scholarly journals Ruptured Intracranial Mycotic Aneurysm in Infective Endocarditis: A Natural History

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
Isabel Kuo ◽  
Theodore Long ◽  
Nathan Nguyen ◽  
Bharat Chaudry ◽  
Michael Karp ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Natural History ◽  
Intracranial Aneurysms ◽  
Mycotic Aneurysm ◽  
Treatment Modalities ◽  
Intraparenchymal Hemorrhage ◽  
Retrospective Case ◽  
Aneurysm Clipping ◽  
History Of ◽  
Mycotic Aneurysms

Mycotic aneurysms are a rare cause of intracranial aneurysms that develop in the presence of infections such as infective endocarditis. They account for a small percentage of all intracranial aneurysms and carry a high-mortality rate when ruptured. The authors report a case of a 54-year-old man who presented with infective endocarditis of the mitral valve and acute stroke. He subsequently developed subarachnoid hemorrhage during antibiotic treatment, and a large intracranial aneurysm was discovered on CT Angiography. His lesion quickly progressed into an intraparenchymal hemorrhage, requiring emergent craniotomy and aneurysm clipping. Current recommendations on the management of intracranial Mycotic Aneurysms are based on few retrospective case studies. The natural history of the patient's ruptured aneurysm is presented, as well as a literature review on the management and available treatment modalities.

Abstract 1122‐000053: Trends in Intervention Modality for Patients with Mycotic Aneurysms: A Nationwide Analysis

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Giana Dawod ◽  
Giana Dawod ◽  
Cenai Zhang ◽  
Hang Shi ◽  
Alexander E Merkler ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
The United States ◽  
Sample Survey ◽  
Treatment Modalities ◽  
National Inpatient Sample ◽  
Mycotic Aneurysms ◽  
Over Time ◽  
Infectious Intracranial Aneurysms

Introduction : Mycotic aneurysms, also known as infectious intracranial aneurysms, are sometimes responsible for intracranial hemorrhage in patients with infective endocarditis. Data regarding when and how to treat mycotic aneurysms most effectively are sparse. Given the widespread adoption of endovascular treatments for non‐infectious intracranial aneurysms and acute stroke, we hypothesized that endovascular treatment is increasingly utilized for patients with mycotic aneurysms. We examined trends in endovascular versus open neurosurgical treatment of mycotic aneurysms in patients with infective endocarditis. Methods : We performed a trends analysis using data from 2000–2015 from the National Inpatient Sample. The National Inpatient Sample is an all‐payer database that includes data for a representative sample of hospitalizations to non‐federal hospitals in the United States. We included all hospitalizations for patients with ruptured (on the basis of subarachnoid hemorrhage) or unruptured cerebral aneurysms alongside a diagnosis of infective endocarditis; diagnoses were ascertained using ICD‐9‐CM codes. Treatment modalities were categorized as endovascular versus open neurosurgical repair based on ICD‐9‐CM procedure codes. National Inpatient Sample survey weights were used to calculate nationally representative estimates. Logistic regression was used to evaluate the association between calendar year and intervention rate, presented as an odds ratio for each additional year. Results : We identified 1,015 hospitalizations for patients with a ruptured or unruptured cerebral aneurysm in the setting of infective endocarditis. Their mean age was 54.6 years (SD, 16.6), and 60.1% were male. The overall rate of intervention was 11.9% (95% CI, 9.6‐14.2%), and this rate did not change appreciably over time (p = 0.772). In comparing intervention modalities over time, there was a decrease in open neurosurgical repair (OR, 0.89; 95% CI, 0.84‐0.95; p = 0.001), offset by an increase in endovascular repair (OR, 1.07; 95% CI, 1.01‐1.14; p = 0.023) (Figure). Conclusions : Rates of mycotic aneurysm intervention during hospitalizations for infective endocarditis have not changed. However, the use of endovascular treatment has become more commonplace while the use of open neurosurgical treatments has decreased. Further directions include understanding whether this shift has improved patients’ outcomes and ultimately enumerating best practices for patients with mycotic aneurysms.

