title: [The Therapeutic Dilemma in Treatment of Intracranial Infectious Aneurysm in Patients with Infective Endocarditis: Proposal for a Patient-Centered, Interdisciplinary Treatment Concept].
abstract: Intracranial infectious aneurysms are rare but hazardous complications of an infective endocarditis. To date, there are no evidence-based recommendations for the treatment of patients with this condition. Therefore, it remains an interdisciplinary challenge to decide which treatment steps are required and in which order they should be carried out. To illustrate the interdisciplinary dilemma in the treatment of these patients, we here present a case of a 23-year-old, drug-addicted woman with infectious endocarditis. While antibiotic treatment of the streptococcus-mitis-induced endocarditis stabilized the overall status of the patient, rupture of a basilar artery aneurysm caused her sudden death. We discuss the decision-making processes of the treatment, potential difficulties and dilemmas when dealing with patients suffering from infectious endocarditis and infectious intracranial aneurysm. Based upon case reports, studies and reviews, we present the options and risks of conservative, neurosurgical, endovascular, and cardiosurgical treatment of intracranial infectious aneurysms, and propose a patient-centered, interdisciplinary treatment concept.
authors.affiliation: Uniklinik Köln, Klinik und Poliklinik für Neurologie, Köln.
authors.forename: S
authors.initials: S
authors.lastname: Leuenhagen
authors.affiliation: Heilig Geist-Krankenhaus Köln, Klinik für Neurologie, Köln.
authors.forename: L
authors.initials: L
authors.lastname: Burghaus
authors.affiliation: Uniklinik Köln, Klinik und Poliklinik für Neurologie, Köln.
authors.forename: J
authors.initials: J
authors.lastname: Kukolja
authors.affiliation: Uniklinik Köln, Klinik III für Innere Medizin und Zentrum für Molekulare Medizin Köln (ZMMK), Herzzentrum, Köln.
authors.forename: S
authors.initials: S
authors.lastname: Rosenkranz
authors.affiliation: Uniklinik Köln, Institut und Poliklinik für Radiologische Diagnostik, Köln.
authors.forename: C
authors.initials: C
authors.lastname: Kabbasch
authors.affiliation: Uniklinik Köln, Klinik und Poliklinik für Neurologie, Köln.
authors.forename: G R
authors.initials: GR
authors.lastname: Fink
authors.affiliation: Uniklinik Köln, Klinik und Poliklinik für Neurologie, Köln.
authors.forename: O A
authors.initials: OA
authors.lastname: Onur
mesh_terms: D000328:Adult; D000465:Algorithms; D000785:Aneurysm, Infected / Q000150:complications* / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000150:complications; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D003131:Combined Modality Therapy; D038524:Diffusion Magnetic Resonance Imaging; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000628:therapy*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D002532:Intracranial Aneurysm / Q000150:complications* / Q000628:therapy*; D009460:Neurologic Examination; D018802:Patient-Centered Care; D013290:Streptococcal Infections / Q000150:complications* / Q000628:therapy*; D034361:Streptococcus mitis
chemical_list: D000900:Anti-Bacterial Agents