Mycotic aneurysm. Case report with novel sequential angiographic findings.

Abstract

Neurologic complications occur in 20% to 30% of patients with bacterial endocarditis.1-5These complications include ischemic lesions resulting in focal neurologic signs, abscess formation, meningeal reaction, and formation of cerebral mycotic aneurysm—with or without intracranial hemorrhage. Cerebrovascular lesions occur in approximately 50% of patients in this group.1,2The frequency of subarachnoid hemorrhage (SAH) secondary to ruptured mycotic aneurysm in several large series appears to vary between 2.6% and 8%.6,7The incidence of clinically apparent mycotic aneurysm in patients with bacterial endocarditis varies between 2% and 10%.1,2,6,8 9Perhaps because of the low incidence of this entity and because the initial sign is often a catastrophic, fatal SAH, the pathogenesis and natural history of mycotic aneurysm are not as well known as other types of intracranial aneurysms. Recent experience with a patient with subacute bacterial endocarditis coupled with a unique evolution of angiographie findings provoked a reconsideration