Cerebral aneurysm rupture as the first presentation of infectious endocarditis after placement of contraceptive subcutaneous implant: An unforeseen complication of a regular procedure

• Main Authors: Lídia Nunes Dias, Luís Marques, Marta Rebelo, Conceição Marques, José Cabral
• Format: Article
• Language: English
• Published: Elsevier 2020-12-01
• Series: Interdisciplinary Neurosurgery
• Subjects: Infectious cerebral aneurysm; Contraceptive subcutaneous implant; Infectious endocarditis, cerebral aneurysm; Infectious aneurysm
• Online Access: http://www.sciencedirect.com/science/article/pii/S2214751920304151

Introduction: Infectious intracranial aneurysms are rare complications of systemic infections. It occurs mostly in adult-young men in relation to embolization after bacterial endocarditis. A subcutaneous contraceptive implantation is a common procedure and usually occurrence-free.We describe an unforeseen complication of a subcutaneous contraceptive implantation in a young female, the full diagnostic work-up, the most common correlated pathologies, and a brief literature review, in order to propose some «informal guidelines» for any potentially implicated physician. Clinical case: We report a clinical case of a 20-year-old woman with vomiting, prostration and fever (for several weeks) as the first presentation of an intraparenchymal hemorrhage due to a ruptured posterior cerebral artery aneurysm. Further investigations showed a mitral endocarditis with severe mitral regurgitation probably evolving since the placement of a subcutaneous contraceptive implant. After a multidisciplinary discussion the decision was made for the patient to undergo cranial surgery for aneurysmal exclusion and hematoma drainage followed by cardiac surgery. Conclusion: A high suspicion and a multidisciplinary approach is essential for a prompt etiological study in infectious aneurysms and choice of the best treatment of the concurrent pathologies for a good clinical outcome. Minor procedures as subcutaneous contraceptive implantation can also be the cause of catastrophic infectious events, especially if they are overlooked by most physicians.