[A case of ruptured mycotic cerebral aneurysm associated with repeated arterial narrowing and remission].

The patient is a 23-year-old male in whom aortic valve regurgitation was pointed out at the age of about 13. From July 26, 1985 he developed a high fever of 39.7 degrees C and on August 5 he suddenly became unconscious with left hemiparesis. On August 10, his consciousness became further disturbed and he was admitted to this Department on the following day. Computed tomographic scan showed subarachnoid hemorrhage and a low density area in the right temporoparietal lobe. Carotid angiography (CAG) revealed an aneurysm 10 mm in size at the end of the horizontal portion of the right middle cerebral artery (MCA) and severe narrowing of the arteries, mainly the right MCA. A mycotic aneurysm due to bacterial endocarditis was diagnosed. In the CAG conducted on August 14, aneurysm had been almost disappeared, but arterial narrowing had been further increased. On September 4, there was a remission of the narrowing, but the aneurysm could again be visualized to be 7 mm in size, which increased to 14 mm on September 20. A neck clipping of the aneurysm and an aneurysmectomy were performed on September 27. Operative findings showed degeneration and thickening of the walls of the aneurysm and arteries with inflammatory reaction. An arterial blood culture conducted at the time of a recurrence of bacterial endocarditis demonstrated non-hemolytic Streptococcus. CAG conducted on November 1 showed remarkable narrowing of the right MCA, but CAG performed on April 1, 1986 showed the narrowing to be alleviated. There is a danger of rupture in mycotic aneurysm due to bacterial endocarditis.(ABSTRACT TRUNCATED AT 250 WORDS)