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Neurology
Delayed formation and rupture of intracranial aneurysm following Abiotrophia defectiva endocarditis
  1. Shinya Tokunaga1,
  2. Akinori Miyakoshi1,
  3. Kenta Ito2 and
  4. Tsukasa Sato1
  1. 1Neurosurgery, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
  2. 2Clinical Laboratory Medicine, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
  1. Correspondence to Dr Shinya Tokunaga; stokunaga129{at}gmail.com

Abstract

Abiotrophia defectiva is a type of Streptococci and is a rare cause of infectious endocarditis. The progression and outcomes of infectious intracranial aneurysms (IIAs) associated with this species are unknown due to a limited number of reported cases. A woman in her 20s with a sudden headache had a subarachnoid haemorrhage on a head CT scan. Cerebral angiography showed an aneurysm on the right middle cerebral artery. She was diagnosed with infectious endocarditis caused by A. defectiva and underwent parent artery occlusion. Despite initiating targeted antibiotic therapy, a new IIA developed and ruptured 14 days postadmission. A second parent artery occlusion was performed on the new IIA. Following 6 weeks of continued antibiotic therapy, she underwent mitral valve repair and was discharged with no neurological symptoms. Endocarditis caused by A. defectiva can lead to the delayed formation of an IIA. Endovascular treatment was effective for repeated ruptured IIAs.

  • Stroke
  • Infectious diseases
  • Cardiovascular medicine

https://doi.org/10.1136/bcr-2023-258922

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: ST, AM, KI and TS. ST and AM are equal contributors to this work and are designated as co-first authors. The following authors gave final approval of the manuscript: ST.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.