Wang Joshua L, Hinduja Archana P, Powers Ciarán J
Department of Neurological Surgery, The Ohio State University Wexner Medical Center, United States.
Department of Neurology, The Ohio State University Wexner Medical Center, United States.
J Clin Neurosci. 2017 May;39:95-98. doi: 10.1016/j.jocn.2017.01.021. Epub 2017 Feb 10.
Infectious intracranial aneurysms (IIAs) are rare entities and are often associated with septic embolus from infectious endocarditis. They may develop rapidly and carry a higher risk of rupture and mortality compared to noninfectious aneurysms. However, the development and rupture of an IIA within 48h in a patient with septic infarction patient is exceedingly rare.
In this report, we describe a 25-year-old male who presented with left-sided hemiparesis and dysarthria from septic embolus to the right middle cerebral artery. Thirty-nine hours after presentation, he became encephalopathic following a witnessed seizure. Angiography demonstrated a new, ruptured aneurysm, which was successfully treated with endovascular coil embolization. Our study documents the first report of coil embolization in a rapidly developed infectious aneurysm.
Importantly, this case demonstrates that septic infarction may precede and herald IIA development and rupture. If IIA is detected due to rupture, coil embolization can be a safe and effective therapy.
感染性颅内动脉瘤（IIA）较为罕见，常与感染性心内膜炎的脓毒性栓子相关。与非感染性动脉瘤相比，它们可能迅速发展，破裂和死亡风险更高。然而，脓毒性梗死患者在48小时内发生IIA并破裂极为罕见。
在本报告中，我们描述了一名25岁男性，因右大脑中动脉脓毒性栓子出现左侧偏瘫和构音障碍。就诊39小时后，在一次癫痫发作后他出现脑病症状。血管造影显示一个新的破裂动脉瘤，通过血管内弹簧圈栓塞成功治疗。我们的研究记录了快速发展的感染性动脉瘤中首次进行弹簧圈栓塞的报告。
重要的是，该病例表明脓毒性梗死可能先于并预示IIA的发展和破裂。如果因破裂检测到IIA，弹簧圈栓塞可以是一种安全有效的治疗方法。
