Neurological Outcomes of Patients With Mycotic Aneurysms in Infective Endocarditis (original) (raw)
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Ruptured Intracranial Mycotic Aneurysm in Infective Endocarditis: A Natural History
Case Reports in Medicine, 2010
Mycotic aneurysms are a rare cause of intracranial aneurysms that develop in the presence of infections such as infective endocarditis. They account for a small percentage of all intracranial aneurysms and carry a high-mortality rate when ruptured. The authors report a case of a 54-year-old man who presented with infective endocarditis of the mitral valve and acute stroke. He subsequently developed subarachnoid hemorrhage during antibiotic treatment, and a large intracranial aneurysm was discovered on CT Angiography. His lesion quickly progressed into an intraparenchymal hemorrhage, requiring emergent craniotomy and aneurysm clipping. Current recommendations on the management of intracranial Mycotic Aneurysms are based on few retrospective case studies. The natural history of the patient's ruptured aneurysm is presented, as well as a literature review on the management and available treatment modalities.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2004
Mycotic aneurysms are rarely seen in patients who have infective endocarditis, and the management of these patients remains controversial. We present the case of a patient who had infective endocarditis complicated by a mycotic aneurysm of the left middle cerebral artery. There was substantial mitral regurgitation, and Streptococcus viridans was isolated from the blood samples. Dysarthria appeared during the 4th week of the antibiotic therapy, but resolved completely 8 hours after onset. The left middle cerebral artery was embolized with platinum detachable coils. On the 7th day after the radiologic intervention, the native mitral valve was replaced with a 33-mm St. Jude Medical bi-leaflet mechanical mitral prosthesis. Most mycotic aneurysms show notable regression of symptoms with effective antibiotic treatment, and a very few may diminish in size. However it is impossible to predict the response of these aneurysms to therapy. To prevent the perioperative rupture of mycotic aneurys...
Interactive CardioVascular and Thoracic Surgery
OBJECTIVES: The presence of cerebral haemorrhage (CH) preoperatively is a risk factor of in-hospital cerebrovascular complications postvalve surgery for acute infective endocarditis. However, factors related to cerebrovascular complications in the long term are poorly understood. We reviewed a series of these patients to investigate risk factors of in-hospital and long-term outcomes. METHODS: An institutional series of 148 patients who underwent valve surgery for active infective endocarditis between 2000 and 2016 were enrolled. Patients were divided into 2 groups based on the presence of preoperative CH:CH group (n = 25) and non-CH group (n = 123). Of them, 14 (10%) patients were preoperatively diagnosed with mycotic aneurysm (MA). RESULTS: The 30-day mortality was 5% with no difference between the 2 groups. The 5-year survival rate was 92% in the CH group and 77% in the non-CH group. Freedom from CH at 5 years was 92% in the CH group and 97% in the non-CH group. There was no difference in the postoperative haemorrhage rate between patients who had surgery within 14 days from the onset of CH and those who had surgery after 14 days. Freedom from CH at 5 years was 99% in patients without MA and 71% in those with MA. The presence of MA preoperatively was the only independent risk factor of postoperative CH (P = 0.002). CONCLUSIONS: Valve surgery for acute infective endocarditis is safe, even in patients with CH preoperatively, regardless of the timing of surgery. Patients with intracranial MA are associated with postoperative CH in the hospital and long term.
