A case of multiple infectious intracranial aneurysms concurrently presenting with intracerebral hemorrhage and epistaxis

Infectious intracranial aneurysms (IIAs) have the specific features of rapid growth and multiplicity, which often show various pathologies and serious symptoms when ruptured. There are few previous reports of multiple IIAs that concurrently present with intracerebral hemorrhage (ICH) and epistaxis. A 62-year-old man with a history of tooth extraction 1.5 months before experienced an intracranial abscess in the left Sylvian fissure and insula cortex. The patient underwent a craniotomy to drain the abscess and he experienced a heavy epistaxis, which required intranasal gauze packing immediately after surgery. Subsequently, he had a massive ICH on the left temporal lobe resulting from a ruptured IIA in the left middle cerebral artery on day 8. Surgical trapping of the aneurysm contributed to a complete cure. Oral indigenous bacteria was obtained by culturing an aspirate of the abscess cavity. A follow-up radiological examination revealed that the right internal carotid artery (ICA) aneurysm in the cavernous segment concurrently grew and the aneurysmal rupture had caused the epistaxis. We performed stent-assisted coil embolization for the aneurysm on day 20 and achieved radiological resolution. Although right hemiparesis and some communication problems remained, the patient recovered but needed minimal assistance. Given multiple progressions and their destructive pathology, more attention needs to be paid to IIAs. Our multimodal strategy achieved clinical resolution, and IIAs should be treated immediately with appropriate radical intervention depending on the lesion location.