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A patient with subdural hematoma associated with multiple mycotic intracranial aneurysms is reported. A 22-year-old woman presented with headache and disturbance of consciousness. A CT showed subdural hematoma at the tentrium and the left cerebral convexity. Conservative treatment and was used and she was discharged 10 days later. However, follow-up CT demonstrated a parenchymal hematoma in the right posterior temporal lobe. Cerebral angiography demonstrated a large right posterior cerebral aneurysm and multiple right middle cerebral aneurysms. A cardiac ultrasonography showed a verruca at the mitral valve. The posterior cerebral aneurysms increased in size and one new middle cerebral aneurysm appeared at follow-up angiography one week later. Endovascular treatment with coils was applied for the right posterior cerebral aneurysm, and others were treated with antibiotic therapy under serial observation, using MR angiography. She was discharged without any symptoms two months after embolization. Follow-up angiography at one year after embolization showed disappearance of the aneurysms. The possibility of mycotic aneurysm should be considered in the differential diagnosis of non-traumatic acute subdural hematoma.
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PMID:[A case of multiple mycotic intracranial aneurysms presenting with subdural hematoma]. 1180 11

We reported a 64-years-old woman with pachymeningitis associated with a ruptured mycotic cerebral aneurysm due to Aspergillus infection. She had suffered from diabetes mellitus and been treated since she was 49 years old. She complained of headache at the age of 62 and loss of her left visual acuity three months later. She was treated by the pulse therapy of methylprednisolone as neuritis retrobulbaris and her visual acuity recovered. But her headache continued. Three months later, her right visual acuity was lost, and the pulse therapy was not effective this time. Six months later, she died of subarachnoid hemorrhage following acute meningitis. The autopsy was granted, but limited to the cranial cavity. Macroscopically, it disclosed brownish thickened dura around sella turucica involving trigeminal ganglion and optic nerve, and fresh subarachnoid hemorrhage in the basal cisterns and a ruptured aneurysm (3 mm in diameter) between internal carotid and posterior cerebral artery on the left side. Histologically, the brownish thickened dura was infiltrated by lymphocytes, plasma cells, and multinucleated giant cells. The wall around the aneurysm was infiltrated by lymphocytes and plasma cells as well as many fungi. Immunohistochemistry demonstrated the presence of Aspergillus in the thickened dura and the arterial wall around the aneurysm. There were lymphocytes and plasma cell infiltration in the basal subarachnoid space and scattered microabcesses in the brain. Although the first entry of Aspergillus to the dura was unclear, we assume that the final intravascular dissemination of Aspergillus from the dura caused meningitis and mycotic aneurysm.
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PMID:[An autopsied case of pachymeningitis associated with a ruptured, cerebral aneurysm due to Aspergillus infection]. 1199 87

A patient with multiple mycotic aneurysms associated with infective endocarditis is reported. A 45-year-old man was admitted on February 16, 2001 under the diagnosis of infective endocarditis. After alpha-streptococcus was identified by a blood culture, he was treated with high doses of antibiotics. However, 2 weeks after admission, he suddenly suffered from headache and mild left hemiparesis. A CT showed a parenchymal hematoma in the right parietal lobe. Cerebral angiography demonstrated aneurysms of the bilateral middle cerebral artery and the left posterior cerebral artery. At first, we trapped and resected the ruptured right middle cerebral aneurysm. After the surgery, we tried to treat two unruptured aneurysms by endovascular treatment. During the provocation test for the posterior cerebral artery, the arterial wall was perforated by a guide wire. The parent artery was occluded by coils at this site. Although the aneurysm was still filled by retrograde blood flow, it finally disappeared six months after treatment. The left middle cerebral artery aneurysm could not be treated because the provocation test showed cognitive deficits. The patient recovered from infective endocarditis after four-months of antibiotic therapy; and the unruptured aneurysm had not changed in size for 11 months. Recently, the outcome of patients with intracranial mycotic aneurysm is improved by development of multimodality management. Especially, endovascular therapy may become an effective treatment for unruptured aneurysms, but it is necessary to take risks, such as arterial perforation into consideration.
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PMID:[A case of multiple mycotic intracranial aneurysms]. 1253 8

A 23-year-old woman presented with a history of some months of malaise, anorexia, fever and behavioural changes. She had been examined by a general physician on repeated occasions before coming to the hospital. After physical examination and laboratory investigations, she was sent home. She returned to the hospital the same day with increased drowsiness and headache. Additional diagnostic procedures were performed. An echocardiography showed vegetations on the mitral valve. A CT scan of the brain showed a left frontotemporal haemorrhage. Infective endocarditis with septic embolisation to the brain, which resulted in a cerebral haemorrhage, was diagnosed. The patient was admitted and intravenous antibiotics were administered. Because of haemodynamic instability, a mitral valve replacement was performed on the fifth day of admission. The patient recovered well postoperatively. Four weeks later, she was found in a comatose condition. She died as a result of a second intracerebral haemorrhage, which was probably caused by a mycotic aneurysm. An important lesson to be learned from this case is that endocarditis should be considered in patients with a long history of anorexia, weight loss, malaise and fever, especially when a heart murmur is present. Secondly, if intracranial haemorrhage has occurred in patients with infective endocarditis, therapeutic options should always be discussed with a neurosurgeon, even in those cases where the probability of a mycotic aneurysm is low.
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PMID:[Clinical reasoning and decision making in practice. A 23 year old woman with malaise, anorexia, fever and behavior changes]. 1549 47

