design and conception of this manuscript. EG and DS performed the literature search. EG, AHF, BMZ, and AJ compiled the primary manuscript. BMZ and EG compiled the figures. EG, AHF, DS, BMZ, and AJ critically revised the manuscript. All authors have approved the manuscript as it is written.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.