Endovascularly treated cerebral aneurysm using Guglielmi detachable coils acting as a nidus for brain abscess formation secondary to Salmonella bacteremia: case report.
OBJECTIVE
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.


METHODS
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.


METHODS
The patient was treated successfully with long-term cephalosporin therapy. Follow-up imaging studies revealed regression of the abscess.


CONCLUSIONS
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.
Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool, England.
Ramez W
RW
Kirollos
Jark J D
JJ
Bosma
Jayakumar
J
Radhakrishnan
Timothy D J
TD
Pigott
D016470:Bacteremia / Q000000981:diagnostic imaging / Q000209:etiology*; D001922:Brain Abscess / Q000000981:diagnostic imaging / Q000209:etiology*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002555:Cerebrospinal Fluid / Q000382:microbiology; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D005549:Foreign-Body Reaction / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D016920:Meningitis, Bacterial / Q000000981:diagnostic imaging / Q000209:etiology*; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D019736:Prostheses and Implants / Q000009:adverse effects*; D012307:Risk Factors; D012480:Salmonella Infections / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed