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Case Reports
. 2020;14(7):268-272.
doi: 10.5797/jnet.cr.2019-0120. Epub 2020 Apr 8.

Differentiating between Mycotic and Dissecting Aneurysms in a Case of Ruptured Distal Superior Cerebral Artery Aneurysm

Kenji Miki  1   2 , Yoshihiro Natori  1 , Yasutoshi Kai  1 , Tetsuhisa Yamada  1 , Megumu Mori  1   3 , Naoki Noguchi  1
Affiliations
Case Reports

Differentiating between Mycotic and Dissecting Aneurysms in a Case of Ruptured Distal Superior Cerebral Artery Aneurysm

Kenji Miki et al. J Neuroendovasc Ther. 2020.

Abstract

Objective: We present a case of subarachnoid hemorrhage (SAH) due to ruptured mycotic aneurysm found in the distal superior cerebellar artery (SCA).

Case presentation: A 64-year-old man was admitted to our hospital with sudden unconsciousness. He had a history of alcoholism but no family history of SAH. Computed tomography (CT) showed apparent SAH; however, CT angiography (CTA) showed no apparent cause of SAH except for two small aneurysms in the same branch of the left distal SCA. We suspected mycotic aneurysm and prescribed antibiotics. It was difficult to diagnose the condition as mycotic aneurysm because there were no vegetations or caries at the time of admission. Because there were two aneurysms in the same branch with partial dilatation and stenosis, we suspected dissecting aneurysm, but continued to administer antibiotics for possible mycotic aneurysm. After the first operation, we diagnosed mycotic aneurysm because a vegetation and valve degeneration was found.

Conclusion: It is difficult to distinguish mycotic aneurysms from dissecting aneurysms because of similar appearance on imaging, especially if no vegetation is found. Nevertheless, it is important to start treatment for mycotic aneurysm. If there is the possibility of mycotic aneurysm, appropriate antibiotics should be administered, and endovascular treatment could be considered for patients with deteriorating conditions.

Keywords: distal SCA aneurysm; mycotic aneurysm; subarachnoid hemorrhage.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1. Preoperative CT and DWI images. (A) CT scan revealing subarachnoid hemorrhage surrounding the brainstem. Angiography revealing the aneurysm in the distal SCA: (B) frontal view, (C) lateral view (arrow), (D) DWI revealing infarction in the SCA territory. CT: computed tomography; DWI: diffusion-weighted imaging; SCA: superior cerebral artery
Fig. 2
Fig. 2. Preoperative and postoperative angiography (Working angles were LAO 30° and cranial 14). (A) Angiography revealing an enlarged aneurysm in the SCA. (B) Postoperative angiography revealing little blood flow in the neck of the aneurysm. (C) Follow-up angiography revealing that blood flow in the neck of the aneurysm and that the distal aneurysm had become larger (arrow). LAO: lateral anterior oblique; SCA: superior cerebral artery
Fig. 3
Fig. 3. Preoperative and postoperative angiography of the second treatment (Working angles were LAO 30°and cranial 14°). (A) Preoperative angiography revealing that the blood flow was reduced, and the distal aneurysm had disappeared. (B) Postoperative angiography revealing no blood flow in the aneurysm. LAO: lateral anterior oblique
See this image and copyright information in PMC

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