Peripheral mycotic aneurysms in infective endocarditis
The Journal of Heart Valve Disease, 2005
Today, infective endocarditis (IE) remains a severe illness, with high mortality and morbidity. Mycotic aneurysms (MAs) are rare complications of IE. For most patients, surgical intervention represents the only hope for radical cure of extracranial MAs, and survival. A total of 238 patients with IE was treated at the authors' center between January 1990 and December 2003. Among these patients, 10 underwent surgical intervention due to peripheral MAs. Concomitant surgery for intracardiac and extracardiac pathology was applied in three patients with native valve endocarditis to excise infected material. Aneurysmectomy and revascularization were performed in four patients with native endocarditis, and in three with prosthetic valve endocarditis (PVE). The intracardiac pathologies of these seven patients were treated with antimicrobial agents. Eight patients underwent surgery after completion of three weeks' antibiotic therapy. An autologous saphenous vein interposition was performed in eight patients, but in two cases, due to size discrepancy, a polytetraflouroethylene (PTFE) graft was chosen as the initial conduit to achieve arterial continuity. Saphenous vein graft rupture occurred in one patient; a PTFE graft was used to achieve second revascularization. Limb salvage was achieved in nine patients. Below-knee amputation was necessary in one patient; this was due to prior embolism of the distal arterial tree. Two patients died, one due to cerebral embolism and another to rupture of undiagnosed visceral MA. All other patients remain alive, without complications. Complete revascularization should be essential to treat peripheral MA in IE. Adequate resection, appropriate parenteral administration of antimicrobial agents and size discrepancy are far more important factors than the type of graft material in preventing suture-line infection and vessel or graft rupture.
Intracranial mycotic aneurysm due to infective endocarditis--successful NBCA glue embolisation
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2005
Symptomatic intracranial mycotic aneurysms (ICMAs) are one of the most serious neurological sequelae of infective endocarditis. Changing cardiac murmurs and the sudden onset of neurological symptoms and signs are markers of this lethal combination. If computed tomography (CT) scan demonstrates an intracerebral haemorrhage in a patient with such a combination of findings, further imaging using cerebral angiography is essential. The primary treatment is antibiotics for at least 6 weeks. Transcatheter embolisation or surgical intervention may be required in some instances. We report on a patient with an intracerebral haematoma referred from a peripheral hospital to the neurosurgery department at our institution. The diagnosis of the cardiac condition, and probable mycotic basis for the intracranial aneurysm, were first suggested following peri-procedural examination during endovascular therapy in our angiography suite.
Rare Presentation of Endocarditis and Mycotic Brain Aneurysm
The Annals of Thoracic Surgery, 2019
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Case reports in neurological medicine, 2022
e incidence of infective endocarditis is estimated to be around 30 cases per million inhabitants/year. It can be responsible for various neurological complications such as cerebral infarction, meningitis, cerebral abscesses, and cerebral hemorrhage due to ruptured mycotic aneurysms. Several germs have been incriminated in this condition including Staphylococcus, Streptococcus, and Enterococcus. We report the case of a 64-year-old patient who presented with an acute motor de cit of the left upper limb associated with dysarthria. MRI showed infarcts in both cerebral hemispheres, and the TOF sequence showed an amputation of M2. On transesophageal ultrasound, there was evidence of vegetations at the mitral valve. Blood culture isolated Streptococcus oralis. With antibiotic treatment, the evolution was marked by a stable apyrexia with regression of the dysarthria. Before her surgery, she suddenly developed aphasia with worsening of the motor de cit. CT scan showed a right fronto-parietal hematoma which was related to a ruptured cerebral aneurysm. She underwent endovascular embolisation and subsequent cardiac surgery.
Ruptured mycotic aneurysms: Report and outcomes of two surgically managed patients
Surgical neurology international, 2017
Mycotic aneurysm is a rare potentially life-threatening complication of infective endocarditis (IE). Little data is available on the management and outcomes of ruptured mycotic aneurysms with large intracerebral hematoma. Few cases have been described on the management of mycotic aneurysm in the presence of life-threatening hematoma and mass effect. We are presenting two cases of ruptured mycotic aneurysm with intracerebral hematoma and impending brain herniation. Both patients had signs of high intracranial pressure and required urgent surgical evacuation of clot. One patient survived while the other patient expired soon after surgery. Mycotic aneurysm of middle cerebral artery (MCA) in IE with intracranial hemorrhage is rare and urgent surgical decompression, and aneurysmal clipping can be lifesaving.