- •Ruptured mycotic aneurysm (MA) manifesting as subdural hematoma (SDH) is extremely rare.
- •In infective endocarditis (IE) MAs may manifest as acute SDH (ASDH).
- •Even rare, MA should be considered as a cause of acute SDH of unknown origin.
- •Necessity to repeat CT-Angiography/MRA in IE associated ASDH, even isolated.
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 5 days later revealed ischemic spots and minime ASDH over the right convexity. Cerebral angiography, revealed a 3 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 15 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.
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Published online: January 09, 2019
Accepted: December 23, 2018
Received: November 5, 2018
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