Blood Culture-Negative but Clinically Diagnosed Infective Endocarditis Complicated by Intracranial Mycotic Aneurysm, Brain Abscess, and Posterior Tibial Artery Pseudoaneurysm

Figure 1

Dynamic changes on brain MRI and CT imaging. ((a) and (b)) On admission, DWI or T2 sequences of MRI showed hyperintense signal intensity in the right centrum semiovale and hyperintense lacunar lesions adjacent to the left lateral ventricle. ((c) and (d)) On day 7 of admission, MRI showed hyperintense signal intensity in the left cerebellar hemisphere, left temporal lobe, and bilateral frontal-parietal lobe. A flow void was found in the left hemisphere (arrow). (e) MRA did not show any abnormality in the intracranial arteries. ((f) and (g)) On day 11 of admission, CT scan revealed high density nodules in the right frontal-parietal region and a low density shadow in the right parietal lobe. ((h)–(j)) On day 20 of admission, Contrast-enhanced CT showed high density nodules surrounded by edema in the left frontal-parietal region and a ring-enhancing nodule in the right parietal lobe with peripheral edema (arrow). ((k)–(n)); CT angiography showed an aneurysm on a cortical branch of the left middle cerebral artery.

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