P001 Subarachnoid hemorrhage associated to multiple intracranial mycotic aneurysm in congenital HIV with VZV leptomeningitis: endovascular treatment of ruptured mycotic aneurysm with ethylene vinyl alcohol copolymer (Onyx)

<h3>Introduction</h3> A mycotic aneurysm is a dilation of the arterial wall secondary to infection. While typically caused by bacterial infections, fungal and viral infections can also be responsible. They are rare, accounting for only a small fraction of cerebral aneurysms, with a higher incidence in immunocompromised patients. Typically, they manifest as distal, multiple, and fusiform aneurysms. <h3>Case Description</h3> We present the case of a 30-year-old female with HIV infection and poor adherence to antiretroviral therapy, who presented with headache and fever. Initial imaging (NCCT) showed no abnormalities. Four days later, she developed right hemiparesis and worsening headache. Complementary imaging (CT/CTA) revealed a left thalamic acute/subacute ischemic lesion without vascular abnormalities. Due to persistent headache and meningeal signs, CSF analysis was conducted, revealing VZV infection, prompting initiation of antiviral therapy and reinstatement of antiretrovirals. Fifteen days later, an MRI revealed a prior subarachnoid hemorrhage and an aneurysmal lesion located distally in the right M1, along with additional suspicious lesions in the surrounding vasculature. DSA confirmed multiple intracranial aneurysmal lesions, with the largest coinciding with the hemorrhage site. Endovascular treatment with Onyx embolization was performed, resulting in complete occlusion of the aneurysm along with the distal segment of the fronto-basal branch (figure 1a, b, c). Subsequent DSAs showed progressive reduction of the remaining aneurysms. PCR and culture tests confirmed viral eradication. The patient was discharged with no neurological deficits. <h3>Results</h3> This case highlights the feasibility and low morbidity of endovascular treatment with Onyx for ruptured mycotic aneurysms in non-eloquent areas. <h3>Disclosure of Interest</h3> no.