CNS aspergillosis with mycotic aneurysm, cerebral granuloma and infarction

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Acta Neurochirurgica

Publisher: Springer-Verlag Wien

ISSN: 0001-6268 (Paper) 0942-0940 (Online)

DOI: 10.1007/s00701-004-0292-6

Issue: Volume 146, Number 8

Date: July 2004

Pages: 851 - 856

Case Report

CNS aspergillosis with mycotic aneurysm, cerebral granuloma and

infarction

C. L. Ho1 and M. J. Deruytter1

(1) Department of Neurosurgery, Heilig Hart (Teaching Hospital)

Ziekenhuis, Roeselaere, Belgium

Published online: 1 June 2004

Summary 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.

Keywords: Invasive aspergillosis; mycotic aneurysm; granuloma;

superior cerebellar artery; galactomannan; brainstem infarction.