Cases reported • Neuroaspergillosis

1/3. Fatal subarachnoid hemorrhage, with brainstem and cerebellar infarction, caused by aspergillus infection after cerebral aneurysm surgery: case report.

OBJECTIVE AND IMPORTANCE: Intracranial aspergillosis has been reported to cause subarachnoid hemorrhage (SAH) attributable to ruptured mycotic aneurysms. We describe a case of aspergillus arteritis that caused SAH without aneurysm formation, followed by successive brainstem and cerebellar infarction. CLINICAL PRESENTATION: A 50-year-old woman experienced a sudden onset of headache. Computed tomography demonstrated SAH. After angiography revealed an aneurysm of the anterior communicating artery, a complete neck-clipping operation was performed, without neurological deterioration. However, the patient experienced another episode of SAH on the 26th postoperative day. INTERVENTION: We repeated the craniotomy and confirmed that the clip was still intact. A second angiographic evaluation did not reveal an aneurysm or any other cause of hemorrhage. On the 30th postoperative day, magnetic resonance imaging demonstrated cerebellar infarction in the territory of the anteroinferior cerebellar artery. The patient died on the 40th postoperative day, after another episode of SAH and progressive cerebellar and brainstem infarction. The postmortem examination revealed destruction of the basilar artery and occlusion of the basilar and vertebral arteries attributable to aspergillus arteritis. CONCLUSION: When a patient presents with SAH of unknown origin followed by cerebral infarction, aspergillus arteritis should be included in the differential diagnosis. Earlier recognition of this fungal infection improves the prognosis.

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keywords = subarachnoid
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2/3. subarachnoid hemorrhage as a result of fungal aneurysm at the posterior communicating artery associated with occlusion of the internal carotid artery: case report.

BACKGROUND: Fungal or "true" mycotic aneurysms of the intracranial circulation are very rare. rupture of a fungal aneurysm is fatal in almost 100% of cases. CASE DESCRIPTION: We report a 65-year-old woman with a ruptured fungal aneurysm on the posterior communicating artery associated with occlusion of the internal carotid artery. She had a past history of gastric malignant lymphoma and subsequent granulocytopenia. She survived after surgical treatment including trapping of the aneurysm and a superficial temporal artery-to-middle cerebral artery bypass. CONCLUSION: Improved immune response at the time of the onset of subarachnoid hemorrhage, as well as additional vasoreconstructive surgery, may have contributed to favorable outcome after surgical treatment.

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keywords = subarachnoid
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3/3. CNS aspergillosis with mycotic aneurysm, cerebral granuloma and infarction.

We are reporting a case of an immunocompromised patient with invasive aspergillosis (IA) who developed aspergillotic granulomas and a mycotic aneurysm of the superior cerebellar artery. The route of infection of the central nervous system (CNS) was hematogenous spread from a pulmonary focus. IA was detected with the Galactomannan (GM) technique. However, despite treatment with amphotericin b, progressive involvement of the vessel wall occurred causing fatal subarachnoid hemorrhage and massive brainstem and cerebellar infarction.This case provides pathologic-imaging correlation of one of the most devastating types of fungal involvement affecting the CNS with a fungal aneurysm. Finally the literature regarding the pathogenetic, and diagnostic investigations and the management of CNS aspergillosis is reviewed.

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keywords = subarachnoid
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