Abstract
30 years old lady, a beautician presented to private hospital with sudden onset of headache and left sided weakness. Computed tomography angiography (CTA) of the brain revealed acute right temporal lobe intracerebral haematoma with right Sylvian fissure subarachnoid haemorrhage and right middle cerebral artery aneurysm. She underwent emergency clipping of the aneurysm. Histopathology examination showed extensive suppurative inflammation with tissue necrosis consistent with mycotic aneurysm. She was subsequently referred to our centre for further management. Further history revealed history of prolonged fever at age 18 years and she was diagnosed to have infective endocarditis requiring intravenous antibiotics for a month. She was advised for yearly follow up with echocardiogram but defaulted. She had orthodontic braces inserted with tooth extraction 3 months prior, of which no antibiotic prophylaxis was prescribed. She denied intravenous drug abuse and was not sexually active.
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