Abstract
Background
Intracranial infectious aneurysms (IA) are infrequent, but can be fatal.
Objectives
To compare the clinical profile of IAs associated with intravascular/systemic infection
like infective endocarditis with that associated with local infections like meningitis,
orbital cellulitis and cavernous sinus thrombosis.
Methods
We analysed all cases of IA, treated in this Institute from 1976 to 2003, in order
to identify prognostic factors.
Results
There were 25 persons (mean age 24.8±17.3 years, males 17) with 29 IA (carotid circulation 19, vertebrobasilar circulation
10). Headache (83%) and fever (67%) were the most common presenting symptoms. In contrast
to noninfectious aneurysms, intracerebral haemorrhage (60%) and focal signs were more
common than subarachnoid haemorrhage (7%) with IA. Sources of infection were cardiac
(10), meningitis (12), orbital cellulitis (2) or uncertain (1). Infective agents included
bacteria (18), fungi (4), and tubercle bacilli (3). Fifteen IA were distal and 14
were proximal. IAs associated with meningitis were proximal (75%) while those associated
with cardiac diseases preferentially involved carotid territory and were distal (p=0.013). The overall mortality was 32%. Survivors were younger than those who expired
(p=0.015). Of the sixteen patients treated medically, seven recovered (44%), others (56%)
had treatment failure (three died and six required surgery later). Another five patients
underwent early surgery (one died). Mortality of IA was significantly higher with
meningitis, fungal aetiology and vertebrobasilar location.
Conclusions
IAs associated with local infections like meningitis had different clinical profile
as compared to IAs associated with intravascular/systemic infections like infective
endocarditis.
Keywords
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References
- Inflammatory intracranial aneurysm.in: Wilkins R.H. Rengachary S.S. Neurosurgery. Mc Graw-Hill, New York1996: 2379-2382
- Intracranial mycotic aneurysms of extra vascular origin.J Neurosurg. 1972; 36: 552-559
- Bacterial aneurysms of the intracavernous carotid artery.J Neurosurg. 1984; 60: 1236-1242
- Acute inflammation of arteries. Charles C Thomas, Springfield, Ill1946: 16
- Intracranial infective aneurysms presenting with hemorrhage: an analysis of angiographic findings, management and outcome.Clin Radiol. 2000; 55: 946-953
- Intracranial aneurysm. Springer Verlag Inc, New York1983: 418-428
- Management of intracranial infectious aneurysms: a series of 16 cases.Neurosurgery. 2002; 51: 1145-1151
- Bacterial intracranial aneurysm.J Neurosurg. 1978; 48: 369-382
- New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service.Am J Med. 1994; 96: 200-209
- Diagnosis of adult tuberculous meningitis by use of clinical and laboratory features.Lancet. 2002; 360: 1287-1292
- Fever and cerebral vasospasm in ruptured intracranial aneurysms.Surg Neurol. 1980; 14: 459-465
- The international cooperative study on the timing of aneurysm surgery. Part 1: overall management results.J Neurosurg. 1990; 73: 18-36
- Endocarditis-related cerebral aneurysms: radiologic changes with treatment.Am J Neuroradiol. 1995; 16: 745-748
- Bacterial intracranial aneurysms.J Neurosurg. 1980; 53: 633-641
- Treatment of mycotic intracranial aneurysms.J Neurosurg. 1977; 46: 428-437
- Microsurgery for intracranial aneurysm, clinical analysis of 1041 cases.Zhonghua Vi Xue Za Zhi. 2003; 83: 6-8
- Prevalence of intracranial saccular aneurysms in a Japanese community based on a consecutive autopsy series during a 30-year observation period. The Hisayama study.Stroke. 1999; 30: 1390-1395
- Incidence and prevalence of intracranial aneurysms and hemorrhage in Olmsted County, Minnesota, 1965 to 1995.Neurology. 1998; 51: 405-411
- Infectious intracranial aneurysms: comparison of groups with and without endocarditis.Neurosurgery. 1990; 27: 562-572
- Intracerebral aneurysms in human immunodeficiency virus infection: case report and literature review.Pediatr Neurol. 2000; 23: 252-255
- The role of serial angiography in the management of bacterial and fungal intracranial aneurysms—report of two cases and review of the literature.Neurol Med Chir (Tokyo). 1989; 29: 202-216
Article info
Publication history
Accepted:
January 23,
2007
Received in revised form:
December 21,
2006
Received:
July 4,
2006
Identification
Copyright
© 2007 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
