• World Neurosurg · Oct 2020

    Case Reports

    Ruptured Vertebral Artery Dissecting Aneurysm in a Patient with Recurrent Bacterial Meningitis.

    • Zaid Aljuboori, Dale Ding, and Norberto Andaluz.
    • Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA. Electronic address: zaid.aljuboori@yahoo.com.
    • World Neurosurg. 2020 Oct 1; 142: 176-178.

    BackgroundIntracranial mycotic aneurysms are uncommon. They can occur due to extravascular extension or intravascular seeding of the vessel wall. They often result in subarachnoid hemorrhage with poor prognosis. We present a rare case of subarachnoid hemorrhage due to vertebral artery dissection with aproximal anterior inferior cerebellar artery (AICA)-posterior inferior cerebellar artery common trunk mycotic aneurysm after an episode of bacterial meningitis.Case DescriptionA 66-year-old male with history of 2 episodes of culture-negative bacterial meningitis presented with a Hunt and Hess grade II, Fisher grade III subarachnoid hemorrhage. Catheter angiography showed a right-sided intracranial vertebral artery (VA) dissection and a fusiform AICA-posterior inferior cerebellar artery trunk aneurysm. The patient underwent an endovascular occlusion of the VA dissecting aneurysm followed by an occipital artery to AICA bypass with trapping of the aneurysm. The patient developed a left-sided numbness and weakness after the coiling procedure due to anteromedian medullary stroke (occlusion of the right anterior spinal artery). The patient's magnetic resonance imaging 3 weeks before the aneurysm rupture and during the second episode of meningitis showed new enhancement of both vertebral arteries with a mild reduction in the right VA caliber. At 6 weeks' follow-up the patient was off the ventilator but had a modified Rankin Scale score of 5.ConclusionsBacterial meningitis can lead to inflammatory injury of the intracranial vessels with resultant aneurysm formation. New enhancement of the vessel wall indicates that patients are at risk of developing mycotic aneurysms; therefore close observation with repeated vascular imaging is necessary.Copyright © 2020 Elsevier Inc. All rights reserved.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…