Publication year: 2012
Source:World Neurosurgery
David J. Fusco, Walter Jermakowicz, Giacomo Consiglieri, Robert F. Spetzler
Objective Mycotic aneurysm rupture has been described as a rare, universally fatal complication of central nervous system Coccidioides immitis meningitis. Recently, however, we reported the successful surgical management of a midbasilar dissecting mycotic aneurysm related to Coccidioides immitis meningitis in a 24-year-old pregnant woman with acquired immune deficiency syndrome (AIDS). Methods A 24-year-old, pregnant woman with known AIDS and a history of Coccidioides immitis meningitis presented to our institution with subarachnoid and intraventricular hemorrhage. Diagnostic cerebral angiography revealed a dissecting, midbasilar aneurysm involving the right anterior inferior cerebellar artery (AICA) and causing stenosis of the proximal basilar artery. Through a retrosigmoid craniotomy, clip reconstruction of the basilar artery under hypothermic circulatory arrest was performed. The patient was neurologically intact at discharge (postoperative day 19) with the exception of mild disconjugate gaze and headache. Results At her 53-month follow up, the patient was neurologically intact with only mild disconjugate gaze on upgaze. There was no evidence of local aneurysm recurrence or regional aneurysm formation, and the basilar artery was patent. Her Coccidioides immitis meningitis was well controlled. The patient is maintained on oral highly active antiretroviral therapy (HAART) and antifungal regimen. Conclusion Our patient represents the only survivor of a Coccidioides immitis mycotic aneurysm rupture. In her case, long-term clinical and radiographic stability were achieved through a vigilant multidisciplinary approach.
Source:World Neurosurgery
David J. Fusco, Walter Jermakowicz, Giacomo Consiglieri, Robert F. Spetzler
Objective Mycotic aneurysm rupture has been described as a rare, universally fatal complication of central nervous system Coccidioides immitis meningitis. Recently, however, we reported the successful surgical management of a midbasilar dissecting mycotic aneurysm related to Coccidioides immitis meningitis in a 24-year-old pregnant woman with acquired immune deficiency syndrome (AIDS). Methods A 24-year-old, pregnant woman with known AIDS and a history of Coccidioides immitis meningitis presented to our institution with subarachnoid and intraventricular hemorrhage. Diagnostic cerebral angiography revealed a dissecting, midbasilar aneurysm involving the right anterior inferior cerebellar artery (AICA) and causing stenosis of the proximal basilar artery. Through a retrosigmoid craniotomy, clip reconstruction of the basilar artery under hypothermic circulatory arrest was performed. The patient was neurologically intact at discharge (postoperative day 19) with the exception of mild disconjugate gaze and headache. Results At her 53-month follow up, the patient was neurologically intact with only mild disconjugate gaze on upgaze. There was no evidence of local aneurysm recurrence or regional aneurysm formation, and the basilar artery was patent. Her Coccidioides immitis meningitis was well controlled. The patient is maintained on oral highly active antiretroviral therapy (HAART) and antifungal regimen. Conclusion Our patient represents the only survivor of a Coccidioides immitis mycotic aneurysm rupture. In her case, long-term clinical and radiographic stability were achieved through a vigilant multidisciplinary approach.
Sent with MobileRSS HD FREE
No comments:
Post a Comment