Anzeige
Erschienen in:
01.02.2016 | Imaging in Intensive Care Medicine
Rapid development and rupture of a cerebral mycotic aneurysm in Candida infective endocarditis
Erschienen in: Intensive Care Medicine | Ausgabe 2/2016
Einloggen, um Zugang zu erhaltenExcerpt
A 55-year-old man with Candida infective endocarditis developed subarachnoid hemorrhage (SAH) (Fig. 1a) from a dissecting intracranial mycotic aneurysm of the right vertebral artery (Fig. 1b) despite of antifungal treatment. Further aneurysms were excluded (not shown) and the aneurysm was treated by coil embolization of the right vertebral artery. Repeated follow-up CT angiographies confirmed the absence of further aneurysms on day 12 (Fig. 1c), but they detected a newly developed mycotic aneurysm of an M2 branch of the right middle cerebral artery on day 20 (Fig. 1d). Because of bilateral dilated pupils a follow-up CT scan 1 h and 22 min later was performed and revealed an ultra-rapid progression in aneurysm size (Fig. 1e) and rupture (Fig. 1f). The patient died the same day.
Fig. 1
a CT scan showing subarachnoid hemorrhage (SAH) involving the suprasellar cistern and completely filling the prepontine cistern (asterisk) with hyperdense blood. b Pre-interventional subtraction angiography revealed a dissecting mycotic aneurysm of the right vertebral artery (red arrow) involving the base of the posterior inferior cerebellar artery (PICA, blue arrowhead). Further intracranial aneurysms were excluded (not shown). c Follow-up routine CT angiography at day 12 (CW circle of Willis, MCA middle cerebral artery). d At day 20 a newly developed aneurysm measuring 5.4 by 5.1 mm was detected (red arrow). e Within 1 h and 22 min the aneurysm rapidly expanded to 7.8 by 6.6 mm (red arrow) and ruptured. f At that time point the CT scan showed diffuse SAH involving the right sylvian cistern (asterisk) causing mass effect and acute midline shift
× ![]()
…