Antibiotic Therapy Did Not Prevent the Rupture of Mycotic Aneurysm of the Superior Mesenteric Artery

2015 ◽  
Vol 18 (3) ◽  
pp. 088
Author(s):  
Ye-tao Li ◽  
Xiao-bin Liu ◽  
Tao Wang
Keyword(s):  
Abdominal Pain ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mycotic Aneurysm ◽  
Acute Abdominal Pain ◽  
Rare Complication ◽  
Emergency Operation ◽  
History Of

<p class="p1"><span class="s1">Mycotic aneurysm of the superior mesenteric artery (SMA) is a rare complication of infective endocarditis. We report a case with infective endocarditis involving the aortic valve complicated by multiple septic embolisms. The patient was treated with antibiotics for 6 weeks. During preparation for surgical treatment, the patient developed acute abdominal pain and was diagnosed with a ruptured SMA aneurysm, which was successfully treated with an emergency operation of aneurysm ligation. The aortic valve was replaced 17 days later and the patient recovered uneventfully. In conclusion, we present a rare case with infective endocarditis (IE) complicated by SMA aneurysm. Antibiotic treatment did not prevent the rupture of SMA aneurysm. Abdominal pain in a patient with a recent history of IE should be excluded with ruptured aneurysm.</span></p>

Unruptured intracranial aneurysms in children: 18 years’ experience in a tertiary care pediatric institution

2019 ◽  
Vol 24 (2) ◽  
pp. 184-189 ◽  
Author(s):  
Daniel-Alexandre Bisson ◽  
Peter Dirks ◽  
Afsaneh Amirabadi ◽  
Manohar M. Shroff ◽  
Timo Krings ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Natural History ◽  
Internal Carotid Artery ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Tertiary Care ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Mean Size

OBJECTIVEThere are little data in the literature on the characteristics and natural history of unruptured intracranial aneurysms in children. The authors analyzed their experience with unruptured intracranial aneurysms in the pediatric population at their tertiary care pediatric institution over the last 18 years. The first objective was to assess the imaging characteristics and natural history of these aneurysms in order to help guide management strategies in the future. A second objective was to evaluate the frequency of an underlying condition when an incidental intracranial aneurysm was detected in a child.METHODSThe authors conducted a Research Ethics Board–approved retrospective review of incidental intracranial aneurysms in patients younger than 18 years of age who had been treated at their institution in the period from 1998 to 2016. Clinical (age, sex, syndrome) and radiological (aneurysm location, type, size, thrombus, mass effect) data were recorded. Follow-up imaging was assessed for temporal changes.RESULTSSixty intracranial aneurysms occurred in 51 patients (36 males, 15 females) with a mean age of 10.5 ± 0.5 years (range 9 months–17 years). Forty-five patients (88.2%) had a single aneurysm, while 2 and 3 aneurysms were found in 3 patients each (5.8%). Syndromic association was found in 22 patients (43.1%), most frequently sickle cell disease (10/22 [45.5%]). Aneurysms were saccular in 43 cases (71.7%; mean size 5.0 ± 5.7 mm) and fusiform in the remaining 17 (28.3%; mean size 6.5 ± 2.7 mm). Thirty-one aneurysms (51.7%) arose from the internal carotid artery (right/left 1.4), most commonly in the cavernous segment (10/31 [32.3%]). Mean size change over the entire follow-up of 109 patient-years was a decrease of 0.6 ± 4.2 mm (range −30.0 to +4.0 mm, rate −0.12 ± 9.9 mm/yr). Interval growth (2.0 ± 1.0 mm) was seen in 8 aneurysms (13.3%; 4 saccular, 4 fusiform). An interval decrease in size (8.3 ± 10.7 mm) was seen in 6 aneurysms (10%). There was an inverse relationship between aneurysm size and growth rate (r = −0.82, p < 0.00001). One aneurysm was treated endovascularly with internal carotid artery sacrifice.CONCLUSIONSUnruptured pediatric intracranial aneurysms are most frequently single but can occur in multiples in a syndromic setting. None of the cases from the study period showed clinical or imaging signs of rupture. Growth over time, although unusual and slow, can occur in a proportion of these patients, who should be identified for short-term imaging surveillance.

scholarly journals Natural History of Unruptured Intracranial Aneurysms

2018 ◽  
Vol 27 (3) ◽  
pp. 184-191
Author(s):  
Jun C. Takahashi ◽  
Hiroharu Kataoka ◽  
Tetsu Satow ◽  
Hisae Mori
Keyword(s):  
Natural History ◽  
Intracranial Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
History Of

