Bacterial intracranial aneurysms associated with infectious endocarditis--report of 3 cases

Three cases of bacterial intracranial aneurysms associated with infective endocarditis are reported. All of the patients were successfully treated by various combinations of cardiac surgery, neurosurgery and chemotherapy with antibiotics. Case 1: A 39-year-old female was admitted with the complaint of sudden onset of severe headache following persistent fever of several month's duration. CT scan revealed a left frontal old hematoma and angiography detected an aneurysm located in the frontal ascending branch of the left middle cerebral artery. After 2 weeks' antibiotic therapy, the second angiography showed the aneurysm to be decreased in size. The third angiography, performed 2 weeks after cardiac valve replacement for infective endocarditis, demonstrated complete resolution of the aneurysm. Case 2: A 19-year-old male entered hospital with high fever and chills. In addition to infective endocarditis, CT scan and angiography revealed an aneurysm arising from the distal portion of the left posterior cerebral artery. The patient was treated with high dose antibiotics and then his general condition improved. However, angiography examined 4 weeks after the initial study demonstrated the aneurysm to be apparently enlarged. Therefore, the aneurysm was excised before cardiac surgery. Repeated angiography after valve replacement showed no further aneurysm. Case 3: A 30-year-old female was admitted on the diagnosis of infective endocarditis and meningitis. CT scan showed abnormal density areas in the right frontal lobe and the left temporal lobe.(ABSTRACT TRUNCATED AT 250 WORDS)