Successful endovascular treatment of pediatric basilar infectious (mycotic) aneurysm: a case report and review of the li
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CASE REPORT
Successful endovascular treatment of pediatric basilar infectious (mycotic) aneurysm: a case report and review of the literature Kittiphop Somboonnithiphol 1 & Ekachat Chanthanaphak 1 & Sirintara (Pongpech) Singhara Na Ayudhaya 1 & Chaiyos Khongkhatithum 2 & Bandit Sirilert 1 Received: 22 July 2020 / Accepted: 1 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Intracranial infectious aneurysms are rarely reported in children; in particular, they are very rare in infants. They are mostly related to infective endocarditis and are usually located in the anterior cerebral vasculature. A ruptured intracranial infectious aneurysm is a catastrophic event associated with high morbidity and mortality rates. Case report An 8-month-old female infant presented with a prolonged fever without any organ-specific symptoms. Two weeks after admission, she had a high-grade fever with drowsiness; the cerebrospinal fluid (CSF) examination indicated meningitis. Despite treatments with empiric antibiotic and antiviral agents, both her condition and the repeated CSF profiles worsened. The ineffective medications were promptly changed to susceptible antibiotic after the CSF culture showed Pseudomonas aeruginosa. Three days after the diagnosis of meningitis, the patient suddenly developed seizures and alteration of consciousness. The computerized tomography and angiography (CT and CTA) of the brain demonstrated a diffuse subarachnoid hemorrhage (SAH) with intraventricular hemorrhage (IVH) and a lobulated fusiform aneurysm at the proximal basilar artery, suggestive of a ruptured basilar infectious aneurysm. Endovascular treatment was planned and a transarterial occlusion of the vertebrobasilar junction was performed in order to disrupt inflow of the aneurysm. After endovascular intervention, her clinical symptoms gradually improved and the patient was discharged after completing a 4-week course of antibiotics. At the 6-week follow-up, she was doing well without neurological deficit. Conclusion To our knowledge, this is the first reported case of a ruptured basilar infectious aneurysm in an infant secondary to Pseudomonas meningitis, successfully treated with parent artery occlusion. Keywords Infectious (mycotic) aneurysm . Basilar artery . Infant . Intracranial hemorrhage . Endovascular parent artery occlusion
Introduction Intracranial infectious aneurysms are rarely reported in children; in particular, they are very rare in infants [23]. Infectious aneurysms develop secondary to the invasion of infectious pathogens in the tunica media causing vascular wall necrosis. Infectious pathogens frequently disseminate through the arterial wall via the bloodstream, principally * Bandit Sirilert [email protected] 1
Department of Radiology, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok 10400, Thailand
2
Department of Pediatrics, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok 10400, Thailand
from infective endocarditis. Occasionally, pathogen
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