Subarachnoid hemorrhage secondary to Brucella-induced cerebral aneurysm: a case report

Abstract

Background: Brucellosis is a common zoonotic disease that is prevalent in many areas worldwide. This infectious disease can occasionally affect the central nervous system but intracranial arteries are rarely involved.

Case presentation: A 17-year-old female who had a history of recurrent fever for 1 month was admitted for subarachnoid hemorrhage due to cerebral aneurysm rupture. Surgery was performed to fix the aneurysm, but the patient had persistent fever after the surgery. Cerebrospinal fluid testing showed a high white blood cell count and elevated protein level but no pathogen was identified in the first two tests. Brucella melitensis was identified in the third cerebrospinal fluid culture, and a diagnosis of brucellosis was finally rendered. The patient was subsequently treated with anti-Brucella medications and her symptoms improved significantly at the last follow-up.

Conclusion: Although extremely rare, Brucella-induced cerebral aneurysms can occur and this should be considered in the differential diagnosis of cerebrovascular accidents, especially in Brucella epidemic areas.

Keywords: Brucella; Case report; Cerebral mycotic aneurysm; Subarachnoid hemorrhage.

Fig. 1

CT and angiography of the patient’s brain. An axial CT scan of the head showed signs of subarachnoid hemorrhage in left fissure and cistern (panel a, white arrow). CT angiography illustrated an aneurysm in M2 segment of the left middle cerebral artery (panel b, white arrow)