Presentation
Headache, recent prosthetic aortic valve endocarditis (Streptococcus sanguinis)
Patient Data
Age: 65 years
Gender: Male
From the case:
Mycotic aneurysm
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Subarachnoid hemorrhage in the left Sylvian fissure.
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- New left temporal intraparenchymal hematoma with surrounding edema
- Increased subarachnoid hemorrhage in the basal cisterns and sulci of the left cerebral hemisphere
- Suspected 8 mm left middle cerebral artery M2 aneurysm, anterior to the intraparenchymal hematoma
From the case:
Mycotic aneurysm
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6 mm left middle cerebral artery M2 bifurcation aneurysm with active extravasation
Case Discussion
A ruptured distal/peripheral cerebral aneurysm in a patient with recent history of left-sided infective endocarditis is consistent with a mycotic aneurysm. A peripheral location is highly uncommon for non-mycotic berry aneurysms. This patient was treated endovascularly with coil embolization, so pathologic proof of mycotic aneurysm was not obtained.