ArticleNMC case report journal2025
Punctate Hyperdensity on Noncontrast-enhanced Computed Tomography before Rupture of a Mycotic Cerebral Aneurysm in a Patient with Infective Endocarditis: A Case Report.
Article in NMC case report journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Mycotic cerebral aneurysms secondary to infective endocarditis carry a high risk of fatal rupture. Early identification and appropriate intervention are critical. We present a case in which a punctate hyperdense lesion on noncontrast-enhanced computed tomography appeared several days before aneurysm formation and rupture. A 43-year-old man with infective endocarditis presented with a ruptured mycotic aneurysm in the peripheral left middle cerebral artery. The patient underwent emergency craniotomy. During the postoperative follow-up, 2 new punctate hyperdense lesions were detected on noncontrast-enhanced computed tomography. A total of 3 days later, one of these lesions progressed to aneurysm formation and hemorrhage, requiring repeat surgery. The outcome was favorable, with a modified Rankin scale score of 2. This case highlights that punctate hyperdense lesions on noncontrast-enhanced computed tomography may serve as an early radiological marker of impending mycotic aneurysm formation and suggests the importance of close imaging surveillance to prevent catastrophic rupture.
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