PMC8571298_01
(a) MRI Flair sequence shows right frontal lesion with surrounding edema and subarachnoid hemorrhage consistent with cerebral abscess and ruptured mycotic aneurysm. (b and c) Digital subtraction angiography anterior-posterior and oblique views shows mycotic aneurysm measuring 1 mm. (d and e) show roadmap angiography with microcatheter approach to the aneurysm. (f) Microcatheter injection just proximal to the mycotic aneurysm. (g) Internal carotid artery digital subtraction angiography after onyx embolization of the mycotic aneurysm with no residual filling and no unintended thromboembolic phenomena.
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The MRI revealed a 1.4 x 1.4 x 1.6 cm rim-enhancing lesion in the right middle frontal gyrus with surrounding vasogenic edema suggestive of a pyogenic abscess [Figure 1a]. After visualization of the suspected abscess on MRI [Figure 1a], a repeat CTA was performed revealing a 1 mm aneurysmal dilation in the M4 frontal branch of the right distal middle cerebral artery (MCA) [Figure 1b and c]. A superselective M3 and M4 angiogram were then performed, allowing for visualization of the 1 mm infectious aneurysm in the cortical M4 frontal MCA branch [Figure 1d-f]. On visualizing the feeding vessels, Onyx 18 material was advanced through the Synchro microwire into the M4 pedicle, filling the aneurysm [Figure 1g].