title: HydroCoil embolization of a ruptured infectious aneurysm in a pediatric patient: case report and review of the literature.
abstract: BACKGROUND
  Intracranial infectious aneurysms in the pediatric population are rare. Although surgery has been the traditional treatment of ruptured pediatric infectious aneurysms, endovascular coil embolization has become an attractive alternative due to its low rate of morbidity and mortality.
  
  
  METHODS
  A 9-year-old boy with a significant medical history of aortic valve replacement, antibiotic-treated infective endocarditis, and multiple embolic cerebral infarcts presented with a high-grade intraventricular hemorrhage due to the rupture of a large infectious proximal posterior circulation aneurysm. Computed tomography and cerebral angiogram demonstrated a right crural/ambient cistern hematoma and an associated infectious aneurysm of the right proximal posterior cerebral artery. The ruptured infectious aneurysm was coil-embolized with hydrogel-coated platinum coils without sacrifice of the distal parent artery. The aneurysm was completely occluded, and the patient regained all neurological function.
  
  
  CONCLUSIONS
  Ruptured infectious aneurysms in the pediatric population occur despite aggressive medical therapy. Patients with infective endocarditis and embolic infarcts should be followed closely due to the risk of major hemorrhagic events, including aneurysm rupture. Hybrid coil embolization of ruptured infectious aneurysms with preservation of the distal parent artery is exceedingly rare and effective in the management of ruptured infectious aneurysms in the pediatric population.
authors.affiliation: Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, 676 N. St. Claire, Suite 2210, Chicago, IL 60611, USA. eddleman@md.northwestern.edu
authors.forename: Christopher
authors.initials: C
authors.lastname: Eddleman
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Nikas
authors.forename: Ali
authors.initials: A
authors.lastname: Shaibani
authors.forename: Pervez
authors.initials: P
authors.lastname: Khan
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Dipatri
authors.forename: Tadanori
authors.initials: T
authors.lastname: Tomita
mesh_terms: D000785:Aneurysm, Infected / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D004696:Endocarditis / Q000150:complications; D006801:Humans; D007223:Infant; D002532:Intracranial Aneurysm / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D008297:Male; D020769:Posterior Cerebral Artery / Q000382:microbiology / Q000473:pathology; D013290:Streptococcal Infections / Q000150:complications* / Q000473:pathology; D016896:Treatment Outcome