Mycotic aneurysm of the posterior cerebral artery

Case contributed by Melbourne Uni Radiology Masters
Diagnosis almost certain


Known bacterial endocarditis, now presenting with headaches.

Patient Data

Age: 40 years
Gender: Male

Cerebral angiogram (DSA)


Angiogram via left vertebral artery injection again demonstrated irregular fusiform aneurysmal dilatation of the P2 segment of the right posterior cerebral artery associated with multiple saccular aneurysms arising from its superior and inferior divisions. These have increased in size and number compared to the DSA performed on 5/11/15, with the largest measuring 3.7 x 3.6 mm. Via a Scepter 4 x 10 mm catheter with its tip positioned in the right P2 just proximal to its bifurcation,

Case Discussion

Intracerebral mycotic aneurysms are uncommon. They are now most commonly seen in patients with a history of drug use and secondary endocarditis.

They are more common in the anterior and middle cerebral artery territories.

They are often more peripheral in location than berry aneurysms.

Rupture with subarachnoid or intracerebral bleed is the feared complication.

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