Aneurisma micotico cerebral bilateral em criança: registro de um caso e revisão da literatura

Coutinho, Lígia M. B.; Coutinho, Mario F.; Teixeira, Luiz Carlos; Seibert, Cláudio A.; Antunes, Apio C. M.

doi:10.1590/S0004-282X1976000300004

Resumos

Os autores relatam caso de paciente masculino, de 6 anos de idade, hospitalizado com diagnóstico de meningite purulenta. A pneumencefalografia mostrou processo expansivo fronto-temporal esquerdo. A arteriografia carotídea bilateral demonstrou presença de aneurisma da artéria frontal ascendente, com hematoma circundante, à esquerda e, aneurisma da artéria temporal posterior, à direita. Cirurgia para evacuação do hematoma e clipagem do aneurisma foi realizada. O paciente piorou no pós-operatório e faleceu. A autópsia demonstrou a presença de hemorragia subaracnóide, hematoma fronto-temporal esquerdo e para-capsular direito. No interior do hematoma, à direita, evidencia-se massa arredondada, cujo exame histopatológico demonstrou tratar-se de paredes arteriais dilatadas, com intenso processo inflamatório supurativo. Os autores tecem considerações a respeito da frequência de aneurismas micóticos na infância, a multiplicidade dos mesmos, a sua etiopatogenia, a localização dos mesmos na árvore arterial intracraniana, do valor diagnóstico da angiografia carotídea e da indicação cirúrgica.

The case of a 6 year-old boy, who was hospitalized with the diagnosis of purulent meningitis is reported. The CSF examination disclosed pleocytosis and the antibioticotherapy was instituded. The bilateral carotid angiography demonstrated an arterial aneurysm of the frontal ascendent artery with hematoma in the left side, and another in the posterior temporal artery, in the right side. The patient was operated on because of the hematoma, in the left side. The condition of the patient in the post-operatory period deteriorated and the death ocurred. The post-mortem examination disclosed a sub-arachnoidal hemorrhage, fronto-temporal hematoma in the left side and a para-capsular hematoma in the right side. The histological examination of the central part of the hematoma revealed a dilated arterial walls with a supurative inflammatory process. The authors took in consideration the frequency of mycotic aneurysms in children, especially the multiplicity of them, the etiopathogeny and their localization in the intracranial arterial tree.

Aneurisma micotico cerebral bilateral em criança. Registro de um caso e revisão da literatura

Bilateral cerebral mycotic aneurysm in a child: case report and review of the literature

Lígia M. B. Coutinho^I; Mario F. Coutinho^II; Luiz Carlos Teixeira^III; Cláudio A. Seibert^IV; Apio C. M. Antunes^IV

^IAuxiliar de Ensino no Departamento de Patologia da Fundação Faculdade Católica de Medicina de Porto Alegre

^IIProfessor de Neurocirurgia da Fundação Faculdade Católica de Medicina de Porto Alegre e Professor de Neurologia da Faculdade de Medicina da Universidade Federal de Pelotas

^IIINeurocirurgião do Hospital da Criança Santo Antonio de Porto Alegre

^IVResidentes do Serviço de Neurologia e Neurocirurgia do Prof. Mário Coutinho

RESUMO

Os autores relatam caso de paciente masculino, de 6 anos de idade, hospitalizado com diagnóstico de meningite purulenta. A pneumencefalografia mostrou processo expansivo fronto-temporal esquerdo. A arteriografia carotídea bilateral demonstrou presença de aneurisma da artéria frontal ascendente, com hematoma circundante, à esquerda e, aneurisma da artéria temporal posterior, à direita. Cirurgia para evacuação do hematoma e clipagem do aneurisma foi realizada. O paciente piorou no pós-operatório e faleceu. A autópsia demonstrou a presença de hemorragia subaracnóide, hematoma fronto-temporal esquerdo e para-capsular direito. No interior do hematoma, à direita, evidencia-se massa arredondada, cujo exame histopatológico demonstrou tratar-se de paredes arteriais dilatadas, com intenso processo inflamatório supurativo.

Os autores tecem considerações a respeito da frequência de aneurismas micóticos na infância, a multiplicidade dos mesmos, a sua etiopatogenia, a localização dos mesmos na árvore arterial intracraniana, do valor diagnóstico da angiografia carotídea e da indicação cirúrgica.

