Akimoto Ken, Yanaka Kiyoyuki, Nakamura Kazuhiro, Takeda Hayato, Saura Minami, Takada Maya, Hosoo Hisayuki, Matsumaru Yuji, Ishikawa Eiichi
1Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan; and.
2Division of Stroke Prevention and Treatment, and.
J Neurosurg Case Lessons. 2022 Feb 14;3(7). doi: 10.3171/CASE21685.
Infected intracranial aneurysms are relatively rare but tend to occur in multiple locations. Establishing an optimal treatment strategy for multiple ruptured aneurysms is often challenging, especially when simultaneous ruptures occur in different locations. We report a case of simultaneous intracerebral and subarachnoid hemorrhages caused by the rupture of multiple infected intracranial aneurysms.
A 23-year-old male with a 2-week history of chronic fever presented with sudden onset of severe headache and visual disturbance. Computed tomography showed intracerebral hemorrhage in the right occipital lobe and subarachnoid hemorrhage in the area of the left Sylvian fissure. Further investigation documented Staphylococcus bacteremia, verrucae on the mitral valve, and aneurysms arising from the right posterior cerebral artery (PCA) and the left middle cerebral artery (MCA). A larger aneurysm arising from the PCA was successfully occluded endovascularly, but subsequent endovascular occlusion of the MCA aneurysm was unsuccessful because some important branches were observed extending from the aneurysm. The left MCA aneurysm was then obliterated by angioplastic clipping via left pterional craniotomy. The patient showed a favorable neurological recovery after treatment.
In such complex cases of infectious aneurysms, the method and timing of treatment need to be carefully determined based on the medical condition.
感染性颅内动脉瘤相对罕见，但往往发生在多个部位。为多发破裂动脉瘤制定最佳治疗策略通常具有挑战性，尤其是当不同部位同时发生破裂时。我们报告一例由多个感染性颅内动脉瘤破裂引起的脑内和蛛网膜下腔同时出血的病例。
一名23岁男性，有2周慢性发热病史，突发剧烈头痛和视力障碍。计算机断层扫描显示右枕叶脑内出血和左外侧裂区蛛网膜下腔出血。进一步检查发现葡萄球菌菌血症、二尖瓣疣状赘生物，以及右侧大脑后动脉（PCA）和左侧大脑中动脉（MCA）动脉瘤。起源于PCA的较大动脉瘤成功通过血管内栓塞闭塞，但随后对MCA动脉瘤进行血管内闭塞未成功，因为观察到一些重要分支从动脉瘤发出。然后通过左翼点开颅术进行血管塑形夹闭，闭塞左侧MCA动脉瘤。患者治疗后神经功能恢复良好。
在这种感染性动脉瘤的复杂病例中，需要根据病情仔细确定治疗方法和时机。
