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The Importance of Repeated Angiography in the Treatment of Mycotic-Embolic Intracranial Aneurysms

1966; American Association of Neurological Surgeons; Volume: 25; Issue: 2 Linguagem: Inglês

10.3171/jns.1966.25.2.0189

1933-0693

Robert C. Cantu, Marjorie LeMay, Harold A. Wilkinson,

Vascular Malformations Diagnosis and Treatment

A ANEURYSM caused b y an i n v a d i n g o rga n ism, e i t he r f rom t h e a d j a c e n t t i ssues ou t s i de t he vessel wal l or (as fa r m o r e c o m m o n l y occurs) f rom wi th in , ha s been k n o w n as m y c o t i c s ince Os le r 6 f i rs t a p p l i e d t h e t e r m to a case in 1885 to focus a t t e n t i o n on i t s i n f l a m m a t o r y n a t u r e . E p p i n g e r , 3 in his c lass ic m o n o g r a p h on th i s e n t i t y , d i scussed t h e p a t h o g e n e s i s of m y c o t i c a n e u r y s m s of i n t r a v a s c u l a r or ig in wh ich he ca l led m y c o t i c e m b o l i c . T h i s is p e r h a p s a m o r e des c r i p t i ve t e r m for t he i n t r a v a s c u l a r v a r i e t y w h i c h we d iscuss in th i s p a p e r . M y c o t i c an e u r y s m s occu r m o s t c o m m o n l y w i th v e g e t a t i ve b a c t e r i a l endoca rd i t i s , e i t he r a c u t e or s u b a c u t e , a n d r a r e l y w i t h s e p t i c e m i a s of o t h e r or igins . E a r l y a c c o u n t s of t he i r occurr ences inc lude t h e r e p o r t of a case of R h e u m a t i s m in 1851, 5 a n d in 1869 a case of suba r a c h n o i d h e m o r r h a g e s e c o n d a r y to a r u p t u r e d a n e u r y s m in a p a t i e n t w i t h h e a r t v a l v e v e g e t a t i o n s . 2 A l t h o u g h t h e inc idence of th i s les ion has been r e d u c e d s ince t h e i n t r o d u c t i on of an t i b io t i c s , i t s t i l l a c c o u n t s for ~ .5 4 . 5 % of a l l i n t r a c r a n i a l a n e u r y s m s . 4,7 T h e p u r p o s e of th is p a p e r is to d i scuss t he s igni f icance of r e p e a t e d a n g i o g r a p h y in t he t r e a t m e n t of m y c o t i c i n t r a c r a n i a l a n e u r y s m s as i l l u s t r a t e d b y an u n u s u a l case in wh ich no a n e u r y s m was d e m o n s t r a b l e 1 d a y a f t e r a s u b a r a c h n o i d h e m o r r h a g e . A n a n e u r y s m , 1.5 cm. in d i a m e t e r , was seen s m o n t h s a f t e r t h e h e m o r r h a g e , b u t was n o t seen in an ang lo g r a m done 3 m o n t h s l a t e r .