Mycotic aneurysm

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  1. 4% of all intracranial aneurysms
  2. occurs most commonly is distal MCA branches (75-80%)
    1. 20% of patients have multiple mycotic aneurysms
    2. most start in the adventitia and spread inwards (although this is disputed as a mechanism)
    3. about 20% of mycotic aneurysms cause SAH
  3. most common agents
    1. streptococcus 44%
    2. staphylococcus 18%
  4. treatment: Unruptured: 6-8 weeks of antibiotics; may clip after antibiotic treatment though should reimage as aneurysm may decrease in size. Ruptured: acute surgical or endovascular treatment of aneurysm. If surgical intraparenchymal clot removal is required, surgical trapping may be performed at the same time. Methods include surgical clipping and coiling. However, as these aneurysms may not be saccular, may incorporate the entire vessel, and are extremely thin-walled, trapping techniques are often employed.
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