A 59-year-old woman was admitted to the hospital after having severe headache for 1 day. Her medical history was significant for coronary artery disease, diabetes, atrial fibrillation, and rheumatic heart disease. The patient was in remission from stage II left breast cancer (T2 N0 M0) in 1997, treated with lumpectomy, 6 cycles of chemotherapy (cyclophosphamide, methotrexate, and 5-fluorouracil), and local radiation therapy (total 6000 cGy). Head magnetic resonance imaging scan showed left occipital hemorrhage. Subsequent angiogram showed a possible mycotic aneurysm of distal parietal occipital branch of the posterior cerebral artery. Cardiology was consulted to evaluate for a cardioembolic source.
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PMID:An unusual cause of stroke from a left atrial mass. 1748 95

Cerebral angioinvasion is a fatal complication of disseminated aspergillosis and has been rarely described in diabetic population in the absence of ketoacidosis. We present a case of invasive fungal sinusitis in a 79 year old diabetic man who presented with chronic frontal headaches. Despite appropriate medical and surgical treatment, the disease progressed and the patient eventually succumbed to a fatal ruptured mycotic aneurysm. We emphasize that clinicians should consider this in the differential diagnoses of all diabetics who present with chronic sinusitis, as early diagnosis could be the key in the successful treatment.
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PMID:Chronic fungal sinusitis leading to disastrous cerebral aspergillosis: a case report. 2006 73

A 58-year-old woman with a history of Bentall aortic graft and bioprosthetic aortic valve replacement 3 months prior to admission, presented with headache and fever. Imaging yielded a large obstructive filling defect in the ascending aorta, a subarachnoid hemorrhage, and a mycotic aneurysm. Intraoperative specimens grew Aspergillus fumigatus, and despite aggressive measures the patient died. Aspergillus infections of prosthetic vascular grafts are rare surgical complications and are difficult to diagnose given the low incidence of positive microbiology cultures and the long median time between surgery and diagnosis. Treatment has consisted of antifungal and surgical treatment, although mortality remains high.
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PMID:Aspergillus fumigatus vegetation of a prosthetic aortic root graft with mycotic aneurysm and subarachnoid hemorrhage. 2331 24

Intracavernous carotid artery mycotic aneurysms are rare and management is determined by clinical presentation. We describe the first documented proximal intracranial mycotic aneurysm treated by a balloon expandable Aneugraft PCS covered stent. An 11-year-old female child presented with acute onset fever, headache, chemosis followed by diplopia, right-sided ptosis with ophthalmoplegia. Magnetic resonance imaging revealed bilateral cavernous sinus thrombosis. Subsequent work-up included serial computed tomographic arteriography and digital subtraction angiography which revealed a progressively enlarging intracavernous carotid aneurysm. An Aneugraft PCS covered stent was successfully deployed endovascularly, and complete exclusion of the aneurysm was achieved while maintaining the patency of the parent artery. The use of covered stents in intracranial vasculature can be an effective and safe treatment modality for exclusion of the mycotic aneurysm in selected cases.
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PMID:Endovascular treatment of a mycotic intracavernous carotid artery aneurysm using a stent graft. 2407 80

Mycotic aneurysms are rare inflammatory neurovascular lesions. Ruptured mycotic aneurysm manifesting as subdural hematoma is extremely rare. A 72-year-old male patient was admitted to our hospital with headache and drowsiness. Computer tomography (CT) of brain and CT angiography revealed subdural hematoma and an aneurysm located at the M4 segment of the left middle cerebral artery (MCA). Cerebral angiogram revealed 2 aneurysms; one located at the left distal MCA and the other at the bifurcation of left MCA. Laboratory studies showed leukocytosis and elevated inflammatory factors. The patent was treated with antibiotic therapy for 4 weeks. The follow-up CT and cerebral angiography showed that the mycotic aneurysm was completely resolved, and the patient was nearly free of symptoms.
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PMID:Ruptured mycotic aneurysm of the distal middle cerebral artery manifesting as subacute subdural hematoma. 2416 6

We report a case of spinal subarachnoid hemorrhage (SAH) caused by rupture of a mycotic anerurysm. A 59-year-old woman was admitted to our hospital with a sudden onset of headache and tetraparesis. Computed tomography (CT) scan of the brain revealed SAH, and magnetic resonance imaging (MRI) of the cervical spine showed an acute intradural hematoma. On angiogram, a saccular aneurysm was found on the C5 radiculomedullary artery, which arose from the left ascending cervical artery. Subsequently, her consciousness status deteriorated due to rebleeding, and she was brought to surgery. An aneurysm was found at the cephalad aspect of the left C5 root. On histological examination, it showed typical characteristics of mycotic aneurysms. Spinal mycotic aneurysm is a very rare entity with scant description in the literature. It can be extremely brittle and therefore warrants expeditious surgical treatment. When encountering spinal origin of subarachnoid hemorrhage, it should be included in the differential diagnosis.
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PMID:Spinal Subarachnoid Hemorrhage Caused by a Mycotic Aneurysm of the Radiculomedullary Artery: A Case Report and Review of Literature. 2866 63


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