title: Management of infectious intracranial aneurysms in the pediatric population.
abstract: BACKGROUND
  Infectious intracranial aneurysms (IIAs) account for approximately 15 % of all pediatric intracranial aneurysms. Histologically, they are pseudoaneurysms that develop in response to an inflammatory reaction within the adventitia and muscularis layers, ultimately resulting in disruption of both the internal elastic membrane and the intima. The majority of pediatric IIAs are located within the anterior circulation, and they can be multiple in 15-25 % of cases.
  
  
  BACKGROUND
  The most common presentation for an IIA is intracerebral and/or subarachnoid hemorrhage. In children with a known diagnosis of infective endocarditis who develop new neurological manifestations, it is imperative to exclude the existence of an IIA. The natural history of untreated infectious aneurysms is ominous; they demonstrate a high incidence of spontaneous rupture. High clinical suspicion, prompt diagnosis, and adequate treatment are of paramount importance to prevent devastating neurological consequences.
  
  
  CONCLUSIONS
  The prompt initiation of intravenous broad-spectrum antibiotics represents the mainstay of treatment. Three questions should guide the management of pediatric patients with IIAs: (a) aneurysm rupture status, (b) the presence of intraparenchymal hemorrhage or elevated intracranial pressure, and (c) relationship of the parent vessel to eloquent brain tissue. Those three questions should orient the treating physician into either antibiotic therapy alone or in combination with microsurgical or endovascular interventions. This review discusses important aspects of the epidemiology, the diagnosis, and the management of IIAs in the pediatric population.
authors.affiliation: Department of Neurological Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Mail Code 8855, Dallas, TX, 75390, USA. Bruno.Flores@yahoo.com.
authors.forename: Bruno C
authors.initials: BC
authors.lastname: Flores
authors.affiliation: Department of Neurological Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Mail Code 8855, Dallas, TX, 75390, USA.
authors.forename: Ankur R
authors.initials: AR
authors.lastname: Patel
authors.affiliation: Department of Neurological Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Mail Code 8855, Dallas, TX, 75390, USA.
authors.forename: Bruno P
authors.initials: BP
authors.lastname: Braga
authors.affiliation: Department of Neurological Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Mail Code 8855, Dallas, TX, 75390, USA.
authors.forename: Bradley E
authors.initials: BE
authors.lastname: Weprin
authors.affiliation: Department of Neurological Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Mail Code 8855, Dallas, TX, 75390, USA.
authors.forename: H Hunt
authors.initials: HH
authors.lastname: Batjer
mesh_terms: D000785:Aneurysm, Infected / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D019468:Disease Management; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D010372:Pediatrics
keywords: Infectious aneurysms; Management; Mycotic aneurysms; Pediatric aneurysms; Review