Document Detail

Fatal subarachnoid hemorrhage, with brainstem and cerebellar infarction, caused by Aspergillus infection after cerebral aneurysm surgery: case report.
MedLine Citation:
PMID:  11950421     Owner:  NLM     Status:  MEDLINE    
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.
Toshiki Endo; Teiji Tominaga; Hidehiko Konno; Takashi Yoshimoto
Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Neurosurgery     Volume:  50     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  2002 May 
Date Detail:
Created Date:  2002-04-12     Completed Date:  2002-06-28     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1147-50; discussion 1150-1     Citation Subset:  IM    
Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
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MeSH Terms
Arteritis / microbiology*
Brain Stem / blood supply
Cerebellum / blood supply
Cerebral Angiography
Cerebral Arteries*
Cerebral Infarction / diagnosis,  microbiology*
Fatal Outcome
Intracranial Aneurysm / diagnosis,  surgery*
Middle Aged
Neuroaspergillosis / complications*,  pathology
Postoperative Complications
Subarachnoid Hemorrhage / diagnosis,  microbiology*
Tomography, X-Ray Computed

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