OBJECTIVE AND IMPORTANCE: Intracranial infections related to the various foreign materials used to secure intracranial aneurysms are extremely rare. The lack of neoendothelium formation across the necks of aneurysms, which is particularly prone to occur when the sac is incompletely packed by Guglielmi detachable coils (GDC), results in the absence of isolation of the coils from the circulation. Colonization of GDCs, which act as a foreign-body nidus after hematogenous spread from infections with bacteremia, may result in localized intracranial infection. CLINICAL PRESENTATION: A 55-year-old woman developed meningitis and a brain abscess surrounding a giant aneurysm that was treated endovascularly with GDC 3 1/2 years earlier. Four weeks before she sought care, she experienced an infective illness with proven Salmonella bacteremia. Salmonella group D was isolated from cerebrospinal fluid. INTERVENTION: The patient was treated successfully with long-term cephalosporin therapy. Follow-up imaging studies revealed regression of the abscess. CONCLUSION: This case suggests that the GDC acted as a colonized foreign body, resulting in the surrounding abscess formation after infection with Salmonella bacteremia. Alternatively, the reaction of the surrounding tissue to the GDC was the predisposing factor and acted as the nidus for the abscess formation.
OBJECTIVE AND IMPORTANCE: Intracranial infections related to the various foreign materials used to secure intracranial aneurysms are extremely rare. The lack of neoendothelium formation across the necks of aneurysms, which is particularly prone to occur when the sac is incompletely packed by Guglielmi detachable coils (GDC), results in the absence of isolation of the coils from the circulation. Colonization of GDCs, which act as a foreign-body nidus after hematogenous spread from infections with bacteremia, may result in localized intracranial infection. CLINICAL PRESENTATION: A 55-year-old woman developed meningitis and a brain abscess surrounding a giant aneurysm that was treated endovascularly with GDC 3 1/2 years earlier. Four weeks before she sought care, she experienced an infective illness with proven Salmonella bacteremia. Salmonella group D was isolated from cerebrospinal fluid. INTERVENTION: The patient was treated successfully with long-term cephalosporin therapy. Follow-up imaging studies revealed regression of the abscess. CONCLUSION: This case suggests that the GDC acted as a colonized foreign body, resulting in the surrounding abscess formation after infection with Salmonella bacteremia. Alternatively, the reaction of the surrounding tissue to the GDC was the predisposing factor and acted as the nidus for the abscess formation.
Authors: J P Cruz; T Marotta; C O'Kelly; M Holtmannspötter; G Saliou; R Willinsky; T Krings; R Agid Journal: AJNR Am J Neuroradiol Date: 2014-05-29 Impact factor: 3.825