SUMMARY

The case of a 6 year-old boy, who was hospitalized with the diagnosis of purulent meningitis is reported. The CSF examination disclosed pleocytosis and the antibioticotherapy was instituded. The bilateral carotid angiography demonstrated an arterial aneurysm of the frontal ascendent artery with hematoma in the left side, and another in the posterior temporal artery, in the right side. The patient was operated on because of the hematoma, in the left side. The condition of the patient in the post-operatory period deteriorated and the death ocurred. The post-mortem examination disclosed a sub-arachnoidal hemorrhage, fronto-temporal hematoma in the left side and a para-capsular hematoma in the right side. The histological examination of the central part of the hematoma revealed a dilated arterial walls with a supurative inflammatory process.

The authors took in consideration the frequency of mycotic aneurysms in children, especially the multiplicity of them, the etiopathogeny and their localization in the intracranial arterial tree.

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18. LAITINEN, L. Cit. por Thompson e col.⁴⁷.

21. MacCALLUM, W. G. Cit. por Rathmell e col. ³⁴.

43. STENGEL, A. & WOLFERTH, C. C. Cit. por Shnider e Cotsonas Jr.⁴³.

Departamento de Patologia Fundação Faculdade Católica de Medicina de Porto Alegre Rua Sarmento Leite 245 90000 Porto Alegre, RS Brasil.

