Ruptured Infective (Mycotic) Intracranial Aneurysm Secondary to Bacterial Meningitis: A Case Report and Review of Literature

Mycotic Aneurysm (MA), a rare complication of systemic infections, is a result of degradation and dilation of the arterial wall. Etiology can be due to endovascular seeding of infective emboli (e.g. infective endocarditis, bacteremia) or extravascular spread of infection (e.g. meningitis, osteomyelitis, orbital cellulitis). Infective Intracranial Aneurysms (IIA) is extremely rare and account for a small fraction of all intracranial aneurysms. Most IIA are caused by bacterial or fungal infections. IIA has a higher risk of rupture as compared to other aneurysms due to their rapid progression and increased vessel fragility. Diagnosis is mostly based on clinical history and neurovascular imaging. Medical management and endovascular intervention can be considered the first-line treatment for unruptured IIA. Open surgery is done in cases of complications or failed endovascular intervention. A case of suspected ruptured IIA secondary to bacterial meningitis is discussed in detail along with a review of the literature. Certain proposals on diagnosis, management, and complication have been put forth.