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Intracranial mycotic aneurysm: a case report

Intracranial mycotic aneurysms are extremely rare and commonly associated with infective endocarditis. The unusual location of these aneurysms should alert the clinician to the possibility of a mycotic aneurysm. We report an unusual case of a 46 year old woman with previous history of insulin dependent diabetes and an ophthalmic artery aneurysm clipped 10 years ago. She underwent a successful resection of a right frontoparietal meningioma, however, two weeks post‐operatively she presented with subarachnoid hemorrhage (SAH). An angiogram was performed and it was negative. She remained hospitalized and developed recurrent SAH two weeks later. A repeat angiogram revealed a distal basilar artery 1cm fusiform aneursym with irregular excrescences. She expired within 3 days of the last angiogram and a brain only autopsy was performed. The skull base showed extensive hemorrhage in the posterior fossa, SAH, right uncal and upward cerebellar herniation and a 2.5cm basilar tip aneurysm. Coronal sections of brain showed intraventricular hemorrhage with softening and necrosis of the brainstem. Histopathologic examination showed extensive acute and chronic inflammation with septae fungal hyphae present in the thrombi and the wall of the basilar tip aneurysm. A high index of clinical suspicion for mycotic aneurysm following surgical intervention may result in early treatment and improved patient outcome.