Bacterial intracranial aneurysm

Abstract

Cases of bacterial intracranial aneurysm documented since 1954, and an additional 4 cases, are tabulated and analyzed. In 85 cases the overall mortality was 46%. Elimination of patients dying before reaching the hospital makes this figure spuriously low. Figures for patients hospitalized for endocarditis before neurological symptoms occurred suggest a true mortality of 80% from aneurysms that rupture and 30% if the aneurysm remains intact. Multiple reports of spontaneously resolving, enlarging, diminishing, multiple and sequentially appearing aneurysms, all of which occurred in the 4th case, clarify the need for complete and sequential angiography. Computerized tomographic (CT) scanning in this disease was not reported, but experience with these scans demonstrates considerable potential value. A protocol of complete cerebral angiography and CT scanning of these neurologically asymptomatic patients is proposed to assess the true incidence of bacterial intracranial aneurysm, to learn more of its natural history and to prevent some neurological catastrophes.