Middle cerebral artery aneurysm due to nocardia asteroides: Case report of aneurysm excision and extracranial-intracranial bypass

Nocardia asteroides is an uncommon human pathogen typically encountered in immunocompromised patients. Primary central nervous system (CNS) nocardiosis is rare and usually manifests as cerebritis or abscesses. The case of a young woman who presented with CNS Nocardia abscesses complicated by an infective middle cerebral artery aneurysm is reported. Treatment, which included abscess aspiration, aneurysm excision, and end-to-end extracranial to intracranial bypass and prolonged antibiotic therapy, resulted in an excellent outcome. This case and the management of CNS nocardiosis are reviewed.