Ruptured bacterial intracranial aneurysm in pregnancy. A case report

BACKGROUND: Rupture of a documented infectious cerebral aneurysm is a rare complication of infectious endocarditis, with a high morbidity and mortality rate. The only previously reported case was associated with maternal and neonatal mortality. No known report exists of a ruptured bacterial intracranial aneurysm complicating an ongoing pregnancy with maternal or fetal survival. CASE: A 38-year-old, white woman, gravida 9, para 4, at 18 weeks' gestation, developed infectious endocarditis with peripheral and cerebral emboli secondary to intravenous drug abuse, causing renal failure and cortical strokes. She required hemodialysis and also suffered a subarachnoid hemorrhage due to rupture of cerebral bacterial aneurysms. A team approach to her care was necessary. At 28 weeks' gestation she delivered by cesarean section for abruptio placentae. Both the mother and neonate recovered. CONCLUSION: Rupture of mycotic aneurysms can be catastrophic and is often managed surgically. The patient described here was severely affected, and though indicated, surgical intervention was not possible. An aggressive team approach provided a good maternal and fetal outcome.