J Cerebrovasc Endovasc Neurosurg.  2013 Sep;15(3):235-240. 10.7461/jcen.2013.15.3.235.

Ruptured Mycotic Aneurysm of the Distal Middle Cerebral Artery Manifesting as Subacute Subdural Hematoma

• Lee SM
• Park HS
• Choi JH
• Huh JT

• KMID: 1491445
• DOI: http://doi.org/10.7461/jcen.2013.15.3.235

Abstract

Mycotic aneurysms are rare inflammatory neurovascular lesions. Ruptured mycotic aneurysm manifesting as subdural hematoma is extremely rare. A 72-year-old male patient was admitted to our hospital with headache and drowsiness. Computer tomography (CT) of brain and CT angiography revealed subdural hematoma and an aneurysm located at the M4 segment of the left middle cerebral artery (MCA). Cerebral angiogram revealed 2 aneurysms; one located at the left distal MCA and the other at the bifurcation of left MCA. Laboratory studies showed leukocytosis and elevated inflammatory factors. The patent was treated with antibiotic therapy for 4 weeks. The follow-up CT and cerebral angiography showed that the mycotic aneurysm was completely resolved, and the patient was nearly free of symptoms.

Keyword

Mycotic aneurysm; Subdural hematoma; Middle cerebral artery

MeSH Terms

Aged
Aneurysm
Aneurysm, Infected
Angiography
Brain
Cerebral Angiography
Follow-Up Studies
Headache
Hematoma, Subdural
Humans
Leukocytosis
Male
Middle Cerebral Artery
Sleep Stages

Figure

• 

  Fig. 1 Enhanced computed tomography (CT) of brain shows subacute subdural hematoma (SDH) and an enhancing nodule in the left fronto-parietal region and scanty subacute SDH in right fronto-parietal region. The CT angiography reveals that the enhancing nodule is a saccular aneurysm located at the M4 segment of left middle cerebral artery.

• 

  Fig. 2 Initial cerebral angiogram reveals 2 aneurysms; one located at the M4 segment of the left middle cerebral artery (MCA) and the other at the bifurcation of the left MCA.

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  Fig. 3 Follow-up computed tomography (CT) scan 10 days after admission shows that both subdural hematomas were partially resolving state, and the enhanced CT scan shows that the enhancing nodule in the left parietal area disappears.

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  Fig. 4 Cerebral angiography 20 days after antibiotic therapy reveals that the aneurysm located at the M4 segment of the left middle cerebral artery (MCA) disappears and that the aneurysm located at the bifurcation of the left MCA has no interval change.

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