Mycotic aneurysm presenting as subdural empyema: illustrative case.

Joshua T M Lucas,Alexander Yu,Seung W Jeong,Shahed Elhamdani

doi:10.3171/case21507

Joshua T M Lucas, Alexander Yu + Show 2 more

Open Access

https://doi.org/10.3171/case21507

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Abstract

BACKGROUNDMycotic aneurysms (MAs) are rare intracranial pathologies. They are associated with spontaneous rupture, which is often the first presenting sign. Subarachnoid hemorrhage and intraparenchymal hemorrhage are the most common sequelae of ruptured MAs, with subdural hematoma being an atypical presentation. The presentation of an MA as a subdural empyema has not yet been reported in the literature.OBSERVATIONSThe authors discussed a 68-year-old man who presented with subdural empyema and received surgery for evacuation. He was found to have a ruptured mycotic aneurysm intraoperatively.LESSONSThis case demonstrated a rare and atypical presentation of an MA.

Highlights

Mycotic aneurysms (MAs) are rare intracranial pathologies
Observations MAs are rare intracranial pathologies that typically present after rupture
The literature has indicated that MAs are clinically recognized in 3%–10% of patients with infective endocarditis and account for

Summary

BACKGROUND

Mycotic aneurysms (MAs) are rare intracranial pathologies They are associated with spontaneous rupture, which is often the first presenting sign. Subarachnoid hemorrhage and intraparenchymal hemorrhage are the most common sequelae of ruptured MAs, with subdural hematoma being an atypical presentation. OBSERVATIONS The authors discussed a 68-year-old man who presented with subdural empyema and received surgery for evacuation. He was found to have a ruptured mycotic aneurysm intraoperatively. MAs remain clinically silent until spontaneous rupture Once ruptured, they primarily present as either intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH).[4,5] Rarely do MAs present as subdural hematoma, with only 13 cases reported in the literature (Table 1). The presentation of an MA as subdural empyema, has not been reported in the literature

Illustrative Case

Not reported

Findings

Discussion