Successful coil embolization of a ruptured mycotic aneurysm that developed three days after septic embolic infarction: Case report and review of the literature

Abstract

Background: Infectious intracranial aneurysms (IIAs) are rare entities and are often associated with septic embolus from infectious endocarditis. They may develop rapidly and carry a higher risk of rupture and mortality compared to noninfectious aneurysms. However, the development and rupture of an IIA within 48h in a patient with septic infarction patient is exceedingly rare.

Case description: In this report, we describe a 25-year-old male who presented with left-sided hemiparesis and dysarthria from septic embolus to the right middle cerebral artery. Thirty-nine hours after presentation, he became encephalopathic following a witnessed seizure. Angiography demonstrated a new, ruptured aneurysm, which was successfully treated with endovascular coil embolization. Our study documents the first report of coil embolization in a rapidly developed infectious aneurysm.

Conclusions: Importantly, this case demonstrates that septic infarction may precede and herald IIA development and rupture. If IIA is detected due to rupture, coil embolization can be a safe and effective therapy.

Keywords: Coil embolization; Infectious endocarditis; Infectious intracranial aneurysm; Mycotic aneurysm; Septic emboli.