Simultaneous intracerebral and subarachnoid hemorrhages caused by multiple infectious intracranial aneurysms treated endovascularly and by microsurgical clipping: illustrative case.

Ken Akimoto,Yuji Matsumaru,Hisayuki Hosoo,Maya Takada,Kiyoyuki Yanaka,Kazuhiro Nakamura,Hayato Takeda,Eiichi Ishikawa,Minami Saura

doi:10.3171/case21685

Abstract

BACKGROUNDInfected intracranial aneurysms are relatively rare but tend to occur in multiple locations. Establishing an optimal treatment strategy for multiple ruptured aneurysms is often challenging, especially when simultaneous ruptures occur in different locations. We report a case of simultaneous intracerebral and subarachnoid hemorrhages caused by the rupture of multiple infected intracranial aneurysms.OBSERVATIONSA 23-year-old male with a 2-week history of chronic fever presented with sudden onset of severe headache and visual disturbance. Computed tomography showed intracerebral hemorrhage in the right occipital lobe and subarachnoid hemorrhage in the area of the left Sylvian fissure. Further investigation documented Staphylococcus bacteremia, verrucae on the mitral valve, and aneurysms arising from the right posterior cerebral artery (PCA) and the left middle cerebral artery (MCA). A larger aneurysm arising from the PCA was successfully occluded endovascularly, but subsequent endovascular occlusion of the MCA aneurysm was unsuccessful because some important branches were observed extending from the aneurysm. The left MCA aneurysm was then obliterated by angioplastic clipping via left pterional craniotomy. The patient showed a favorable neurological recovery after treatment.LESSONSIn such complex cases of infectious aneurysms, the method and timing of treatment need to be carefully determined based on the medical condition.

Highlights

Infected intracranial aneurysms are relatively rare but tend to occur in multiple locations
With simultaneous intracerebral and subarachnoid hemorrhages caused by the rupture of multiple intracranial aneurysms (IIAs) that were successfully resolved with a combination of endovascular treatment and open surgery
Conservative treatment is considered for unruptured aneurysms while craniotomy and/or endovascular treatment are generally

Summary

BACKGROUND

Infected intracranial aneurysms are relatively rare but tend to occur in multiple locations. Establishing an optimal treatment strategy for multiple ruptured aneurysms is often challenging, especially when simultaneous ruptures occur in different locations. We report a case of simultaneous intracerebral and subarachnoid hemorrhages caused by the rupture of multiple infected intracranial aneurysms. Treatment strategies for IIAs, such as craniotomy or endovascular treatment, depend on whether the aneurysm is ruptured or unruptured as well as location, shape, and size.[3,8,10,11] Establishing a treatment strategy for a single ruptured aneurysm may be relatively straightforward, it is difficult to develop an optimal treatment strategy, especially when multiple aneurysms simultaneously rupture at different locations. Unauthenticated | Downloaded 02/28/22 08:42 PM UTC with simultaneous intracerebral and subarachnoid hemorrhages caused by the rupture of multiple IIAs that were successfully resolved with a combination of endovascular treatment and open surgery

Illustrative Case

Findings

Discussion