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November 1974

Mycotic Aneurysm: Case Report With Novel Sequential Angiographic Findings

Author Affiliations

From the departments of neurology (Drs. Katz and Selzer) and radiology (Dr. Goldberg), Hospital of the University of Pennsylvania, and the Department of Neuroradiology (Dr. Goldberg), Stroke Research Center, Philadelphia General Hospital. Dr. Katz is now with the Department of Neurology, Albert Einstein Medical Center, Northern Division, and Temple University Hospital, Philadelphia.

Arch Intern Med. 1974;134(5):939-942. doi:10.1001/archinte.1974.00320230149027

Neurologic complications occur in 20% to 30% of patients with bacterial endocarditis.1-5 These complications include ischemic lesions resulting in focal neurologic signs, abscess formation, meningeal reaction, and formation of cerebral mycotic aneurysm—with or without intracranial hemorrhage. Cerebrovascular lesions occur in approximately 50% of patients in this group.1,2 The frequency of subarachnoid hemorrhage (SAH) secondary to ruptured mycotic aneurysm in several large series appears to vary between 2.6% and 8%.6,7 The incidence of clinically apparent mycotic aneurysm in patients with bacterial endocarditis varies between 2% and 10%.1,2,6,8 9 Perhaps because of the low incidence of this entity and because the initial sign is often a catastrophic, fatal SAH, the pathogenesis and natural history of mycotic aneurysm are not as well known as other types of intracranial aneurysms. Recent experience with a patient with subacute bacterial endocarditis coupled with a unique evolution of angiographie findings provoked a reconsideration

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