Mycotic aneurysms of the intracranial and peripheral circulation: A rare complication of bacterial endocarditis

• Published in: Annals of the Indian Academy of Neurology Vol. 17; no. 1; pp. 82 - 84
• Main Authors: Jain, Rajendra Singh, Mathur, Tarun, Srivastava, Trilochan, Jain, Rahul, Sannegowda, Raghavendra Bakki
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.01.2014; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Aneurysm, Infected; Aneurysms; Case studies; Complications and side effects; Drug therapy; Endocarditis, Bacterial; Fever; Images in Neurology; Medical imaging; Neurological research; Thrombosis; Veins & arteries; India
• DOI: 10.4103/0972-2327.128560
• ISSN: 0972-2327

Blood cultures were repeatedly sent in view of history of longstanding recurrent fever and clinical suspicion of bacterial endocarditis, but were negative each time however still a diagnosis of possible infective endocarditis could be made from Duke's minority criteria [1] as there was predisposing heart condition, presence of persistent fever, evidence of vascular phenomenon in the form of mycotic aneurysm and intracranial hemorrhage (as detailed in discussion) and immunological phenomenon in the form of glomerulonephritis. {Figure 3} After 1 month, he developed a pulsatile painful swellling in left elbow region and in view of clinical suspicion of arterial aneurysm, upper limb angiogram was carried out along with brain angiogram, which revealed large pseudoaneurysm arising from left brachial artery while in CT angio brain there was the paucity of flow in left middle cerebral artery distal branches with complete disappearance of previously visible left MCA aneurysm [Figure 4] suggestive of complete thrombosis of that aneurysm.