Hospital: Hospital Universitario Central de Asturias.
Ciudad:
Nº:
Aut@r o Autores: S. Martín García, N. Sordo Alonso, K. Del Castillo Arango, J. Jimenez Pérez, H. Cigarrán Sexto, J. Calvo Blanco.,
Presentación:
A 34-year-old woman was referred to the Emergency Department with decreased level of consciousness. Relatives revealed seven days history of otalgia and progressive worsening general condition. She also presented high fever, vomiting and cervical pain during the last 8 hours. In the afternoon they found her unconscious. Physical examination revealed pyrexia (temperature of 38.9 ºC), Glasgow coma score 4 and anisocoria. Orotracheal intubation was performed and corticoid and empirical antibiotic treatment was applied. In the blood analysis revealed severe neutrophilic leukocytosis. Emergency brain CT was performed with diffuse cerebral edema and effaced basal cisterns. She was diagnosed of probable meningitis of otogenic origin. Subsequently, the presence of streptococcus pneumoniae in the cerebrospinal fluid was confirmed Sedation was withdrawn a week later and the patient did not show reactivity, so a new CT was requested and intracerebral bleeding was evident in parasagital frontal lobe. Cerebral arteries CTA was performed, finding an aneurysm of an ACA branch close to the intracerebral bleeding. Emergency cerebral arteries angiography was performed that showed an aneurysm in an ACA branch that was embolized with glue.
Discusión:
Relying on patient’s medical history and the performed tests, the diagnosis of mycotic aneurysm was made. Mycotic aneurysms are due to vessel wall damage by an infection that can be caused by several organisms, usually bacterial. They are unusual and life-threatening because they can evolve to sepsis and spontaneous arterial rupture. They are not the only complication of meningitis that can be seen in CT scan. Other findings are vein or arterial thrombosis, cerebral artery spasm, subdural hematoma, hygroma or empyema, hydrocephalus, cerebral infarctation or abscess, cerebral edema, vasculitis, acute cerebral hemorrhage and ventriculitis.
Conclusión:
Relying on patient’s medical history and the performed tests, the diagnosis of mycotic aneurysm was made. Mycotic aneurysms are due to vessel wall damage by an infection that can be caused by several organisms, usually bacterial. They are unusual and life-threatening because they can evolve to sepsis and spontaneous arterial rupture. They are not the only complication of meningitis that can be seen in CT scan. Other findings are vein or arterial thrombosis, cerebral artery spasm, subdural hematoma, hygroma or empyema, hydrocephalus, cerebral infarctation or abscess, cerebral edema, vasculitis, acute cerebral hemorrhage and ventriculitis.
Bibliografía:
– Hughes DC, Raghavan A, Mordekar SR, Griffiths PD, Connolly DJ. Role of imaging in the diagnosis of acute bacterial meningitis and its complications. Postgrad Med J. 2010, 86: 478-85.