Rapid enlargement of a pre-existing intracranial aneurysm during infective endocarditis: a case report

IF 2.1 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2026-03-01 Epub Date: 2026-01-15 DOI:10.1016/j.jstrokecerebrovasdis.2026.108561

Mamoru Ishida MD, PhD, Ryosuke Nishiwaki MD, Hisashi Mizutani MD, Yuichi Kawasaki MD, Takahiro Oyama MD, Mitsuhiro Yoshida MD

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引用次数: 0

Abstract

Background

Infectious intracranial aneurysms (IIAs) are generally thought to develop de novo as a consequence of septic embolization during infective endocarditis (IE). Rapid infection-related enlargement of a pre-existing unruptured aneurysm during IE has not been previously documented. We report a case in which a small middle cerebral artery (MCA) aneurysm, previously identified on imaging, enlarged rapidly in the course of IE.

Case Description

A 67-year-old woman with a history of mitral valve repair presented with progressive general malaise and mild left hemiparesis. MRI demonstrated acute infarctions in the right caudate nucleus and putamen, and MRA showed occlusion of the right M2 superior branch. A previously identified 2.2-mm right MCA bifurcation aneurysm was not visualized on admission MRA. Infective endocarditis was subsequently diagnosed, and the aneurysm reappeared on day 9 at 5.5 mm and enlarged further to 9.5 mm by day 15. Endovascular coil embolization was performed on day 16, achieving complete aneurysm occlusion. The patient later underwent mitral valve surgery without complications.

Conclusion

This case demonstrates infection-related enlargement of a pre-existing intracranial aneurysm during IE, documented chronologically with serial MRA. These findings highlight the need for careful interval imaging in patients with IE and known aneurysms, and rapid morphological change should prompt urgent aneurysm treatment.

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感染性心内膜炎时原有颅内动脉瘤迅速增大1例。

背景：感染性颅内动脉瘤（IIAs）通常被认为是感染性心内膜炎（IE）期间脓毒性栓塞的结果。IE期间存在的未破裂动脉瘤的快速感染相关扩大以前没有文献记载。我们报告一个病例，其中一个小的大脑中动脉（MCA）动脉瘤，先前在影像学上发现，在IE过程中迅速扩大。病例描述：一名67岁女性，有二尖瓣修复史，表现为进行性全身不适和轻度左偏瘫。MRI显示右侧尾状核和壳核急性梗死，MRA显示右侧M2上支闭塞。先前确定的2.2 mm右MCA分叉动脉瘤在入院MRA上未见。随后诊断为感染性心内膜炎，第9天动脉瘤再次出现，直径5.5 mm，第15天进一步扩大至9.5 mm。第16天行血管内线圈栓塞术，实现动脉瘤完全闭塞。患者后来接受了二尖瓣手术，无并发症。结论：该病例显示IE期间已有的颅内动脉瘤感染相关肿大，按时间顺序通过系列MRA记录。这些发现强调了IE和已知动脉瘤患者需要仔细的间隔成像，快速的形态学改变应该促使动脉瘤紧急治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.