Skip to main content

Advertisement

SpringerLink
Log in

Successful endovascular treatment of pediatric basilar infectious (mycotic) aneurysm: a case report and review of the literature

  • Case Report
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ahmad FU, Mahajan H, Mahapatra AK, Suri A (2006) Mycotic aneurysm. An unusual cause of pyrexia of unknown origin in an immunodeficient infant. Pediatr Neurosurg 42(4):237–239

    Article  Google Scholar 

  2. Alawieh A, Chaudry MI, Turner RD, Turk AS, Spiotta AM (2018) Infectious intracranial aneurysms: a systematic review of epidemiology, management, and outcomes. J Neurointerv Surg 10(7):708–716

    Article  Google Scholar 

  3. Allison JW, Davis PC, Sato Y, James CA, Haque SS, Angtuaco EJ et al (1998) Intracranial aneurysms in infants and children. Pediatr Radiol 28(4):223–229

    Article  CAS  Google Scholar 

  4. Ares WJ, Tonetti DA, Greene S, Sharma MS, Xavier F, Jankowitz BT, Jadhav A (2019) Pipeline embolization of an infectious basilar artery aneurysm in a 2-year-old child: case report, discussion of the literature and perioperative considerations. Oper Neurosurg (Hagerstown) 17(5):E224–E2e8

    Article  Google Scholar 

  5. Aspoas AR, de Villiers JC (1993) Bacterial intracranial aneurysms. Br J Neurosurg 7(4):367–376

    Article  CAS  Google Scholar 

  6. Barrow DL, Prats AR (1990) Infectious intracranial aneurysms: comparison of groups with and without endocarditis. Neurosurgery 27(4):562–572 discussion 72–3

  7. Chimparlee N, Jittapiromsak P, Tantivatana J, Chattranukulchai P (2014) Classical complication of infective endocarditis: ruptured, large mycotic cerebral aneurysm. BMJ Case Rep 2014: brc2013202275. https://doi.org/10.1136/brc-2013-202275

  8. Daugherty WP, Clarke MJ, Cloft HJ, Lanzino GL (2009) Going viral: fusiform vertebrobasilar and internal carotid aneurysms with varicella angiitis and common variable immunodeficiency. J Neurosurg Pediatr 4(6):528–531

    Article  Google Scholar 

  9. Ducruet AF, Hickman ZL, Zacharia BE, Narula R, Grobelny BT, Gorski J et al (2009) Intracranial infectious aneurysms: a comprehensive review. Neurosurg Rev 33(1):37

    Article  Google Scholar 

  10. Flores BC, Patel AR, Braga BP, Weprin BE, Batjer HH (2016) Management of infectious intracranial aneurysms in the pediatric population. Childs Nerv Syst 32(7):1205–1217

    Article  Google Scholar 

  11. Fulmer BB, Dillard SC, Musulman EM, Palmer CA, Oakes J (1998) Two cases of cerebral aneurysms in HIV+ children. Pediatr Neurosurg 28(1):31–34

    Article  CAS  Google Scholar 

  12. Garg M, Shambanduram S, Singh PK, Sebastian LJD, Sawarkar DP, Kumar A, Gaikwad S, Chandra PS, Kale SS (2018) Management of pediatric posterior circulation aneurysms-12-year single-institution experience. World Neurosurg 116:e624–ee33

    Article  Google Scholar 

  13. Goldman JA, Fleischer AS, Leifer W, Parent A, Schwarzman SW, Raggio J (1979) Candida albicans mycotic aneurysm associated with systemic lupus erythematosus. Neurosurgery. 4(4):325–328

    Article  CAS  Google Scholar 

  14. Kannoth S, Iyer R, Thomas SV, Furtado SV, Rajesh BJ, Kesavadas C, Radhakrishnan VV, Sarma PS (2007) Intracranial infectious aneurysm: presentation, management and outcome. J Neurol Sci 256(1–2):3–9

    Article  Google Scholar 

  15. Lasjaunias P, Wuppalapati S, Alvarez H, Rodesch G, Ozanne A (2005) Intracranial aneurysms in children aged under 15 years: review of 59 consecutive children with 75 aneurysms. Childs Nerv Syst 21(6):437–450

    Article  Google Scholar 

  16. Laurencikas E, Sandstedt B, Söderman M (2006) Intrathecal aspergillosis and fusiform arterial aneurysms in an immunocompromised child: a clinico-pathological case report. Childs Nerv Syst 22(11):1497–1501

