A Surgical Case of Infective Endocarditis Presenting with Intracranial Hemorrhage due to Ruptured Cerebral Mycotic Aneurysm

(Division of Cardiovascular Surgery, Tominaga Hospital, Osaka, Japan)

Tomoyuki Yunoki Kenji Minakata
It is still controversial how to treat patients with active infective endocarditis associated with cerebral complications such as embolic stroke or intracranial hemorrhage. Cerebral mycotic aneurysm is a major risk factor for intracranial hemorrhage both preoperatively and intraoperatively. We encountered a 62-year-old man who presented with intracranial hemorrhage due to ruptured cerebral mycotic aneurysm associated with active infective endocarditis. Echocardiography demonstrated severe aortic and mitral regurgitation with vegetation and perforation of leaflets. Since he did not have significant heart failure symptoms, we performed craniotomy including removal of hematoma and exclusion of the mycotic aneurysm. Subsequently, we performed the open heart procedure for his mitral, aortic and tricuspid valves after 4 weeks from the onset of intracranial hemorrhage. His postoperative course was uneventful and he recovered completely without neurological deficits. Here, we report this case with some literature review.
@Jpn. J. Cardiovasc. Surg. 37: 21-24 (2008)