Ruptured Vertebral Artery Dissecting Aneurysm in a Patient with Recurrent Bacterial Meningitis.

Abstract Background Intracranial mycotic aneurysms are uncommon, it can occur due extravascular extension or intravascular seeding of the vessel wall. It often results subarachnoid hemorrhage (SAH) with poor prognosis. We present a rare case of ruptured proximal anterior inferior cerebellar artery- posterior inferior cerebellar artery (AICA-PICA) mycotic aneurysm after an episode of bacterial meningitis. Case Description A 66-year-old male with history of two episodes of culture-negative bacterial meningitis presented with a Hunt and Hess grade II, Fisher grade III (SAH). Catheter angiography showed a right-sided intracranial vertebral artery dissection (VAD) and a fusiform AICA-PICA aneurysm. The patient underwent an endovascular occlusion of the VADA followed by an occipital artery to AICA bypass with trapping of the aneurysm. The patient developed a left-sided numbness and weakness after the coiling procedure due to anteromedian medullary stroke (occlusion of the right anterior spinal artery). The patient’s magnetic resonance imaging (MRI) 3 week prior to the aneurysm rupture and during the second episode of meningitis showed new enhancement of both VA with a mild reduction in the right VA caliber. On 6 weeks follow up the patient was off the ventilator but with Modified Rankin Scale (MRS) 5. Conclusion Bacterial meningitis can lead to inflammatory injury of the intracranial vessels with resultant aneurysm formation. A new enhancement of the vessel wall indicates that patients at risk of developing mycotic aneurysms, therefore a close observation with repeated vascular imaging is necessary.