Background

Intracranial infectious aneurysms are rarely reported in children; in particular, they are very rare in infants. They are mostly related to infective endocarditis and are usually located in the anterior cerebral vasculature. A ruptured intracranial infectious aneurysm is a catastrophic event associated with high morbidity and mortality rates.

Case report

An 8-month-old female infant presented with a prolonged fever without any organ-specific symptoms. Two weeks after admission, she had a high-grade fever with drowsiness; the cerebrospinal fluid (CSF) examination indicated meningitis. Despite treatments with empiric antibiotic and antiviral agents, both her condition and the repeated CSF profiles worsened. The ineffective medications were promptly changed to susceptible antibiotic after the CSF culture showed Pseudomonas aeruginosa. Three days after the diagnosis of meningitis, the patient suddenly developed seizures and alteration of consciousness. The computerized tomography and angiography (CT and CTA) of the brain demonstrated a diffuse subarachnoid hemorrhage (SAH) with intraventricular hemorrhage (IVH) and a lobulated fusiform aneurysm at the proximal basilar artery, suggestive of a ruptured basilar infectious aneurysm. Endovascular treatment was planned and a transarterial occlusion of the vertebrobasilar junction was performed in order to disrupt inflow of the aneurysm. After endovascular intervention, her clinical symptoms gradually improved and the patient was discharged after completing a 4-week course of antibiotics. At the 6-week follow-up, she was doing well without neurological deficit.

Conclusion

To our knowledge, this is the first reported case of a ruptured basilar infectious aneurysm in an infant secondary to Pseudomonas meningitis, successfully treated with parent artery occlusion.

中文翻译：

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小儿基底层感染性（真菌性）动脉瘤血管内治疗成功：病例报告及文献复习

背景

儿童颅内感染性动脉瘤很少报道；特别是，它们在婴儿中非常罕见。它们大多与感染性心内膜炎有关，通常位于大脑前脉管系统。颅内感染性动脉瘤破裂是一种具有高发病率和死亡率的灾难性事件。

案例报告

一名 8 个月大的女婴出现长期发热，没有任何器官特异性症状。入院两周后，她出现高烧并嗜睡；脑脊液（CSF）检查提示脑膜炎。尽管使用经验性抗生素和抗病毒药物进行治疗，但她的病情和反复出现的脑脊液特征都恶化了。脑脊液培养显示铜绿假单胞菌后，无效药物及时换用敏感抗生素。. 脑膜炎诊断三天后，患者突然出现癫痫发作和意识改变。大脑的计算机断层扫描和血管造影（CT 和 CTA）显示弥漫性蛛网膜下腔出血 (SAH) 伴脑室内出血 (IVH) 和基底动脉近端分叶状梭形动脉瘤，提示基底感染性动脉瘤破裂。计划进行血管内治疗并进行椎基底动脉交界处的经动脉闭塞以阻断动脉瘤的流入。经血管内介入治疗，临床症状逐渐好转，完成4周抗生素疗程后出院。在 6 周的随访中，她表现良好，没有神经功能障碍。

结论

据我们所知，这是第一例继发于假单胞菌脑膜炎的婴儿基底层感染性动脉瘤破裂的报告病例，成功治疗了载瘤动脉闭塞。