1. ARAI, H.; SUGIYAMA, Y.; KAWAKAMS, S. & MIYAZAWA, N. Multiple intracranial aneurysms and vascular malformation in an infant: case report. J. Neurosurg. 37:357, 1972.
2. ARAI, H.; UEKI, K. & TAKAHARA, J. Intracranial aneurysm in an infant. Surg. Neurol. 1:94, 1973.
3. ACHSLOGH, J. & KULAKOWSKI, S. Problème de l'anévrysme intra-crânien chez l'enfant. Acta Paedit. Belgica 24:507, 1970.
4. BARKER, W. F. Mycotic aneurysms. Ann. Surg. 139:84, 1954.
5. CANTU, R. C.; LEMAY, M. & WILKINSON, H. A. The importance of repeated angiography in the treatment of mycotic embolic intracranial aneurysms. J. Neurosurg. 25:189, 1966.
6. COURSON, B.; DUMAS, M. & COLLOMB, H. Les anévrysmes artériels distaux ou des branches péripheriques de l'artère cérebrale moyenne. Neuro-Chirurgie (Paris) 16:15, 1970.
7. DANDY, W. E. Intracranial Arterial Aneurysms. 2.Ş Edição, Comstock Publishing Co. Inc., Cornell University, 1945, p. 5.
8. DAVIDSON, P. & ROBERTSON, D. M. A true mycotic (Aspergillus) aneurysm leading to fatal subarachnoid hemorrhage in a patient with hereditary hemorrhagic telegiectasia: case report. J. Neurosurg. 35:71, 1971.
9. DAVID, M.; PRADAT, P. & DOYON, D. Anévrysme de 1'artère sylvienne chez un enfant de 3 ans. Neuro-Chirurgie (Paris) 14:822, 1968.
10. DEVADIGA, K.; MATHAI, K. U. & CHANDY, J. Spontaneous cure of intracavernous aneurysm of the internal carotid in a 14 month-old child: case report. J. Neurosurg. 30:165, 1969.
11. GARCIA-CHAVEZ, C. & MOOSSY, J. Cerebral artery aneurysm in infancy: association with agenesis of the corpus callosum. J. Neuropath. Exp. Neurol. 24:492, 1965.
12. HEIDELBERGER, K. P.; LAYTON Jr., W. M. & FISHER, R. G. Multiple cerebral mycotic aneurysms complicating post traumatic pseudomonas meningitis: case report. J. Neurosurg. 29:631, 1968.
13. JANE, J. A. A large aneurysm of the posterior inferior cerebellar artery in a 1-year-old child. J. Neurosurg. 18:245, 1961.
14. JONES, R. K. & SHEARBURN, E. W. Intracranial aneurysm in a four-week-old infant: diagnosis by angiography and successful operation. J. Neurosurg. 18:122, 1961.
15. JONES Jr., H. R.; SIEKERT, R. G. & GERACI, J. E. Neurologic manifestations of bacterial endocarditis. Ann. Int. Med. 71:21, 1969.
16. KIMBELL Jr., F. D.; LLEWELLYN, R. C. & KIRGIS, H. D. Surgical treatment of ruptured aneurysm with intracranial and subarachnoid hemorrhage in a 16-month-old infant. J. Neurosurg. 17:331, 1960.
17. KING, B. Successful surgical treatment of an intracranial mycotic aneurysm complicated by subdural hematoma. J. Neurosurg. 17:788, 1960.
19. LAPRAS, C.; GOUTELLE, A.; BRAUNAT, M. & DECHAUME, J. Q. Les anévrysmes intra-crâniens chez J'enfant: a propos de 4 observations. Neuro-Chirurgie (Paris) 14:891, 1968.
20. LOCKSLEY, H. B. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations based on 6368 cases in the Cooperative Study. J. Neurosurg. 25:219, 1966.
22. MATSON, D. D. Intracranial arterial aneurysms in childhood. J. Neuro-surg. 23:578, 1965.
23. McDONALD, C. A. & KORB, M. Intracranial aneurysms. Arch. Neurol. Psychiat. (Chicago) 42:298, 1934.
24. McKEE, E. E. Mycotic infection of the brain with arteritis and subarachnoid hemorrhage: report of case. Am. J. Clin. Path. 20:381, 1950.
25. McNEEL, D.; EVANS, R. A. & ORY, E. M. Angiography of cerebral mycotic aneurysms. Acta Radiol. (Diagn.) 9:407, 1969.
26. MITCHELL, N. & ANGRIST, A. Intracranial aneurysms: a report of thirty-six cases. Ann. Int. Med. 19:909, 1943.
27. MOLINARI, G. F.; SMITH, L.; GOLRSTEIN, R. N. & SATRAN, R. Pathogenesis of cerebral mycotic aneurysms. Neurology (Minneapolis) 23:907, 1973.
28. MONTRIEUL, B.; TERRASSE, J.; ALIX, B. & LATOUR, J. P. Sur les relations entre hématome intra-cérébrale, anévrysme mycotique, septicémics a staphilocoques et endocardites. Sem. Hôp. Paris 49:2009, 1973.
29. MORRISS Jr., F. H. & SPOCK, A. Intracranial aneurysm secondary to mycotic orbital and sinus infection: report of a case implicating Penicillium as an opportunistic fungus. Am. J. Dis. Child. 119:357, 1970.
30. MOSKOWITZ, M. A.; ROSENBAUM, A. E. & TYLER, H. R. Angiographically monitored resolution of cerebral mycotic aneurysms. Neurology (Minneapolis) 24:1103, 1974.
31. NOONAN, J. A.; WILSON, C. B.; SPENCER, F. C. & TLBERT Jr., W. M. Cerebral and cardiac complications from bacterial endocarditis: a successful managed case with anusual complications. Am. J. Dis. Child. 116:666, 1968.
32. PATEL, A. N. & RICHARDSON, A. E. Ruptured intracranial aneurysms in the first two decades of life: a study of 58 patients. J. Neurosurg. 35:571, 1971.
33. PICKERING, L. K.; HOGAN, G. R. & GILBERT, E. F. Aneurysm of the posterior inferior cerebellar artery: rupture in a newborn. Am. J. Dis. Child. 119:155, 1970.
34. RATHMELL, T. K.; MORA, G. & PESSEL, J. F. Mycotic aneurysm of the circle of Willis. J.A.M.A. 150:555, 1952.
35. RIGGS, H. E. & RUPP, I. Miliary aneurysms. Relation of anomalies of the circle of Willis to aneurysm formation. J. Neuropath. Exp. Neurol. 1:442, 1942.
36. RITCHIE, W. P. & HAINES, G. Spontaneous intracranial hemorrhage in children. Arch. Surg. 66:452, 1953.
37. ROACH, M. R. & DRAKE, C. G. Ruptured cerebral aneurysms caused by micro-organisms. New England Med. J. 29:240, 1965.
38. SEDZIMIR, C. B.; OCCLESHAW, J. V. & BUXTON, P. H. False cerebral aneurysm: case report. J. Neurosurg. 29:636, 1966.
39. SEDZIMIR, C. B. & ROBINSON, J. Intracranial hemorrhage in children and adolescents. J. Neurosurg. 38:269, 1973.
40. SEDZIMIR, C. B.; JONES, E. W.; HAMILTON, D. & EDWARDS, R. Management of coartation of aorta and bleeding intracranial aneurysm in paediatric cases. Neuropäediatrie 4:124, 1973.
41. SHNIDER, B. I. & COTSONAS Jr., N. J. Embolic mycotic aneurysms, a complication of bacterial endocarditis. Am. J. Med. 16:246, 1954.
42. SHUCART, W. A. & WOLPERT, S. M. Intracranial arterial aneurysm in childhood. Am. J. Dis. Child. 127:288, 1974.
44. SUWANWELA, C.; SUWANWELA, N.; CHARUNCHINDA, S. & HONGSAPRABHAS, C. Intracranial mycotic aneurysms of extravascular origin. J. Neurosurg. 36:552, 1972.
45. SYPERT, G. W. & YOUNG, H. F. Ruptured mycotic pericallosal aneurysm with meningitis due to neisseria meningitis infection: case report. J. Neurosurg. 37:467, 1972.
46. THIERRY, M. A.; KLEPHING, C.; DESTAING, F.; BINNERT, D.; DUMAS, R.; FOISSAL, F. C. & LAMY, A. Hématome intra-cérébrale spontané au cours d'une septicémie à staphilocoques, sans endocardite infectieuse. Neuro-Chirurgie 18:175, 1972.
47. THOMPSON, R. J.; HARWOOD-NASH, D. C. & FITZ, C. R. Cerebral aneurysms in children. Am. J. Roentgenol. Radium Ther. Nucl. Med. 118: 163, 1973.
48. VAPALAHTI, P. M.; SCHUGK, P.; TARKKANEN, L. & BJÖRKESTEN, G. Intracranial arterial aneurysm in a three-old infant: case report. J. Neurosurg. 30:169, 1969.
49. VISUDHIPHAN, P.; BUNYARATAVEJ, S. & KHANTANAPHAR, S. Cerebral aspergillosis: report of three cases. J. Neurosurg. 38:472, 1973.
50. ZIMENT, I. & JOHNSON Jr., B. L. Angiography in the management of intracranial mycotic aneurysms. Arch. Int. Med. (Chicago) 122:349, 1968.

