Abstract
Ruptured intracranial infective aneurysms are well-known but relatively uncommon. During the past 7 years, we treated 7 cases of angiographically verified, ruptured infective aneurysms. They comprised 1.8% of all the ruptured intracranial aneurysms treated at our institution during the same period. The incidence of ruptured mycotic aneurysm among patients with active infective endocarditis was 13.0% (7 out of 54). Five patients presented with intracerebral hemorrhage, and 2 with pure acute subdural hematoma. Five aneurysms (71.4%) were located on the distal branch of the middle cerebral artery, and 2 (28.6%) on the distal branch of posterior cerebral artery. Four of the 7 aneurysms (57.1%) were located in the “watershed” area between middle and posterior cerebral arteries.
Two patients who presented with acute subdural hematoma were in a life-threatening condition and required emergency surgery; 1 patient showed rapid clinical deterioration due to repeated rebleeding from the aneurysm. Among the 5 patients who presented with intracerebral hemorrhage, 1 underwent evacuation of hematoma and excision of the aneurysms, 2 underwent conservative treatment with antibiotics, and the other 2 were too critically ill to be treated. The infective organism could be identified in 4 of the treated 5 cases; penicillin G was given in 4 patients and cefcapene in one. All 5 treated patients returned to normal life. Ruptured intracranial infective aneurysm should be excised as soon as possible because rebleeding from the aneurysm can cause rapid clinical deterioration.
