Kanaya N, Sato K, Komeichi T, Morimoto S, Ujike Y, Namiki A
Department of Anesthesiology, Sapporo Medical College.
Masui. 1993 Sep;42(9):1359-62.
Mycotic cerebral aneurysms (MCA) are one of the most serious complications of infective endocarditis. The rupture of MCA in patients under anticoagulant therapy following valve replacement carries high mortality. We encountered this serious complication in a patient who had no neurologic symptoms. A 12-year-old girl was scheduled for mitral valve replacement (MVR) 5 weeks after antibiotic therapy for infective endocarditis caused by Staphylococcus aureus. Before the surgery, she did not have any neurologic symptoms or abnormal findings in CT scanning examination. The surgery to remove her mitral valve with bacterial vegetations and replace it with an artificial valve proceeded smoothly and she appeared to begin an uneventful postoperative recovery. However, she suddenly began to complain of severe headache and became unconscious on the fifth days after MVR. A CT scan showed cerebral herniation due to a major subdural hematoma. A ruptured MCA was detected in the orbito-frontal artery and clipped in an emergency operation. She was transferred to the intensive care unit and given continuous infusion of barbiturate to prevent increase of her intracranial pressure. CT scanning and arteriography 10 days after the MCA clipping, revealed a new subdural hematoma and MCA just proximal to the previous clip. It is important to bear in mind that patients with infective endocarditis can have mycotic cerebral aneurysms without any clinical neurologic symptoms.
真菌性脑动脉瘤（MCA）是感染性心内膜炎最严重的并发症之一。瓣膜置换术后接受抗凝治疗的患者中，MCA破裂会导致高死亡率。我们在一名没有神经系统症状的患者身上遇到了这种严重并发症。一名12岁女孩在因金黄色葡萄球菌引起的感染性心内膜炎接受抗生素治疗5周后，计划进行二尖瓣置换术（MVR）。手术前，她没有任何神经系统症状，CT扫描检查也未发现异常。切除带有细菌性赘生物的二尖瓣并置换人工瓣膜的手术进展顺利，术后她似乎开始平稳恢复。然而，在MVR术后第5天，她突然开始抱怨剧烈头痛并失去意识。CT扫描显示因巨大硬膜下血肿导致脑疝。在眶额动脉发现一个破裂的MCA，并在急诊手术中进行了夹闭。她被转到重症监护病房，并持续输注巴比妥酸盐以防止颅内压升高。MCA夹闭术后10天的CT扫描和血管造影显示，在先前夹子近端出现了新的硬膜下血肿和MCA。需要牢记的是，感染性心内膜炎患者可能没有任何临床神经系统症状却患有真菌性脑动脉瘤。
