Presentation
Undergoing hospital treatment with a diagnosis of infectious endocarditis located on the mitral valve. Sudden hemiparesis, rapid deterioration, coma.
Patient Data
Large intraparenchymal hemorrhage in the left frontal and parietal lobes with surrounding areas of hypodensity due to unclotted fresh blood. Slight midline shift.
Enhancing round structure at the distal branch of the MCA is seen in the left parietal lobe adjacent to the intraparenchymal hemorrhage
After two hours in comparison with CT an increasing hematoma size and a midline shift are clearly visible. An annular structure in the left parietal lobe adjacent to intraparenchymal hemorrhage suggestive mycotic aneurysm. Small areas of hemorrhages seen on Gradient Echo which a very likely for multiple aneurysmatic lesions.
Case Discussion
Hemorrhage from a mycotic aneurysm is a rare complication of infective endocarditis, but fatal in most cases. This case demonstrates the typical peripheral localization of such an aneurysm.
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