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In 14 patients infective endocarditis was diagnosed.The patients presented with subarachnoid haemorrhage(4 patients),stroke(9 patients),and seizure(1 patient).CT findings were intracerebral hematoma(5 patients),infarcts(4 patients),subarachnoid hemorrhage(4 patients),and aneurysms(2 patients).On angiography,10(71%)patients had single aneurysms,and 4(29%)patients had multiple aneurysms.Eighteen aneurysms were detected,of which 6(33%)were centrally located,and 12(66%)were located peripherally.The most common site was the peripheral middle cerebral artery(56%).Serial angiography during antibiotic treatment demonstrated complete resolution of 6 aneurysms(33%),with 12 aneurysms remaining after 6 weeks of treatment.Of the latter,there was no change in size in 6 aneurysms(33%),a decrease in size in 3 aneurysms(17%),and an increase in size in 3 aneurysms(17%).No new aneurysms appeared.Surgery was performed on 10 patients with residual aneurysms,11 aneurysms being excised or clipped.After 6 weeks'treatment, there was complete recovery in 7(50%)patients,permanent neurologic deficits in 6 patients,and death from aneurysm rebleed in 1 patient. Follow-up angiography is recommended in all patients with mycotic aneurysms to assess response to antibiotic therapy,to detect new aneurysms,and to identify those aneurysms with no response or with enlargement. |
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