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Neurocritical Care
Published in: Neurocritical Care 1/2008

01-02-2008 | PRACTICAL PEARL

Staphylococcus Endocarditis Associated with Infectious Vasculitis and Recurrent Cerebral Hemorrhages

Authors: Diederik van de Beek, Alejandro A. Rabinstein, Steve G. Peters, Harry Cloft, Eelco F. M. Wijdicks

Published in: Neurocritical Care | Issue 1/2008

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Abstract

Background

Patients with infectious endocarditis, who do not respond to conservative medical therapy usually need rapid valve surgery. This poses a difficult dilemma in patients with intracranial aneurysms and hemorrhage, although endovascular treatment of infectious aneurysms might be an advantage in therapy in these patients.

Methods

We present a patient with ruptured infectious intracranial aneurysm complicating endocarditis with hemorrhage after successful coil occlusion of the aneurysm and review the literature on studies reporting endovascular treatment in adults with infectious aneurysms.

Results

In total 34 adults have been reported with endovascular treatment of infectious aneurysms. All patients were initially presented with hemorrhage. Reported mortality rate was low (6%), and neurologic disability was reported in 37% of other patients. Rehemorrhage has been described in one other patient after endovascular treatment of an infectious aneurysm after rupture of a new aneurysm. In our patient, CT suggested a generalized cerebral infectious vasculitis.

Conclusions

Endovascular treatment of infectious aneurysms seems to be a great advantage, but endovascular coiling may not prevent hemorrhage associated with panvasculitis rupture of a new aneurysm.
Literature
1.
Tleyjeh IM, Steckelberg JM, Murad HS, et al. Temporal trends in infective endocarditis: a population-based study in Olmsted County, Minnesota. JAMA 2005;293:3022–8.PubMedCrossRef
2.
Peters PJ, Harrison T, Lennox JL. A dangerous dilemma: management of infectious intracranial aneurysms complicating endocarditis. Lancet Infect Dis 2006;6:742–8.PubMedCrossRef
3.
Gillinov AM, Shah RV, Curtis WE, Stuart RS, Cameron DE, Baumgartner WA, Greene PS. Valve replacement in patients with endocarditis and acute neurologic deficit. Ann Thorac Surg 1996;61:1125–9.PubMedCrossRef
4.
Chun JY, Smith W, Halbach VV, Higashida RT, Wilson CB, Lawton MT. Current multimodality management of infectious intracranial aneurysms. Neurosurgery 2001;48:1203–13.PubMedCrossRef
5.
Phuong LK, Link M, Wijdicks E. Management of intracranial infectious aneurysms: a series of 16 cases. Neurosurgery 2002;51:1145–51.PubMedCrossRef
6.
Corr P, Wright M, Handler LC. Endocarditis-related cerebral aneurysms: radiologic changes with treatment. AJNR Am J Neuroradiol 1995;16:745–8.PubMed
7.
Khayata MH, Aymard A, Casasco A, Herbreteau D, Woimant F, Merland JJ. Selective endovascular techniques in the treatment of cerebral mycotic aneurysms. Report of three cases. J Neurosurg 1993;78:661–5.PubMedCrossRef
8.
Frizzell RT, Vitek JJ, Hill DL, Fisher WS III. Treatment of a bacterial (mycotic) intracranial aneurysm using an endovascular approach. Neurosurgery 1993;32:852–4.
9.
Scotti G, Li MH, Righi C, Simionato F, Rocca A. Endovascular treatment of bacterial intracranial aneurysms. Neuroradiology 1996;38:186–9.PubMedCrossRef
10.
Cloft HJ, Kallmes DF, Jensen ME, Lanzino G, Dion JE. Endovascular treatment of ruptured, peripheral cerebral aneurysms: parent artery occlusion with short Guglielmi detachable coils. AJNR Am J Neuroradiol 1999;20:308–10.PubMed
11.
Watanabe A, Hirano K, Ishii R. Cerebral mycotic aneurysm treated with endovascular occlusion—case report. Neurol Med Chir (Tokyo) 1998;38:657–60.CrossRef
12.
Chapot R, Houdart E, Saint-Maurice JP, et al. Endovascular treatment of cerebral mycotic aneurysms. Radiology 2002;222:389–96.PubMedCrossRef
13.
Asai T, Usui A, Miyachi S, Ueda Y. Endovascular treatment for intracranial mycotic aneurysms prior to cardiac surgery. Eur J Cardiothorac Surg 2002;21:948–50.PubMedCrossRef
14.
Erdogan HB, Erentug V, Bozbuga N, Goksedef D, Akinci E, Yakut C. Endovascular treatment of intracerebral mycotic aneurysm before surgical treatment of infective endocarditis. Tex Heart Inst J 2004;31:165–7.PubMed
15.
Misser SK, Lalloo S, Ponnusamy S. Intracranial mycotic aneurysm due to infective endocarditis—successful NBCA glue embolisation. S Afr Med J 2005;95:397–9.PubMed
16.
Sugg RM, Weir R, Vollmer DG, Cacayorin ED. Cerebral mycotic aneurysms treated with a neuroform stent: technical case report. Neurosurgery 2006;58:E381.PubMedCrossRef
17.
Ay H, Sahin G, Saatci I, Soylemezoglu F, Saribas O. Primary angiitis of the central nervous system and silent cortical hemorrhages. AJNR Am J Neuroradiol 2002;23:1561–3.PubMed
18.
van de Beek D, de Gans J, Tunkel AR, Wijdicks EF. Community-acquired bacterial meningitis in adults. N Engl J Med 2006;354:44–53.PubMedCrossRef
19.
Molinari GF, Smith L, Goldstein MN, Satran R. Pathogenesis of cerebral mycotic aneurysms. Neurology 1973;23:325-32.PubMed
Metadata
Title
Staphylococcus Endocarditis Associated with Infectious Vasculitis and Recurrent Cerebral Hemorrhages
Authors
Diederik van de Beek
Alejandro A. Rabinstein
Steve G. Peters
Harry Cloft
Eelco F. M. Wijdicks
Publication date
01-02-2008
Publisher
Humana Press Inc
Published in
Neurocritical Care / Issue 1/2008
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-007-9002-6

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