• World Neurosurg · Apr 2017

    Review Case Reports

    Ruptured Mycotic Aneurysm and Cerebral Vasospasm in the Setting of Endocarditis and Heart Failure Requiring Cardiothoracic Surgery: Case Report and Review.

    • Chih-Ta Lin, Bruce Tranmer, Susan Durham, David Johnson, Mark Hamlin, and R Morton Bolman.
    • Division of Neurosurgery, Department of Surgery, University of Vermont, Burlington, Vermont, USA. Electronic address: Chih-Ta.Lin@uvmhealth.org.
    • World Neurosurg. 2017 Apr 1; 100: 711.e13-711.e18.

    BackgroundRuptured mycotic aneurysm in the setting of cardiac failure and cerebral vasospasm presents unique management challenges.Case DescriptionA patient with a ruptured mycotic aneurysm with subarachnoid hemorrhage, cerebral vasospasm, and endocarditis with heart failure successfully underwent craniotomy, neuroendovascular treatment, and cardiopulmonary bypass for mitral valve replacement while in cerebral vasospasm. This case highlights clinical management strategies for a patient with a ruptured mycotic aneurysm, subarachnoid hemorrhage, cerebral vasospasm, endocarditis, and heart failure.ConclusionsOpen craniotomy, neuroendovascular treatment, and cardiac surgery strategies can be used when treating patients with ruptured mycotic aneurysms and cardiac failure. When the patient also has cerebral vasospasm, maintenance of mean arterial pressure is paramount.Copyright © 2017 Elsevier Inc. All rights reserved.

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