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  • A True Intracranial Mycotic Aneurysm of the Posterior Cerebral Vasculature due to Aspergillus – Case Report and Review of the Literature

    Final Number:
    208

    Authors:
    Chen Xu M.D.; Raj Kiran Nangunoori MD; Diana Jho MD, MS; Alejandro Castellvi MD; Cunfeng Pu M.D., Ph.D.; Khaled M. Aziz MD PhD

    Study Design:
    Other

    Subject Category:
    Aneurysm/Subarachnoid Hemorrhage

    Meeting: AANS/CNS Cerebrovascular Section 2015 Annual Meeting

    Introduction: True intracranial mycotic aneurysms are rare and those that arise in the posterior circulation are even more uncommon. The most commonly involved locations are the smaller cortical branches of the middle cerebral artery (MCA), with only 5% occurring in the posterior cerebral circulation [2]. We report a patient who presented with an Aspergillus-infected mycotic aneurysm of the posterior cerebral artery with subarachnoid hemorrhage and subsequent development of a mycotic aneurysm of the superior cerebellar artery. A review of the literature was also performed to review all Aspergillus-related mycotic aneurysm cases with regards to their treatments and outcomes.

    Methods: A review of the medical care and medical course of the patient was reported. In addition, literature review of all Aspergillus-related mycotic aneurysm cases with regards to their treatments and outcomes was performed.

    Results: A review of the literature showed 29 reported cases of Aspergillus-infected intracranial aneurysms from 1970-2014. In the majority of cases treatment was not promptly directed at a fungal etiology and consequently patients suffered aneurysm rupture, subarachnoid hemorrhage, diminished neurological function, and eventual death with Aspergillus infections diagnosed post-mortem. Of all the reported cases, only 4 presented patients surviving after surgical intervention with anti-fungal therapy [1, 3, 4, 5].

    Conclusions: Aspergillus-infected intracranial aneurysm outcomes reported in the literature have been poor. However, early detection and prompt implementation of appropriate medical, specifically anti-fungal, therapy and in appropriate cases, surgical intervention, may serve to prevent enlargement of these lesions and the development of new aneurysms, decrease the incidence of ruptures, and ultimately improve patient outcomes.

    Patient Care: This case report study will show that with intracranial mycotic aneurysms, in addition to the common bacterial sources, the more rare fungal etiologies must be investigated. This will allow for early detection and prompt implementation of the appropriate medical and surgical interventions that will offer patients a treatment regimen directed at the correct source and present them with the best chance at favorable outcomes.

    Learning Objectives: By the conclusion of this session, participants should: 1) Be able to describe the pathogenicity of Aspergillus-infected mycotic aneurysms, 2) Be aware of the importance of prompt identification and implementation of appropriate therapy for this rare disease.

    References: 1. Abecassis IJ, Adel JG, Ayer A, Batjer HH (2013) A ruptured infectious intracranial aneurysm with a combined fungal and bacterial etiology. Clinical Neurology and Neurosurgery 115:2393-2396 2. Davidson P, Robertson DM (1971) A true mycotic (Aspergillus) aneurysm leading to fatal subarachnoid hemorrhage in a patient with hereditary hemorrhagic telangiectasia. J Neurosurg 35:71-76 3. Kim YC, Lee H, Ryu HH, Beom SH, Yang Y, Kim S, Chin HJ (2012) Aspergillus-associated cerebral aneurysm successfully treated by endovascular and surgical intervention with voriconazole in lupus nephritis patient. J Korean Med Sci 27(3):317-320 4. Negoro E, Morinaga K, Taga M, Kaizaki Y, Kawai Y (2013) Mycotic aneurysm due to Aspergillus sinusitis. International J of Hematology 98(1):4-5 5. Pianetti FG, Pedroso ER, Giannetti AV, Darwich R (2005) Cerebral Aspergillus abscess in immunocompetent patient [Portuguese]. Arquivos de Neuro-Psiquiatria 63(4):1094-1098

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