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Proposed diagnostic criteria for intracranial infectious aneurysms
  1. Sudheeran Kannoth
  1. Sree Chitra Tirunal Institute for Medical Sciences and Technology, India
    1. Sanjeev V Thomas (sanjeev{at}sctimst.ker.nic.in)
    1. Sree Chitra Tirunal Institute for Medical Sciences and Technology, India
      1. Suresh Nair
      1. Sree Chitra Tirunal Institute for Medical Sciences and Technology, India
        1. P S Sarma
        1. Sree Chitra Tirunal Institute for Medical Sciences and Technology, India

          Abstract

          Background: We propose a set of criteria for diagnosis of intracranial infectious aneurysm (IA). The proposed diagnostic criteria contain a mandatory criterion (demonstration of intracranial aneurysm by neuroimaging) and twelve supportive criteria drawn from three domains. Domain A encompasses infection, such as infective endocarditis, meningitis, cavernous sinus thrombophlebitis, or orbital cellulitis. Domain B encompasses angiographic features of the aneurysm, such as multiplicity, distal location, fusiform shape, change in size or appearance of new aneurysm at follow-up angiogram. Domain C encompasses other features, such as age < 45 years, recent history of fever, lumbar puncture or cerebral hemorrhage. Each criterion is given one point and the sum under each domain (Asum, Bsum and Csum) and total score are calculated.

          Methods: We evaluated these criteria in 25 patients with confirmed IA and another 111 consecutive patients with non-infectious aneurysm. The sensitivity, specificity and receiver operator characteristic (ROC) curves were calculated for these cohorts.

          Results: The highest ROC was for total score (.997). A total score = 3 had high sensitivity (96%) and specificity (100%), as well as a positive predictive value of 100%, and negative predictive value of 99.4%. A total score = 2 had high sensitivity (100%) but low specificity (87.4%). Other combinations had lower ROC areas, sensitivities and specificities.

          Conclusion: Diagnosis of IA would be clinically compelling if three or more of the proposed supportive criteria are satisfied or clinically probable if two proposed supportive criteria are satisfied besides the mandatory criteria.

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