# Recurrent intracerebral hemorrhage as a rare presentation of mycotic aneurysm secondary to infective endocarditis: A case report

## TL;DR

A rare case of mycotic aneurysm caused by infective endocarditis led to recurrent brain hemorrhages, managed with a combination of conservative and surgical approaches.

## Contribution

This case report highlights the rare presentation of mycotic aneurysm as a cause of recurrent intracerebral hemorrhage and emphasizes the importance of multidisciplinary management.

## Key findings

- Mycotic aneurysms can present as recurrent intracerebral hemorrhage and are a rare complication of infective endocarditis.
- Conservative management with antibiotics is feasible for stable patients with small hematomas.
- Surgical or endovascular treatment is required for massive hemorrhage and clinical deterioration.

## Abstract

Mycotic aneurysms are a rare but serious complication of systemic infections such as infective endocarditis. When ruptured, they carry a high risk of mortality and are an uncommon cause of intracerebral hemorrhage.

A 54-year-old male, initially presented with a right Middle Cerebral Artery (MCA) territory infarct and was managed conservatively. He later developed an intracerebral hemorrhage requiring surgical evacuation, followed by a second hemorrhagic event. Digital Angiography revealed a ruptured mycotic pseudoaneurysm in the right MCA M4 segment; he was managed conservatively with antibiotics and recovered well by three- month follow up.

Mycotic aneurysms are though rare but can be managed medically with early detection and prompt diagnosis. Multidisciplinary team of Neurologists, neurointerventionist, cardiologists, radiologists, clinical psychologist discussion is needed for timely diagnosis of such illness and appropriate treatment. Patient with hemodynamically stable status, small hematoma, can be managed conservatively with antibiotics whereas massive hematoma, ruptured aneurysm needs surgical or endovascular treatments.

Prompt and thorough radiological assessment-including non-contrast CT of the brain and cerebral angiography, coupled with detailed cardiac evaluation such as echocardiography, is pivotal in the early detection of mycotic aneurysm in patients presenting with intracerebral hemorrhage. Such a comprehensive diagnostic approach not only facilitates timely intervention but also significantly contributes to improved clinical outcomes. Treatment should be tailored according to the clinical condition of each patient.

•Mycotic aneurysms are very rare but potentially fatal complications of infective endocarditis.•Hemodynamically and neurologically stable patient can be managed conservatively with antibiotics.•Massive hemorrhage and clinical deterioration warrant surgical/endovascular procedure.

Mycotic aneurysms are very rare but potentially fatal complications of infective endocarditis.

Hemodynamically and neurologically stable patient can be managed conservatively with antibiotics.

Massive hemorrhage and clinical deterioration warrant surgical/endovascular procedure.