Staphylococcus Endocarditis Associated with Infectious Vasculitis and Recurrent Cerebral Hemorrhages
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PRACTICAL PEARL
Staphylococcus Endocarditis Associated with Infectious Vasculitis and Recurrent Cerebral Hemorrhages Diederik van de Beek Æ Alejandro A. Rabinstein Æ Steve G. Peters Æ Harry Cloft Æ Eelco F. M. Wijdicks
Published online: 20 September 2007 Humana Press Inc. 2007
Abstract Background Patients with infectious endocarditis, who do not respond to conservative medical therapy usually need rapid valve surgery. This poses a difficult dilemma in patients with intracranial aneurysms and hemorrhage, although endovascular treatment of infectious aneurysms might be an advantage in therapy in these patients. Methods We present a patient with ruptured infectious intracranial aneurysm complicating endocarditis with hemorrhage after successful coil occlusion of the aneurysm and review the literature on studies reporting endovascular treatment in adults with infectious aneurysms. Results In total 34 adults have been reported with endovascular treatment of infectious aneurysms. All patients were initially presented with hemorrhage. Reported mortality rate was low (6%), and neurologic disability was reported in 37% of other patients. Rehemorrhage has been described in one other patient after endovascular treatment of an infectious aneurysm after rupture of a new aneurysm. In our patient, CT suggested a generalized cerebral infectious vasculitis. Conclusions Endovascular treatment of infectious aneurysms seems to be a great advantage, but endovascular D. van de Beek A. A. Rabinstein E. F. M. Wijdicks (&) Division of Critical Care Neurology, Department of Neurology, Mayo Clinic College of Medicine, W8B, 200 First Street SW, Rochester, MN 55905, USA e-mail: [email protected] S. G. Peters Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA H. Cloft Division of Radiology, Mayo Clinic College of Medicine, Rochester, MN, USA
coiling may not prevent hemorrhage associated with panvasculitis or rupture of a new aneurysm. Keywords Endocarditis Infectious aneurysm Intracranial aneurysm Intracerebral hemorrhage Endovascular treatment Complication
Introduction Patients with infectious endocarditis, who do not respond to conservative medical therapy usually need rapid valve surgery. This poses a difficult dilemma in patients with intracranial aneurysms and hemorrhage. Endovascular treatment of infectious aneurysms is a great advantage. We present a patient with ruptured infectious intracranial aneurysm complicating endocarditis. Recurrent hemorrhage occurred despite coil occlusion. We additionally review prior published cases.
Case Report A 22-year-old right-handed male truck driver with a history of juvenile rheumatoid arthritis was transferred to a tertiary care facility with staphylococcal bacteremia, endocarditis, acute renal insufficiency, and a splenic abscess. Seven days earlier, he was presented at a local emergency room because of blurred vision; the police had pulled him over for suspicious driving, as he was swerving back and forth on the road. On presentati
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