[Multiple bacterial aneurysms: case report].

Abstract

A 59-year-old man presented with an internal carotid artery (ICA) bacterial aneurysm which ruptured during surgery for treatment of another bacterial aneurysm. He had been admitted to our hospital because of the recurrence of colon cancer. He had undergone aortic and mitral valve replacement because of closure incompetence due to bacterial endocarditis two months previously. Two months after treatment for colon cancer, he developed fever, and arterial blood culture demonstrated. Staphylococcus epidermidis. A few days later, he suddenly suffered severe headache and vomiting, followed by deterioration of consciousness. CT showed subarachnoid hemorrhage and angiography showed a saccular aneurysm at the opercular portion of the left middle cerebral artery (MCA). Immediate clipping of the aneurysm was attempted. The carotid cistern was opened via a left frontotemporal craniotomy, but an ICA aneurysm, which had not been previously recognized, ruptured suddenly. The ICA aneurysm was wrapped with Vascwrap with some difficulty. The MCA aneurysm was then trapped. Postoperatively, the patient continued to be stuporous for a few days. Two weeks later, he died of complications caused by pneumonia. Bacterial aneurysm is more likely to be located in the distribution of the distal arterial tree, mainly in the distribution of the MCA. The difficulty of preoperative diagnosis and the unpredictable clinical course of bacterial aneurysms are emphasized.