Datas de Publicação

Publicação nesta coleção
26 Fev 2013
Data do Fascículo
Set 1976

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ARAI, H.; SUGIYAMA, Y.; KAWAKAMS, S. & MIYAZAWA, N. Multiple intracranial aneurysms and vascular malformation in an infant: case report. J. Neurosurg. 37:357, 1972.

[2] 2. ARAI, H.; UEKI, K. & TAKAHARA, J. Intracranial aneurysm in an infant. Surg. Neurol. 1:94, 1973.

[3] 3. ACHSLOGH, J. & KULAKOWSKI, S. Problème de l'anévrysme intra-crânien chez l'enfant. Acta Paedit. Belgica 24:507, 1970.

[4] 4. BARKER, W. F. Mycotic aneurysms. Ann. Surg. 139:84, 1954.

[5] 5. CANTU, R. C.; LEMAY, M. & WILKINSON, H. A. The importance of repeated angiography in the treatment of mycotic embolic intracranial aneurysms. J. Neurosurg. 25:189, 1966.

[6] 6. COURSON, B.; DUMAS, M. & COLLOMB, H. Les anévrysmes artériels distaux ou des branches péripheriques de l'artère cérebrale moyenne. Neuro-Chirurgie (Paris) 16:15, 1970.

[7] 7. DANDY, W. E. Intracranial Arterial Aneurysms. 2.Ş Edição, Comstock Publishing Co. Inc., Cornell University, 1945, p. 5.

[8] 8. DAVIDSON, P. & ROBERTSON, D. M. A true mycotic (Aspergillus) aneurysm leading to fatal subarachnoid hemorrhage in a patient with hereditary hemorrhagic telegiectasia: case report. J. Neurosurg. 35:71, 1971.

