[Infective endocarditis complicated by ruptured mycotic cerebral aneurysm that necessitated open heart surgery after craniotomy;report of a case].

The patient was a 45-year-old female, who was emergently hospitalized with presyncope. Brain magnetic resonance imaging (MRI) confirmed an infarct in the left middle cerebral artery area. Echocardiography revealed mobile vegetations on the mitral valve and aortic valve, and the patient was diagnosed as having infective endocarditis. She was treated conservatively by appropriate antibiotic therapy. Four days after hospitalization, the patient developed brain hemorrhage due to ruptured mycotic cerebral aneurysm, and craniotomy for removal of the hematoma and brain aneurysm clipping were performed on the same day. As 3-dimensional computed tomography (3D-CT) obtained 2 weeks after the surgery suggested the existence of other brain aneurysms, it was determined that continued conservative management of the infection might not be feasible, and mitral valve and aortic valve replacements were performed 3 weeks after the craniotomy. The postoperative clinical course was satisfactory, without the complications of bleeding, aggravation of the cranial nerve disorders or recurrence of the infection. Ruptured mycotic cerebral aneurysms are usually associated with a poor prognosis. There are no specific guidelines for the treatment of infective endocarditis with brain complications like in this case, and it is important to select therapies tailored to individual cases.