Abstract
Bacterial aneurysm rupture, although relatively rarely seen in the daily clinic experience, often becomes critical and has high mortality. We report a case of bacterial cerebral aneurysm rupture after meningitis onset in a subject hospitalized for hypoglycemia. A 78-year-old man with type 2 diabetes mellitus was hospitalized in an emergency for prolonged hypoglycemia due to reduced appetite. On hospital day 10, he developed a high fever and pyuria. Antibiotic therapy did not alleviate the fever, however. On hospital day 17, the man developed nuchal rigidity and an increased cerebrospinal fluid cell count of predominantly polynucleated cells. He was diagnosed with bacterial meningitis and the related treatment initiated. On the morning of hospital day 20, respiratory arrest suddenly occurred and head computed tomography (CT) showed the onset of acute subarachnoid hemorrhage. Emergency craniotomy was done immediately and a diagnosis of bacterial aneurysm rupture was made. A bacterial cerebral aneurysm is difficult to detect before manifestation of an adverse episode. Our case strongly suggests the importance of considering the possibility of bacterial cerebral aneurysm when dealing with meningitis in subjects with diabetes mellitus.
