{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:49:54Z","timestamp":1753876194548,"version":"3.41.2"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T00:00:00Z","timestamp":1700524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Infective endocarditis (IE) can present as a syndromic-like condition with multisystem involvement; this can make early diagnosis particularly challenging. Rarely, left-sided IE can lead to mitral valve aneurysm formation. Showering of septic emboli to the cerebral circulation may result in a mycotic aneurysm that can rupture, leading to haemorrhagic stroke, as in this case.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 28-year-old male presented with a triad of subarachnoid haemorrhage (SAH) from mycotic cerebral aneurysm rupture, left-sided aortic and mitral valve IE causing severe regurgitation and aorto-mitral curtain fistula and mitral valve aneurysm formation. The SAH was the main initial presentation and was immediately treated with coiling by an interventional radiologist. However, the patient later developed heart failure due to severe aortic and mitral valve regurgitation that led to the diagnosis of IE. The patient underwent aortic and mitral valve replacements procedure10 days after SAH presentation. He then recovered satisfactorily from the operationa and successfully discharged home after completeing his course of intravenous antibiotics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>In this article, we shed some light on this unusual syndromic presentation, elaborate on the underlying mechanism, the ultimate importance of clinical examination, pitfalls in diagnosis, the important role of the heart team in IE, and finally the timing of surgery after SAH.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytad567","type":"journal-article","created":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T14:53:28Z","timestamp":1700578408000},"source":"Crossref","is-referenced-by-count":0,"title":["A rare presentation of mycotic cerebral aneurysm, subarachnoid haemorrhage, and mitral valve aneurysm in left-sided lnfective endocarditis: a case report and literature review"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8506-9693","authenticated-orcid":false,"given":"Ahmed A M","family":"Abbas","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Warith Al-Anbiyaa, Iraq-Holy Karbala \/ Baghdad - Karbala Road (7km from Downtown), Iraq"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela F","family":"Brown","sequence":"additional","affiliation":[{"name":"Cardiothoracic Surgery Department, James Cook University Hospital , Marton Rd , Middlesbrough TS4 3BW, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralph W","family":"White","sequence":"additional","affiliation":[{"name":"Cardiothoracic Surgery Department, James Cook University Hospital , Marton Rd , Middlesbrough TS4 3BW, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,11,21]]},"reference":[{"key":"2024030520012086500_ytad567-B1","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1136\/bmj.1.1263.522","article-title":"The Gulstonian Lectures, on malignant endocarditis","volume":"1","author":"Osler","year":"1885","journal-title":"BMJ"},{"key":"2024030520012086500_ytad567-B2","first-page":"1047","volume-title":"Cerebrovascular surgery","author":"Ojemann","year":"1984"},{"key":"2024030520012086500_ytad567-B3","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/S0735-1097(83)80272-1","article-title":"Mitral valve aneurysm: clinical features, echocardiographic-pathologic correlations","volume":"2","author":"Reid","year":"1983","journal-title":"J Am Coll Cardiol"},{"key":"2024030520012086500_ytad567-B4","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/0002-9343(94)90143-0","article-title":"New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings: Duke Endocarditis Service","volume":"96","author":"Durack","year":"1994","journal-title":"Am J Med"},{"key":"2024030520012086500_ytad567-B5","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1086\/313753","article-title":"Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis","volume":"30","author":"Li","year":"2000","journal-title":"Clin Infect Dis"},{"key":"2024030520012086500_ytad567-B6","doi-asserted-by":"crossref","first-page":"ehad193","DOI":"10.1093\/eurheartj\/ehad193","article-title":". 2023 ESC guidelines for the management of endocarditis","volume":"44","author":"Delgado","year":"2023","journal-title":"Eur Heart J"},{"key":"2024030520012086500_ytad567-B7","doi-asserted-by":"crossref","first-page":"2971","DOI":"10.1007\/s00415-020-09953-7","article-title":"Acute convexity subarachnoid hemorrhage (cSAH) in infectious endocarditis (IE): imaging features and follow-up","volume":"267","author":"Boukobza","year":"2020","journal-title":"J Neurol"},{"key":"2024030520012086500_ytad567-B8","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1016\/0003-4975(96)00014-8","article-title":"Valve replacement in patients with endocarditis and acute neurologic deficit","volume":"61","author":"Gillinov","year":"1996","journal-title":"Ann Thorac Surg"},{"key":"2024030520012086500_ytad567-B9","doi-asserted-by":"crossref","first-page":"37e46","DOI":"10.1007\/s10143-009-0233-1","article-title":"Intracranial infectious aneurysms: a comprehensive review","volume":"33","author":"Ducruet","year":"2010","journal-title":"Neurosurg Rev"},{"key":"2024030520012086500_ytad567-B10","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1161\/01.STR.23.6.843","article-title":"Histopathological analysis of the mechanisms of intracranial hemorrhage complicating infective endocarditis","volume":"23","author":"Masuda","year":"1992","journal-title":"Stroke"},{"key":"2024030520012086500_ytad567-B11","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1093\/ejechocard\/jeq004","article-title":"Recommendations for the practice of echocardiography in infective endocarditis","volume":"11","author":"Habib","year":"2010","journal-title":"Eur J Echocardiogr"},{"key":"2024030520012086500_ytad567-B12","doi-asserted-by":"crossref","first-page":"345","DOI":"10.14503\/THIJ-15-5322","article-title":"Infective endocarditis of the aortic valve with anterior mitral valve leaflet aneurysm","volume":"43","author":"Tomsic","year":"2016","journal-title":"Tex Heart Inst J"},{"key":"2024030520012086500_ytad567-B13","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1016\/j.echo.2010.07.015","article-title":"Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (MAIVF): a comprehensive review","volume":"23","author":"Sudhakar","year":"2010","journal-title":"J Am Soc Echocardiogr"}],"container-title":["European Heart Journal - 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