Successful endovascular occlusion of ruptured intracranial mycotic aneurysm in a child with Ventricular Septal Defect and infective endocarditis – A case report

Abstract

Infective endocarditis is associated with significant morbidity and mortality. Neurologic complications associated with infective endocarditis are cerebral infarction, bacterial meningitis, intracerebral haemorrhage, and mycotic aneurysms. Amongthemintracranial mycotic aneurysm and its rupture is associated with highfatality rateup to 80%. The available treatment for aneurysms include medical, surgical, endovascular or combined. There is no consensus on the modality of choice as both surgical and endovascular treatment have their own merits and demerits. Though endovascular treatment has become a standard in adults in recent times, its use is less in children due to technical difficulties and lack of expertise. Here we report an18 month old child with Ventricular Septal Defect (VSD) and infective endocarditis who developed intracranial mycotic aneurysm and rupture, successfully managed with prompt stabilization with neuroprotective intensive care followed by endovascular coiling and embolization. This is followed by a discussion of management of intracranial mycotic aneurysms in children.