[9] 9. DAVID, M.; PRADAT, P. & DOYON, D. Anévrysme de 1'artère sylvienne chez un enfant de 3 ans. Neuro-Chirurgie (Paris) 14:822, 1968.

[10] 10. DEVADIGA, K.; MATHAI, K. U. & CHANDY, J. Spontaneous cure of intracavernous aneurysm of the internal carotid in a 14 month-old child: case report. J. Neurosurg. 30:165, 1969.

[11] 11. GARCIA-CHAVEZ, C. & MOOSSY, J. Cerebral artery aneurysm in infancy: association with agenesis of the corpus callosum. J. Neuropath. Exp. Neurol. 24:492, 1965.

[12] 12. HEIDELBERGER, K. P.; LAYTON Jr., W. M. & FISHER, R. G. Multiple cerebral mycotic aneurysms complicating post traumatic pseudomonas meningitis: case report. J. Neurosurg. 29:631, 1968.

[13] 13. JANE, J. A. A large aneurysm of the posterior inferior cerebellar artery in a 1-year-old child. J. Neurosurg. 18:245, 1961.

[14] 14. JONES, R. K. & SHEARBURN, E. W. Intracranial aneurysm in a four-week-old infant: diagnosis by angiography and successful operation. J. Neurosurg. 18:122, 1961.

[15] 15. JONES Jr., H. R.; SIEKERT, R. G. & GERACI, J. E. Neurologic manifestations of bacterial endocarditis. Ann. Int. Med. 71:21, 1969.

[16] 16. KIMBELL Jr., F. D.; LLEWELLYN, R. C. & KIRGIS, H. D. Surgical treatment of ruptured aneurysm with intracranial and subarachnoid hemorrhage in a 16-month-old infant. J. Neurosurg. 17:331, 1960.

[17] 17. KING, B. Successful surgical treatment of an intracranial mycotic aneurysm complicated by subdural hematoma. J. Neurosurg. 17:788, 1960.

[18] 19. LAPRAS, C.; GOUTELLE, A.; BRAUNAT, M. & DECHAUME, J. Q. Les anévrysmes intra-crâniens chez J'enfant: a propos de 4 observations. Neuro-Chirurgie (Paris) 14:891, 1968.

[19] 20. LOCKSLEY, H. B. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations based on 6368 cases in the Cooperative Study. J. Neurosurg. 25:219, 1966.

[20] 22. MATSON, D. D. Intracranial arterial aneurysms in childhood. J. Neuro-surg. 23:578, 1965.

[21] 23. McDONALD, C. A. & KORB, M. Intracranial aneurysms. Arch. Neurol. Psychiat. (Chicago) 42:298, 1934.

[22] 24. McKEE, E. E. Mycotic infection of the brain with arteritis and subarachnoid hemorrhage: report of case. Am. J. Clin. Path. 20:381, 1950.

[23] 25. McNEEL, D.; EVANS, R. A. & ORY, E. M. Angiography of cerebral mycotic aneurysms. Acta Radiol. (Diagn.) 9:407, 1969.

[24] 26. MITCHELL, N. & ANGRIST, A. Intracranial aneurysms: a report of thirty-six cases. Ann. Int. Med. 19:909, 1943.

[25] 27. MOLINARI, G. F.; SMITH, L.; GOLRSTEIN, R. N. & SATRAN, R. Pathogenesis of cerebral mycotic aneurysms. Neurology (Minneapolis) 23:907, 1973.

[26] 28. MONTRIEUL, B.; TERRASSE, J.; ALIX, B. & LATOUR, J. P. Sur les relations entre hématome intra-cérébrale, anévrysme mycotique, septicémics a staphilocoques et endocardites. Sem. Hôp. Paris 49:2009, 1973.

[27] 29. MORRISS Jr., F. H. & SPOCK, A. Intracranial aneurysm secondary to mycotic orbital and sinus infection: report of a case implicating Penicillium as an opportunistic fungus. Am. J. Dis. Child. 119:357, 1970.

[28] 30. MOSKOWITZ, M. A.; ROSENBAUM, A. E. & TYLER, H. R. Angiographically monitored resolution of cerebral mycotic aneurysms. Neurology (Minneapolis) 24:1103, 1974.

