1Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia; 6Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia.
Acta Clin Croat. 2020 Dec;59(4):754-760. doi: 10.20471/acc.2020.59.04.24.
Infected intracranial aneurysms are a rare type of inflammatory vascular lesions that occur due to infection of intracranial arterial wall. Brain aneurysms of distal arterial branches are equally rare and frequently multiple, including those situated at the peripheral middle cerebral artery segments. Although both types represent a small percentage of all intracranial aneurysms, they may bring about high mortality in case of rupture. The management of such aneurysms includes conservative treatment with broad-spectrum antibiotics, and microsurgical or endovascular treatment, which is gaining more prominence for both asymptomatic and ruptured aneurysms. Herein, we present a case of a 61-year-old male patient with a history of cardiac infective disease and multiple bilateral aneurysms of infected distal branch middle cerebral arteries, discussing the efficacy of available endovascular treatment modalities and reviewing the literature. In conclusion, selective endovascular coiling is a preferable method in the current management of distal branch infected ruptured intracranial aneurysms, which may bring a favorable outcome.
感染性颅内动脉瘤是一种罕见的炎症性血管病变,是由于颅内动脉壁感染引起的。远端动脉分支的脑动脉瘤同样罕见且常为多发性,包括位于大脑中动脉周边节段的动脉瘤。尽管这两种类型在所有颅内动脉瘤中占比较小,但破裂时可能导致高死亡率。此类动脉瘤的治疗包括广谱抗生素的保守治疗以及显微外科或血管内治疗,后者对于无症状和破裂的动脉瘤越来越受到重视。本文报告了一例 61 岁男性患者,有心脏感染性疾病病史,双侧大脑中动脉多发感染性远端分支动脉瘤,讨论了现有的血管内治疗方式的疗效,并复习文献。总之,选择性血管内线圈填塞术是目前治疗感染性破裂颅内远端分支动脉瘤的一种较好方法,可能带来良好的预后。