Presentation
Patient admitted for infectious endocarditis of mechanical aortic valve. Sudden onset headache.
Patient Data
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CT Head:
There are intraparenchymal hemorrhages in the left frontal, right parietal and left occipital lobes with surrounding edema. There is mass effect on the adjacent brain parenchyma with effacement of the left occipital horn and a rightward midline shift. There is intraventricular hemorrhage involving both lateral, third and fourth ventricles associated with prominence of the temporal horns concerning for early hydrocephalus.
CTA:
Enhancing foci are seen adjacent to the intraparenchymal hemorrhages suggestive of mycotic aneurysms.
Case Discussion
Intracranial mycotic aneurysms are rare but devastating complications of hematogenous dissemination of infections, most commonly associated with left sided endocarditis. Unlike berry aneurysms, they are typically peripheral in location.
Intracranial mycotic aneurysms have poor prognosis and high mortality rate. This unfortunate patient was pronounced dead a few hours after this study.