Highlights
- •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.
Abstract
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.
Keywords
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References
- IMAGE (Resonance Magnetic Imaging at the Acute Phase of Endocarditis) Study Group. Effect of early cerebral magnetic resonance imaging on clinical decisions in infective endocarditis: a prospective study.Ann Intern Med. 2010; 152: W175
- Intracranial infectious aneurysms: a comprehensive review.Neurosurg Rev. 2010; 33: 37-46
- Successful surgical treatment of an intracranial mycotic aneurysm complicated by a subdural hematoma.J Neurosurg. 1960; 17: 788-791
- A case of septic aneurysm complicated with simultaneous subdural and intracerebral hematoma.No Shinkei Geka. 1985; 13: 1109-1113
- Late rupture of a mycotic aneurysm after “cure” of bacterial endocarditis.J Neurol. 1986; 233: 51-53
- Ruptured intracranial mycotic aneurysm associated with acute subdural hematoma - Case report.Neurol Med Chir (Tokyo). 1987; 27: 56-59
- Ruptured mycotic aneurysm presenting as an intraparenchymal hemorrhage and nonadjacent acute subdural hematoma: case report and review of the literature.Surg Neurol. 1994; 41: 290-293
- A case of multiple mycotic intracranial Aneurysms presenting with subdural hematoma.No Shinkei Geka. 2002; 30: 73-78
- A ruptured mycotic aneurysm, simultaneously associated with acute subdural hematoma and intracerebral hemorrhage: case report and review of the literature.No Shinkei Geka. 2002; 30: 1211-1215
- Ruptured infectious aneurysm of the distal middle cerebral artery manifesting as intracerebral hemorrhage and acute subdural hematoma–case report.Neurol Med Chir (Tokyo). 2003; 43: 541-545
- Risk factors for acute subdural hematoma from intracranial aneurysm rupture.Neurosurgery. 2012; 71 (discussion 268–269): 264-268
- Aneurysm-related subarachnoid hemorrhage and acute subdural hematoma: single-center series and systematic review.J Neurosurg. 2013; 118: 984-990
- ECHO-IMAGE Study Group. Determinants of cerebral lesions in endocarditis on systematic cerebral magnetic resonance imaging: a prospective study.Stroke. 2013; 44: 3056-3062
- IMAGE study group. Infective endocarditis with symptomatic cerebral complications: contribution of cerebral magnetic resonance imaging.Cerebrovasc Dis. 2013; 35: 327-333
- True cortical saccular aneurysm presenting as an acute subdural hematoma.World Neurosurg. 2018; 113: 58-61
- Infectious endocarditis associated with subarachnoid hemorrhage, subdural hematoma and multiple brain abscesses.Intern Med. 2003; 42: 1244-1247
- Lactococcus garvieae endocarditis presenting with subdural haematoma.BMC Cardiovasc Disord. 2014 Feb; 1: 13
- Non-traumatic subdural hematoma secondary to septic brain embolism: a rare cause of unexpected death in a drug addict suffering from undiagnosed bacterial endocarditis.Forensic Sci Int. 2015; 257: e1-e5
Article info
Publication history
Published online: January 09, 2019
Accepted:
December 23,
2018
Received:
November 5,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
