Mycotic aneurysm presenting in a patient with a ventriculoatrial shunt with positive CSF cultures for Cutibacterium acnes: illustrative case.

Journal of neurosurgery. Case lessons Pub Date : 2026-05-04 DOI:10.3171/CASE25625

Natalie Amaral-Nieves, Krisztina Moldovan, Valerie Xu, Alexander Acevedo-Jetter, Santos Santos-Fontanez, Cody Doberstein, Belinda Shao, Carlin Chuck, Petra Klinge, Radmehr Torabi, Elias Shaaya, Dylan N Wolman

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Abstract

Background: Mycotic aneurysms (MAs) typically present with intracranial hemorrhage but are a rare cause of subdural hematoma (SDH). Although infective endocarditis is the most common etiology, MAs may also result from bacteremia associated with intravenous drug use, meningitis, or poor dentition. Patients with ventriculoatrial shunts (VASs) are at increased risk for shunt-related bacteremia compared to those with ventriculoperitoneal shunts, potentially predisposing them to MA formation.

Observations: This is the case of a 61-year-old female with a fusiform distal left middle cerebral artery MA presenting as an acute-on-chronic SDH without endocarditis, but with positive blood cultures and CSF cultures for Cutibacterium acnes from a long-term VAS.

Lessons: MAs can rarely present as SDHs and should be considered in the differential diagnosis for patients with a long-standing VAS due to the risk of subacute bloodstream infections. https//thejns.org/doi/10.3171/CASE25625.

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真菌性动脉瘤表现为脑室房分流术患者脑脊液培养阳性痤疮表皮杆菌：说明性病例。

背景：真菌性动脉瘤（MAs）通常表现为颅内出血，但是硬膜下血肿（SDH）的罕见原因。虽然感染性心内膜炎是最常见的病因，但MAs也可能由与静脉用药、脑膜炎或牙列不良相关的菌血症引起。与脑室-腹膜分流患者相比，脑室-心房分流患者发生分流相关菌血症的风险增加，这可能使他们容易形成MA。观察：这是一例61岁女性，左大脑中动脉远端梭状MA表现为急性慢性SDH，无心内膜炎，但长期VAS血液培养和脑脊液培养为痤疮表皮杆菌阳性。经验教训：MAs很少表现为sdh，由于亚急性血流感染的风险，应在长期VAS患者的鉴别诊断中加以考虑。https / / thejns.org/doi/10.3171/CASE25625。

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Journal of neurosurgery. Case lessons

CiteScore

0.40

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0.00%

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