MRI Presentation of Infectious Intracranial Aneurysms in Infective Endocarditis

  • Ibrahim Migdady
  • Cory J. Rice
  • Catherine Hassett
  • Lucy Q. Zhang
  • Dolora Wisco
  • Ken Uchino
  • Sung-Min ChoEmail author
Original Article



The radiographic appearance of infectious intracranial aneurysms (IIAs) of infective endocarditis (IE) on magnetic resonance imaging (MRI) of brain is varied. We aimed to describe the IIA-specific MRI features in a series of patients with IIAs.


Records of patients with active IE who had digital subtraction angiography (DSA) at a tertiary medical center from January 2011 to December 2016 were reviewed. MRIs performed prior to IIA treatment were reviewed for findings on susceptibility-weighted imaging (SWI), diffusion-weighted imaging, and T1 with and without contrast.


Of the 732 patients with IE, 53 (7%) had IIAs. Of these, 28 patients had an evaluable pre-treatment MRI, in whom 33 IIAs were imaged. MRI to DSA median time was 1 day (interquartile range = 1–5). On MRI, 12 (36%) IIAs had SWI lesion with contrast enhancement, 7 (21%) had cerebral microbleeds, 3 (11%) had sulcal SWI lesion, 2 (6%) IIAs had abscesses, 3 (9%) had intraparenchymal hemorrhage, 3 (9%) had subarachnoid hemorrhage, and 6 (18%) had ischemic stroke at the anatomical locations of IIAs. Four IIAs (12%) had no correlating MRI findings, though those patients had MRI without contrast.


The MRI features such as SWI lesion and contrast enhancement were the commonest MRI presentations associated with the presence of IIA.


Infective endocarditis Infectious intracranial aneurysms MRI Cerebral angiography 


Authors’ Contribution

IM, MD (first author), was involved in project development; data collection; data analysis; and manuscript writing and editing. CJR, MD, contributed to data collection; data analysis; and manuscript writing and editing. CH, DO, edited the manuscript. LQZ, MD, collected the data and edited the manuscript. DW, MD, edited the manuscript. KU, MD, was involved in project development; data collection; data analysis; and manuscript editing. S-MC, DO (senior and correspondent author), contributed to project development; data analysis; and manuscript editing.

Source of support

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Compliance with Ethical Standards

Conflict of interest

The authors have nothing to disclose.

Ethical Approval

This study was approved by the local Institutional Review Board and all patients or their surrogates consented for participation.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  • Ibrahim Migdady
    • 1
  • Cory J. Rice
    • 1
  • Catherine Hassett
    • 1
  • Lucy Q. Zhang
    • 1
  • Dolora Wisco
    • 1
  • Ken Uchino
    • 1
  • Sung-Min Cho
    • 1
    • 2
    • 3
    Email author
  1. 1.Cerebrovascular Center, Neurological InstituteCleveland ClinicClevelandUSA
  2. 2.Departments of Neurology, Neurological Intensive Care, Anesthesiology and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Division of NCCU, Department of Anesthesiology and Critical Care MedicineJohns Hopkins Medical InstitutionsBaltimoreUSA

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