Dynamic angiographic nature of cerebral mycotic aneurysms in patients with infective endocarditis

Seby John, Kevin M. Walsh, Ferdinand K. Hui, Sophia Sundararajan, Scott Silverman, Mark Bain

Research output: Contribution to journalArticle

Abstract

MA are rare, and difficult to treat cerebrovascular lesions most commonly seen secondary to hematogenous spread of septic emboli from a proximal source, such as bacterial endocarditis. Cerebral angiography is the gold standard imaging modality for detecting MA. Although the sensitivity of noninvasive CT and magnetic resonance imaging to detect small MA is low, the absence of intracranial hemorrhage on noninvasive imaging conveys a high negative predictive value. Thus, patients with IE presenting with intracranial hemorrhage should undergo vascular imaging, preferably with cerebral angiography. There have been no randomized clinical trials or prospective cohort studies evaluating various treatment approaches. Invasive treatment is based on rupture status and surgical risk. However, when MA are managed conservatively, close angiographic follow-up is warranted given its unpredictable nature and potential for rapid changes even on appropriate antibiotics. In addition, focal occlusions from septic emboli should b considered high risk for MA formation.

Original languageEnglish (US)
Pages (from-to)e8-e10
JournalStroke
Volume47
Issue number1
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

Keywords

  • abscess
  • aneurysm
  • cerebral angiography
  • endocarditis
  • mycotic

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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