Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat University Hospital, 75018 Paris, France.
Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Université Paris-Descartes, INSERM UMR 894, Paris, France.
J Clin Neurosci. 2020 Dec;82(Pt B):237-240. doi: 10.1016/j.jocn.2020.11.001. Epub 2020 Nov 25.
A 72-year-old man received a transcatheter aortic valve implantation (TAVI) 2 years ago for leakage of the degenerative bioprosthesis with Corevalve n°31 implantation, presented infective endocarditis (IE) (streptococcus sanguinis) of the bioprosthetic aortic valve. One month after antibiotic treatment was initiated, he presented a left-sided hemiplegia, a right frontal hematoma. MRI/contrast-enhanced magnetic resonance angiography (CE-MRA) revealed 2 infectious intracranial aneurysms (IIAs) of the right (10 mm) and left middle cerebral artery (MCA) (M2 segment, 5 mm). The right MCA IIA was treated within 1 day by glue-embolization. Seven days later, the patient acutely developed motor aphasia. CE-MRA showed significant enlargement (15 mm) and morphologic change of the ruptured left MCA IIA. This IIA was treated with Onyx-embolization. This case adds additional evidence that IIAs, during IE, can show rapid growth and morphological change over a 7 day course and emphasizes the imperative need of close imaging follow-up when IIAs are managed by antibiotic therapy.
一位 72 岁男性因 Corevalve n°31 植入的退行性生物瓣漏，2 年前接受了经导管主动脉瓣植入术（TAVI）。他出现了感染性心内膜炎（IE）（血链球菌）的生物瓣主动脉瓣感染。开始抗生素治疗一个月后，他出现左侧偏瘫，右侧额部血肿。MRI/增强磁共振血管造影（CE-MRA）显示右侧（10 毫米）和左侧大脑中动脉（MCA）（M2 段，5 毫米）各有 2 个感染性颅内动脉瘤（IIA）。右侧 MCA IIA 在 1 天内通过胶栓塞治疗。7 天后，患者突然出现运动性失语。CE-MRA 显示破裂的左侧 MCA IIA 明显增大（15 毫米）和形态改变。该 IIA 采用 Onyx 栓塞治疗。该病例进一步证明，IE 期间的 IIA 在 7 天的病程中会迅速生长和形态改变，并强调了当 IIA 通过抗生素治疗进行管理时，需要密切进行影像学随访。
