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Images in Neurology |

Evolution and Regression of Intracranial Infectious Aneurysm Diagnosed by Brain Computed Tomographic Angiography

Fu-Zong Wu, MD; Ping-Hong Lai, MD
Arch Neurol. 2010;67(9):1147. doi:10.1001/archneurol.2010.216.
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A 55-year-old man presented with high fever, severe headache, and right hemiparesis that lasted 1 week. He had been addicted to heroin for 1 year. Physical examination revealed a grade IV/VI apical systolic murmur with radiation to the left axilla. An echocardiogram revealed mitral regurgitation with vegetation. A diagnosis of infective endocarditis was confirmed by the isolation of Streptococcus viridans. Initial brain computed tomography (CT) revealed recent ischemic infarctions (Figure, A) at the left anterior temporal and right occipital regions. The presumed diagnosis was septic emboli with embolic infarctions. The patient was treated in the intensive care unit with high doses of antibiotic drugs. Two months later, conventional contrast-enhanced brain CT and CT angiography revealed 1 large developing saccular infectious aneurysm (Figure, B and C, arrows) at left middle cerebral artery bifurcation. One year after treatment, brain CT angiography revealed partial regression of the infectious aneurysm (Figure, D, arrow).

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Figure. Evolution and regression of intracranial infectious aneurysm. A, Brain computed tomography (CT) shows left anterior temporal (black arrowhead) and right occipital (arrow) embolic infarctions. Conventional contrast-enhanced brain CT (B) and CT angiography (C) 2 months later demonstrate newly developed infectious aneurysm at left middle cerebral artery bifurcation (B and C, arrow). D, Computed tomographic angiography 1 year later reveals partial regression of the infectious aneurysm (arrow).

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