    Article  Google Scholar 

  17. Mahadevan A, Tagore R, Siddappa NB, Santosh V, Yasha TC, Ranga U, Chandramouli BA, Shankar SK (2008) Giant serpentine aneurysm of vertebrobasilar artery mimicking dolichoectasia-an unusual complication of pediatric AIDS. Report of a case with review of the literature. Clin Neuropathol 27(1):37–52

    Article  CAS  Google Scholar 

  18. Marazzi MG, Bondi E, Giannattasio A, Strozzi M, Savioli C (2008) Intracranial aneurysm associated with chronic mucocutaneous candidiasis. Eur J Pediatr 167(4):461–463

    Article  CAS  Google Scholar 

  19. Messori A, Lanza C, De Nicola M, Menichelli F, Capriotti T, Morabito L et al (2002) Mycotic aneurysms as lethal complication of brain pseudallescheriasis in a near-drowned child: a CT demonstration. AJNR Am J Neuroradiol 23(10):1697–1699

    PubMed  PubMed Central  Google Scholar 

  20. Nunes ML, Pinho AP, Sfoggia A (2001) Cerebral aneurysmal dilatation in an infant with perinatally acquired HIV infection and HSV encephalitis. Arq Neuropsiquiatr 59(1):116–118

    Article  CAS  Google Scholar 

  21. Palacios A, Llorente AM, Ordóñez O, Martínez de Aragón A (2017) Intracranial mycotic aneurysm in a 5 month-old infant with pneumococcal meningitis. Enferm Infecc Microbiol Clin 35(4):267–269

    Article  Google Scholar 

  22. Petropoulou F, Mostrou G, Papaevangelou V, Theodoridou M (2003) Central nervous system aneurysms in childhood AIDS. Aids. 17(2):273–275

    Article  Google Scholar 

  23. Piastra M, Chiaretti A, Tortorolo L (2000) Ruptured intracranial mycotic aneurysm presenting as cerebral haemorrhage in an infant: case report and review of the literature. Childs Nerv Syst 16(3):190–193

    Article  CAS  Google Scholar 

  24. Ren Y, Zhao S, Liu L, Sun H, Liu Y, Li H, Ma L, He M, You C, Li J (2018) Successful microsurgical treatment of intracranial aneurysms in infants: a retrospective study and literature review. Acta Neurochir 160(4):783–792

    Article  Google Scholar 

  25. Saraf R, Shrivastava M, Siddhartha W, Limaye U (2012) Intracranial pediatric aneurysms: endovascular treatment and its outcome. J Neurosurg Pediatr 10(3):230–240

    Article  Google Scholar 

  26. Vyas S, Moudgil S, Kumar A, Goyal M (2018) HIV-associated diffuse intracranial aneurysmal arteriopathy. J Pediatr 203:461–4e1

    Article  Google Scholar 

  27. Wang X, Chen G, Li M, Liang J, Guo H, Song G, Bao Y (2020) Rapid formation and rupture of an infectious basilar artery aneurysm from meningitis following suprasellar region meningioma removal: a case report. BMC Neurol 20(1):94

    Article  CAS  Google Scholar 

  28. Yu W, Rickert K, Flores B, Samson D (2012) Infectious mid basilar artery aneurysm from Pseudomonas meningitis. J Neurointerv Surg 4(3):e10

    Article  Google Scholar 

  29. Zanaty M, Chalouhi N, Starke RM, Tjoumakaris S, Gonzalez LF, Hasan D et al (2013) Endovascular treatment of cerebral mycotic aneurysm: a review of the literature and single center experience. Biomed Res Int 2013:151643

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, 10400, Thailand

    Kittiphop Somboonnithiphol, Ekachat Chanthanaphak, Sirintara (Pongpech) Singhara Na Ayudhaya & Bandit Sirilert

  2. Department of Pediatrics, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, 10400, Thailand

    Chaiyos Khongkhatithum

Authors
  1. Kittiphop Somboonnithiphol
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ekachat Chanthanaphak
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sirintara (Pongpech) Singhara Na Ayudhaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chaiyos Khongkhatithum
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bandit Sirilert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bandit Sirilert.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Somboonnithiphol, K., Chanthanaphak, E., Singhara Na Ayudhaya, S.(. et al. Successful endovascular treatment of pediatric basilar infectious (mycotic) aneurysm: a case report and review of the literature. Childs Nerv Syst 37, 2687–2693 (2021). https://doi.org/10.1007/s00381-020-04917-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-020-04917-8

Keywords

Search

Navigation