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KMID : 1150320200160010062
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Journal of Korean Society of Geriatric Neurosurgery
2020 Volume.16 No. 1 p.62 ~ p.66
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Multiple Infected Cerebral Aneurysms Mimicking Metastatic Brain Tumor: A Case Report
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Shin Jeong-Mo
Park Ik-Seong
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Abstract
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The authors emphasize the importance of accurate history taking through a case report of an infectious cerebral aneurysm after undergoing craniotomy under a metastatic brain’s diagnosis. A 54 years old man was presented with a headache. Brain magnetic resonance images (MRI) revealed multiple small enhancing mass lesion with pial enhancement. No suspicious findings of systemic cancer were observed on positron emission tomography. Follow up MRI scan performed two weeks later showed an increase in mass size. Exploration craniotomy was done. A fusiform dilated vessel with surrounding hematoma was noticed on subarachnoid space. Pathologic study revealed pseudoaneurysm. Multiple vegetations on the left ventricle were detected by echocardiography. But blood culture reported no growth of any bacteria. Cerebral digital subtraction angiography revealed multiple intracerebral aneurysms ranging from 1 to 3 mm. Further investigation of the patient's past history revealed a dental extraction due to carries, which was the most common cause of infected aneurysms. Empirical antibiotics therapy was performed for 6 weeks, and the disappearance of enhanced lesions on Brain MRI and vegetation on echocardiography was confirmed. Sophisticated history taking and a systemic evaluation are essential for the evaluation of uncertain cerebrovascular disease.
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KEYWORD
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Antibiotic therapy, Exploration craniotomy, Infectious intracranial aneurysm, Metastatic brain tumor
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