CASE REPORT
Aneurismas Infecciosos Intracranianos (AIIs) surgem da inflamação da parede arterial causada por infecções bacterianas ou fúngicas. Representando 0,7%–6,5% dos aneurismas cerebrais, são raros em crianças e geralmente múltiplos e de pequeno calibre. A antibioticoterapia precoce é essencial, embora ainda não existam diretrizes claras de tratamento. Relatamos o caso de uma criança de 11 anos com aneurisma micótico secundário a empiema cerebral e meningoencefalite bacteriana, que evoluiu com trombose espontânea e sem déficits neurológicos. Uma revisão sistemática conduzida conforme as diretrizes PRISMA identificou 67 estudos relevantes dentre 2.604 triados. Os dados desses casos revelaram predominância do sexo masculino (66,2%) e idade média de 41 anos. Cefaleia (37%), distúrbios visuais (27,2%) e sintomas neuromusculares (22,2%) foram comuns. As bactérias foram responsáveis por 86,4% das Aneurismas Infecciosos Intracranianos (AIIs) surgem da inflamação da parede arterial causada por infecções bacterianas ou fúngicas. Representando 0,7%–6,5% dos aneurismas cerebrais, são raros em crianças e geralmente múltiplos e de pequeno calibre. A antibioticoterapia precoce é essencial, embora ainda não existam diretrizes claras de tratamento. Relatamos o caso de uma criança de 11 anos com aneurisma micótico secundário a empiema cerebral e meningoencefalite bacteriana, que evoluiu com trombose espontânea e sem déficits neurológicos. Uma revisão sistemática conduzida conforme as diretrizes PRISMA identificou 67 estudos relevantes dentre 2.604 triados. Os dados desses casos revelaram predominância do sexo masculino (66,2%) e idade média de 41 anos. Cefaleia (37%), distúrbios visuais (27,2%) e sintomas neuromusculares (22,2%) foram comuns. As bactérias foram responsáveis por 86,4% das reforçam a importância do controle precoce da infecção - especialmente endocardite - e da inclusão dos AIIs no diagnóstico diferencial da hemorragia subaracnoidea espontânea.
Intracranial Infectious Aneurysms (IIAs) arise from inflammation of the arterial wall due to bacterial or fungal infections. Representing 0.7%–6.5% of cerebral aneurysms, they are rare in children and often multiple and small. Early antibiotic therapy is essential, yet treatment guidelines remain unclear. We report the case of an 11-year-old with a mycotic aneurysm secondary to cerebral empyema and bacterial meningoencephalitis, which resolved with spontaneous thrombosis and no neurological deficits. A systematic review following PRISMA guidelines identified 67 relevant studies from 2,604 screened. Data from these cases revealed a male predominance (66.2%) and mean age of 41 years. Headache (37%), visual disturbances (27.2%), and neuromuscular symptoms (22.2%) were common. Bacteria accounted for 86.4% of infections, especially Streptococcus spp. (34.4%). Aneurysms most frequently involved the middle cerebral artery (53.3%), slightly more on the left (53.4%). Surgical treatment was performed in 77.5% of cases, including endovascular approaches in 58%. Full symptom resolution occurred in 51.4% of patients. Overall mortality was 20%, increasing to 25.4% with aneurysm rupture. These findings underscore the importance of early infection control - especially endocarditis - and consideration of IIAs in the differential diagnosis of spontaneous subarachnoid hemorrhage.
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1Faculdade de Medicina de Marília – FAMEMA, Marília, SP, Brazil.
2Department of Neurosurgery, Universidade Estadual de Campinas – UNICAMP, Campinas, SP, Brazil.
Received May 3, 2025
Accepted Aug 17, 2025
