Aspergillus Mycotic Aneurysm

Abstract

A 61-year-old female developed subarachnoid hemorrhage after trans-sphenoidal surgery for Rathke's cleft cyst. Neuroradiological examination revealed a large aneurysm at the C<SUB>1</SUB> portion of the right in ternal carotid artery. Autopsy revealed marked proliferation of aspergillus hyphae in the wall of the aneurysm. A review of previously reported cases of fungal aneurysm proposes two developmental processes. Aneurysms secondary to fungal meningitis tend to be large in size and located in the ma jor cerebral artery trunk, but aneurysms following fungal sepsis tend to be small and in peripheral branches. The former aneurysms are probably caused by fungus invasion into the intracranium , usually from the paranasal sinus, and the latter may be due to fungal emboli like bacterial emboli in bacterial endocarditis.Ruptured fungal aneurysms are difficult to treat, so fungal meningitis or sepsis must be eradicated before an aneurysm develops.

True Fungal Mycotic Aneurysm of the Basilar Artery: A Clinical and Surgical Dilemma

“…In contradistinction to the acceptable prognosis with medical and surgical treatment of bacterial aneurysms, the fungal aneurysms are quite deadly, with nearly 100% mortality [1, 2, 3, 4, 5, 6, 7]. The fungal aneurysms tend to involve the proximal arterial tree, and are known to be friable and poorly defined, rendering their surgical treatment difficult if not impossible.…”

Fungal Mycotic Aneurysm in a Case of Acute Lymphoblastic Leukemia

“…Fungal aneurysms have tendency to arise from basilar artery or internal carotid artery as compared to bacterial one which commonly involve peripheral vessels. However, it has been seen that aneurysm secondary to meningitis or sinusitis may also be located distally [9,10]. In the index case, sinuses can be considered as a source of fungus for respiratory as well as cerebral vessel infection.…”

Aspergillus Aneurysm of the Middle Cerebral Artery Causing a Fatal Subarachnoid Hemorrhage.

“…Aspergillosis of the CNSis relatively rare, but the incidence of aspergillosis of the CNShas increased in recent years (1)(2)(3)(4)(5)(6).…”

“…Sometimes aspergillosis of CNScauses fatal SAH. It is assumed that Aspergillus has a tendency to invade the vessel walls leading to thrombosis or arteritis (3,5,6). However, the reason why Aspergillus is likely to invade vessel walls is not elucidated.…”