Rothia dentocariosa causing intracranial mycotic aneurysm and ischaemic stroke

2021 ◽  
Vol 14 (3) ◽  
pp. e240349
Author(s):  
Eli Kisilevsky ◽  
Nataly Pesin ◽  
Daniel Mandell ◽  
Edward A Margolin
Keyword(s):  
Intracranial Aneurysms ◽  
Mycotic Aneurysm ◽  
Systemic Infection ◽  
Bacterial Endocarditis ◽  
Medical Assessment ◽  
Subacute Bacterial Endocarditis ◽  
Brain Aneurysm ◽  
High Incidence ◽  
Mycotic Aneurysms ◽  
Untreated Dental Caries

We describe a case of subacute bacterial endocarditis and mycotic brain aneurysm caused by Rothia dentocariosa due to untreated dental caries. R. dentocariosa is a rare cause of endocarditis that has a high incidence of aneurysmal and haemorrhagic complications. All patients with intracranial aneurysms who have signs of systemic infection should be considered to have mycotic aneurysms until proven otherwise. Dental habits should be included in regular medical assessment and dental care should be considered for patients presenting with infectious symptoms.

scholarly journals Trapeziometacarpal joint arthritis: A retrospective study of the natural history of symptomatic thumb arthritis

2019 ◽  
Vol 5 (2) ◽  
pp. 11
Author(s):  
Jessica Frankenhoff ◽  
Jeffrey Stromberg ◽  
Aimee Riley ◽  
Jun He ◽  
Prem Madesh ◽  
...  
Keyword(s):  
Natural History ◽  
Retrospective Chart Review ◽  
Treatment Modalities ◽  
Common Source ◽  
Average Pain ◽  
Average Pain Score ◽  
History Of ◽  
And Function ◽  
Joint Arthritis

Objective: Trapeziometacarpal (TM) joint arthritis is a common source of hand pain in patients presenting to the hand surgeon’s clinic. Long-term data on the natural history of symptomatic TM arthritis is lacking.Methods: We identified 251 patients with symptomatic TM arthritis and performed a retrospective chart review which identified treatment modalities (including surgery) and long term outcomes which were assessed via a telephone survey.Results: We found that of the 251 patients who presented with symptomatic TM arthritis, the 114 patients who had surgery had less pain and disability in the long term than those patients who were treated conservatively with splinting or injection (average pain score 1.8 vs. 3.8). However, the majority of patients did not ultimately undergo surgery.Conclusions: Although patients fare better from a pain and function standpoint with surgery, surgery is not inevitable.

Current implications for the efficacy of noninvasive screening for occult intracranial aneurysms in patients with a family history of aneurysms

1995 ◽  
Vol 83 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Nancy A. Obuchowski ◽  
Michael T. Modic ◽  
Michele Magdinec
Keyword(s):  
Family History ◽  
Natural History ◽  
Life Expectancy ◽  
Intracranial Aneurysms ◽  
Positive Family History ◽  
Aneurysm Rupture ◽  
Average Life Expectancy ◽  
Content Type ◽  
Rupture Rate ◽  
History Of

✓ Although the technology exists for accurate noninvasive screening for intracranial aneurysms, the efficacy of screening depends on several key parameters of the natural history of aneurysms. Recent studies suggest that the prevalence of intracranial aneurysms may reach 20% in the subpopulation of patients with a family history of these lesions; other key parameters are less certain. The authors investigated factors that impact the efficacy of screening to establish interim guidelines. Three plausible models for the natural history of aneurysms were constructed. For each model the monetary cost of screening and the average gain in life expectancy were computed for a range of screening ages and prevalence rates. It is shown that the efficacy of screening depends on the pattern of aneurysm rupture. If aneurysms develop and rupture rapidly, then screening has no benefit. On the other hand, if aneurysms remain at risk for some time after formation, then screening may improve average life expectancy depending on when it occurs. The authors recommend that patients with a positive family history of aneurysms who are 30 years of age or younger be screened. This recommendation is based on the belief that the gains attributable to screening, assuming a constant rupture rate, outweigh the losses attributable to screening using a decreasing rupture rate model.

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