TITLE:
A Rare Cause of Hemiparesis: Intracranial Mycotic Aneurysm—A Case Report, and Review of the Literature
AUTHORS:
Yao Christian Hugues Dokponou, Mehdi Hakkou, Olivier Ouambi, Nourou Dine Adeniran Bankole, Abdessamad El Ouahabi
KEYWORDS:
Mycotic Aneurysm, Endocarditis, Endovascular, Case Report
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.11 No.3,
July
15,
2021
ABSTRACT: Background: The intracranial mycotic aneurysm is known to be a rare complication of
infective endocarditis and it is more clinically challenging to get this
diagnosis right when it happened to be in a patient without a past medical
history of heart diseases. We report a documented case of mycotic aneurysm
revealed by isolated left hemiparesis and our management with the collaboration
of the cardiology department. Case Description: A 48-year-old male patient with a
history of teeth loss, a chronic smoker presented with sudden heaviness in the left
upper and lower limbs. No fever. Physical examination revealed a left
hemiparesis of 3/5 on the muscle tone scale without the stiffness of the neck. The
CT-Scan and the MRI conclude of subarachnoid and cerebral hemorrhage with right
temporal hematoma being most probably a vascular malformation. The cerebral
arteriography concluded of a right Sylvian mycotic distal aneurysm in the M4
segment. Transesophageal echocardiography was performed and concluded of
infectious endocarditis with mitral and aortic valvular disease grade II.
Positive blood culture for staphylococcus coagulase-negative. The patient was
managed with antibiotic therapy and clinically stable after 28 days. He was
then transferred to the cardiology department for follow-up. Six (6) months later
a CT-angiography was done for a check-up and shows no further changes in the
aneurysm. The patient underwent surgery, two (2) months later, for clipping the
aneurysm because the aneurysm did not regress in size. The aneurysm was then excluded
with an eventless post-operative period, confirmed by controlled cerebral
arteriography. The patient was discharged five (5) days later and he is doing
well. Conclusion: Mycotic aneurysm is a rare consequence of infective endocarditis. The distal
sites of the middle cerebral artery are commonly found, and conservative
treatment with a long course of antibiotics like amoxicillin 12 g/24h for 6
weeks or direct surgical clipping or excision can manage it.