Intracranial infectious aneurysms (IA) are infrequent, but can be fatal.
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.
We analysed all cases of IA, treated in this Institute from 1976 to 2003, in order
to identify prognostic factors.
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.
IAs associated with local infections like meningitis had different clinical profile
as compared to IAs associated with intravascular/systemic infections like infective