J Korean Soc Geriatr Neurosurg > Volume 16(1); 2020 > Article
Journal of Korean Society of Geriatric Neurosurgery 2020;16(1):62-66.
DOI: https://doi.org/10.51638/jksgn.20.00437    Published online September 30, 2020.
Multiple Infected Cerebral Aneurysms Mimicking Metastatic Brain Tumor: A Case Report
Jeong Mo Shin, Ik Seong Park
Department of Neurosurgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
전이성 뇌종양으로 오인된 다발성 감염 동맥류
신정모, 박익성
가톨릭대학교 의과대학 부천성모병원 신경외과학교실
Correspondence:  Ik Seong Park, Tel: +82-32-340-7212, Fax: +82-32-340-7391, 
Email: ispahk@gmail.com
Abstract
The authors emphasize the importance of accurate history taking through a case report of an infectious cerebral aneurysm after undergoing craniotomy under a metastatic brain’s diagnosis. A 54 years old man was presented with a headache. Brain magnetic resonance images (MRI) revealed multiple small enhancing mass lesion with pial enhancement. No suspicious findings of systemic cancer were observed on positron emission tomography. Follow up MRI scan performed two weeks later showed an increase in mass size. Exploration craniotomy was done. A fusiform dilated vessel with surrounding hematoma was noticed on subarachnoid space. Pathologic study revealed pseudoaneurysm. Multiple vegetations on the left ventricle were detected by echocardiography. But blood culture reported no growth of any bacteria. Cerebral digital subtraction angiography revealed multiple intracerebral aneurysms ranging from 1 to 3 mm. Further investigation of the patient's past history revealed a dental extraction due to carries, which was the most common cause of infected aneurysms. Empirical antibiotics therapy was performed for 6 weeks, and the disappearance of enhanced lesions on Brain MRI and vegetation on echocardiography was confirmed. Sophisticated history taking and a systemic evaluation are essential for the evaluation of uncertain cerebrovascular disease.
Key Words: Antibiotic therapy, Exploration craniotomy, Infectious intracranial aneurysm, Metastatic brain tumor
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