Singla Vivek, Sharma Rajni, Nagamani A C, Manjunath Cholenahally Nanjappa
Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
BMJ Case Rep. 2013 Jun 28;2013:bcr2013200016. doi: 10.1136/bcr-2013-200016.
Mycotic cerebral aneurysm is a rare and potentially fatal complication of infective endocarditis. A young man was diagnosed with culture negative infective endocarditis of mitral valve with cerebral aneurysm. The patient was started on conservative management, but he died owing to intracerebral haemorrhage. In the absence of large randomised trials, there is a lack of consensus regarding the management of unruptured aneurysms. Since mycotic aneurysms are known to resolve or decrease in size with antimicrobial therapy, several institutions advice the conservative approach. A few case reports like the present case have shown that the risk of aneurysmal rupture and death is considerably high with the conservative approach. Endovascular therapy has shown to reduce the mortality in this subgroup. These patients should be managed aggressively with endovascular or surgical procedure along with antimicrobial therapy.
霉菌性脑动脉瘤是感染性心内膜炎一种罕见且可能致命的并发症。一名年轻男性被诊断为二尖瓣培养阴性的感染性心内膜炎并伴有脑动脉瘤。患者开始接受保守治疗，但因脑出血死亡。由于缺乏大型随机试验，对于未破裂动脉瘤的治疗尚无共识。鉴于已知霉菌性动脉瘤可通过抗菌治疗消退或缩小，一些机构建议采用保守方法。像本病例这样的一些病例报告表明，保守治疗时动脉瘤破裂和死亡的风险相当高。血管内治疗已显示可降低该亚组的死亡率。这些患者应积极接受血管内或外科手术治疗并辅以抗菌治疗。
