Inoue Tomoo, Anzai Takao, Utsumi Yasuhumi
Department of Neurosurgery, Ohara Medical Center, 33 Aza Nakae, Kamata, Fukushima 960-0195, Japan.
No Shinkei Geka. 2006 Oct;34(10):1051-5.
A 38-year-old left-handed male, with a past history of ventricular septal defect, presented to our hospital with complaints of sudden onset of right hemiparesis and restlessness. Computed tomography (CT) showed a hypodense area in the left insular cortex and corona radiata. The symptoms worsened on the next day, and CT demonstrated a new hypodense area in the left temporal lobe. Echocardiography showed vegetation on the mitral valve, so the patient was treated with a high dose of antibiotics under a diagnosis of infective endocarditis. Although the course was uneventful, subarachnoid hemorrhage was observed on the 4th day, which was followed by hemorrhagic infarction. Cerebral angiography revealed an aneurysm of the bifurcation of the middle cerebral artery and occlusion of the superior trunk of the M2 portion. T he aneurysmwas successfully obliterated, and histological examinationestablished the diagnosis of a bacterial aneurysm caused by septic embolism. Septic embolism originating from infectious endocarditis is likely to be followed by acute hemodynamic changes and fatal events. Therefore, the possibility of bacterial aneurysm should be considered immediately in patients with neurological deficits caused by septic embolism.
一名38岁的左利手男性，有室间隔缺损病史，因突发右侧偏瘫和烦躁不安前来我院就诊。计算机断层扫描（CT）显示左侧岛叶皮质和放射冠有低密度区。症状在第二天加重，CT显示左侧颞叶出现新的低密度区。超声心动图显示二尖瓣有赘生物，因此该患者在诊断为感染性心内膜炎后接受了大剂量抗生素治疗。尽管病程平稳，但在第4天观察到蛛网膜下腔出血，随后出现出血性梗死。脑血管造影显示大脑中动脉分叉处有动脉瘤，M2段上干闭塞。动脉瘤成功闭塞，组织学检查确诊为脓毒性栓塞所致的细菌性动脉瘤。源于感染性心内膜炎的脓毒性栓塞很可能继以急性血流动力学改变和致命事件。因此，对于由脓毒性栓塞引起神经功能缺损的患者，应立即考虑细菌性动脉瘤的可能性。