[29] 31. NOONAN, J. A.; WILSON, C. B.; SPENCER, F. C. & TLBERT Jr., W. M. Cerebral and cardiac complications from bacterial endocarditis: a successful managed case with anusual complications. Am. J. Dis. Child. 116:666, 1968.

[30] 32. PATEL, A. N. & RICHARDSON, A. E. Ruptured intracranial aneurysms in the first two decades of life: a study of 58 patients. J. Neurosurg. 35:571, 1971.

[31] 33. PICKERING, L. K.; HOGAN, G. R. & GILBERT, E. F. Aneurysm of the posterior inferior cerebellar artery: rupture in a newborn. Am. J. Dis. Child. 119:155, 1970.

[32] 34. RATHMELL, T. K.; MORA, G. & PESSEL, J. F. Mycotic aneurysm of the circle of Willis. J.A.M.A. 150:555, 1952.

[33] 35. RIGGS, H. E. & RUPP, I. Miliary aneurysms. Relation of anomalies of the circle of Willis to aneurysm formation. J. Neuropath. Exp. Neurol. 1:442, 1942.

[34] 36. RITCHIE, W. P. & HAINES, G. Spontaneous intracranial hemorrhage in children. Arch. Surg. 66:452, 1953.

[35] 37. ROACH, M. R. & DRAKE, C. G. Ruptured cerebral aneurysms caused by micro-organisms. New England Med. J. 29:240, 1965.

[36] 38. SEDZIMIR, C. B.; OCCLESHAW, J. V. & BUXTON, P. H. False cerebral aneurysm: case report. J. Neurosurg. 29:636, 1966.

[37] 39. SEDZIMIR, C. B. & ROBINSON, J. Intracranial hemorrhage in children and adolescents. J. Neurosurg. 38:269, 1973.

[38] 40. SEDZIMIR, C. B.; JONES, E. W.; HAMILTON, D. & EDWARDS, R. Management of coartation of aorta and bleeding intracranial aneurysm in paediatric cases. Neuropäediatrie 4:124, 1973.

[39] 41. SHNIDER, B. I. & COTSONAS Jr., N. J. Embolic mycotic aneurysms, a complication of bacterial endocarditis. Am. J. Med. 16:246, 1954.

[40] 42. SHUCART, W. A. & WOLPERT, S. M. Intracranial arterial aneurysm in childhood. Am. J. Dis. Child. 127:288, 1974.

[41] 44. SUWANWELA, C.; SUWANWELA, N.; CHARUNCHINDA, S. & HONGSAPRABHAS, C. Intracranial mycotic aneurysms of extravascular origin. J. Neurosurg. 36:552, 1972.

[42] 45. SYPERT, G. W. & YOUNG, H. F. Ruptured mycotic pericallosal aneurysm with meningitis due to neisseria meningitis infection: case report. J. Neurosurg. 37:467, 1972.

[43] 46. THIERRY, M. A.; KLEPHING, C.; DESTAING, F.; BINNERT, D.; DUMAS, R.; FOISSAL, F. C. & LAMY, A. Hématome intra-cérébrale spontané au cours d'une septicémie à staphilocoques, sans endocardite infectieuse. Neuro-Chirurgie 18:175, 1972.

[44] 47. THOMPSON, R. J.; HARWOOD-NASH, D. C. & FITZ, C. R. Cerebral aneurysms in children. Am. J. Roentgenol. Radium Ther. Nucl. Med. 118: 163, 1973.

[45] 48. VAPALAHTI, P. M.; SCHUGK, P.; TARKKANEN, L. & BJÖRKESTEN, G. Intracranial arterial aneurysm in a three-old infant: case report. J. Neurosurg. 30:169, 1969.

[46] 49. VISUDHIPHAN, P.; BUNYARATAVEJ, S. & KHANTANAPHAR, S. Cerebral aspergillosis: report of three cases. J. Neurosurg. 38:472, 1973.

[47] 50. ZIMENT, I. & JOHNSON Jr., B. L. Angiography in the management of intracranial mycotic aneurysms. Arch. Int. Med. (Chicago) 122:349, 1968.