Treatment of intracranial mycotic aneurysm: surgery or not. A case report.

Mycotic intracranial aneurysms are of infectious origin and, even nowadays, their treatment remains controversial with advocates for either surgical or medical treatment. We present the case of a 58-year-old patient who was admitted to the hospital with a left hemiparesis due to a large right parietal haematoma. An angiogram demonstrated a small vascular malformation localized on a distal parietal branch of the right Sylvian artery. The patient was operated on and recovered well. Nevertheless, a control angiogram demonstrated the disappearance of the previous malformation but showed a new saccular aneurysm localized on the right rolandic artery. At the same time the patient became septic and the diagnosis of endocarditis complicated by mycotic aneurysm was confirmed. The patient was then medically treated with antibiotics for two months and several angiograms showed the progressive disappearance of this aneurysm. Different treatments of intracranial mycotic aneurysms are finally reviewed and a therapeutic approach is discussed.