Tanaka Tatsuya, Tilyeubyek Talgat, Shimada Furitsu, Takeuchi Yuki, Matsuno Akira
Department of Neurosurgery, International University of Health and Welfare Narita Hospital, Narita, JPN.
Department of Gastroenterology, Kouhoukai Takagi Hospital, Okawa, JPN.
Cureus. 2025 Apr 7;17(4):e81843. doi: 10.7759/cureus.81843. eCollection 2025 Apr.
Infective endocarditis (IE) can lead to serious neurological complications, including septic embolism and infectious intracranial aneurysms (IIAs). Although IIAs are rare, their rupture often results in catastrophic outcomes. Predicting their formation, especially within a short period, remains a clinical challenge. We present the case of a man in his 70s who was newly diagnosed with colon cancer. During preoperative evaluation, transthoracic echocardiography revealed vegetations on the aortic and mitral valves, leading to a diagnosis of IE caused by Streptococcus sanguinis. On the third day of hospitalization, the initial brain magnetic resonance imaging (MRI) revealed asymptomatic cerebral infarction, but magnetic resonance angiography (MRA) did not show any aneurysms. Despite appropriate antibiotic therapy, the patient developed sudden left hemiparesis and impaired consciousness on day 6. Emergent computed tomography (CT) and computed tomography angiography (CTA) revealed a subarachnoid hemorrhage and a newly formed ruptured aneurysm in the M1 segment of the middle cerebral artery. Given the patient's overall prognosis, neurosurgical intervention was deemed inappropriate, and best supportive care was initiated. The patient passed away shortly thereafter. This case highlights the unpredictable nature of IIAs in IE. Although imaging performed just three days prior showed no aneurysms, a rapidly formed and ruptured IIA resulted in fatal subarachnoid hemorrhage. It underscores the challenge of predicting the rupture of infectious aneurysms in IE and emphasizes the importance of frequent imaging follow-up, even when initial imaging findings are normal.
感染性心内膜炎（IE）可导致严重的神经系统并发症，包括脓毒性栓塞和感染性颅内动脉瘤（IIA）。尽管IIA罕见，但其破裂往往导致灾难性后果。预测其形成，尤其是在短时间内形成，仍然是一项临床挑战。我们报告一例70多岁新诊断为结肠癌的男性病例。在术前评估期间，经胸超声心动图显示主动脉瓣和二尖瓣有赘生物，导致诊断为由血链球菌引起的IE。住院第三天，最初的脑部磁共振成像（MRI）显示无症状性脑梗死，但磁共振血管造影（MRA）未显示任何动脉瘤。尽管进行了适当的抗生素治疗，患者在第6天出现突发左侧偏瘫和意识障碍。急诊计算机断层扫描（CT）和计算机断层扫描血管造影（CTA）显示蛛网膜下腔出血以及大脑中动脉M1段新形成的破裂动脉瘤。鉴于患者的整体预后，神经外科干预被认为不合适，遂开始给予最佳支持治疗。此后不久患者死亡。该病例突出了IE中IIA的不可预测性。尽管三天前的影像学检查未显示动脉瘤，但一个迅速形成并破裂的IIA导致了致命的蛛网膜下腔出血。它强调了预测IE中感染性动脉瘤破裂的挑战，并强调了即使初始影像学检查结果正常也需频繁进行影像学随访的重要性。
