Fungal aneurism of the right posterior inferior cerebellar artery (PICA)

Tambuzzi, Stefano; Boracchi, Michele; Maciocco, Francesca; Tonello, Cristina; Gentile, Guendalina; Zoja, Riccardo

doi:10.1016/j.mmcr.2019.09.004

Cited by 9 publications

(10 citation statements)

References 21 publications

(26 reference statements)

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“…To the best of our knowledge, this is the fourth clinical report on A. penicillioides clinical infection. The other three are classified as keratitis, disseminated disease in a child with cystic fibrosis, and central nervous system arteritis 13,14,15 . No information is available on the antifungal sensitivity of this species or the frequency of invasive disease.…”

Section: Discussionmentioning

confidence: 99%

Confirmed Invasive Pulmonary Aspergillosis and COVID-19: the value of postmortem findings to support antemortem management

Santana

Pivoto

Alexandre

et al. 2020

Rev. Soc. Bras. Med. Trop.

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We present postmortem evidence of invasive pulmonary aspergillosis (IPA) in a patient with severe COVID-19. Autopsies of COVID-19 confirmed cases were performed. The patient died despite antimicrobials, mechanical ventilation, and vasopressor support. Histopathology and peripheral blood galactomannan antigen testing confirmed IPA. Aspergillus penicillioides infection was confirmed by nucleotide sequencing and BLAST analysis. Further reports are needed to assess the occurrence and frequency of IPA in SARS-CoV-2 infections, and how they interact clinically.

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Section: Discussionmentioning

confidence: 99%

Confirmed Invasive Pulmonary Aspergillosis and COVID-19: the value of postmortem findings to support antemortem management

Santana

Pivoto

Alexandre

et al. 2020

Rev. Soc. Bras. Med. Trop.

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“…Rare localization of aspergillosis was described by Tambuzzi et al . [ 11 ] The patient applied to the hospital with a fever on the 15 th day after the removal of vestibular schwannoma. During the examination, the patient’s state suddenly worsened, which resulted in a fulminant lethal outcome.…”

Section: Discussionmentioning

confidence: 99%

“…[ 4 ] The prognosis of CNS aspergillosis is unfavorable with the general rate of lethality around 70%. [ 11 ] In many patients, the identification of Aspergillus spp. as a causative agent can be made only retrospectively after the patient’s death, which highlights diagnostic difficulties associated with this condition.…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of ruptured right middle cerebral artery mycotic aneurysm and central nervous system aspergillosis: Clinical case and literature review

Konovalov

Sharipov

Shekhtman

et al. 2021

Surgical Neurology International

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Background: Central nervous system (CNS) aspergillosis is more often met in patients with expressed immune suppression. Still, in 50% of cases of meningitis caused by Aspergillus spp., it is observed in patients without expressed immune suppression. The prognosis of CNS aspergillosis is unfavorable with the general rate of lethality around 70%. Case Description: Clinical case of a 58-year-old man who developed an Aspergillus abscess in the chiasmosellar region and an associated mycotic aneurysm of the right middle cerebral artery (MCA) and intracerebral hemorrhage. Microsurgical clipping of the fusiform-ectatic aneurysm of the right MCA in the conditions of rupture was performed. An extra-intracranial micro anastomosis was formed on the right. An open biopsy of the neoplasm in the chiasmosellar region was made. The neoplasm was yellow and destroyed the bone plate of the skull base. Biopsy results: Mycotic lesion (aspergillosis). The analysis of surgical treatment for mycotic aneurysms in the acute period of hemorrhage in patients with aspergillosis revealed a high rate of lethality. The issue of the feasibility and effectiveness of complicated revascularization interventions in the patients with hemorrhage and aspergillosis remains unsolved. Conclusion: The lack of generally accepted tactics of the treatment of this pathology requires further studies and systemic analysis. A high risk of the lethal outcome in patients with invasive mycotic infection and rupture of mycotic aneurysm highlight the importance of timely diagnostics and the beginning of antimycotic therapy. WThe issue of the evaluation of the revascularization methods effectiveness in patients after surgical treatment of a mycotic aneurysm associated with cerebral aspergillosis remains poor.

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“…In most of the case, they are located at the distal MCA. 6,7 Antibiotic therapy is the cornerstone in the treatment of unruptured infectious aneurysms. In case of a rupture, surgical or endovascular treatment can be applied according to the clinical and radiological findings.…”

Section: Discussionmentioning

confidence: 99%

The Use of Real-Time 3D Intraoperative Ultrasound “Angiography” in Localization and Occlusion Control of a Ruptured Mycotic Aneurysm: A Case Report

Nerntengian

Gkasdaris

Barettas

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Background Infectious (mycotic) aneurysms are rare with high mortality and are most commonly found at the distal branches of the middle cerebral artery (MCA). Because aneurysms of the distal MCA are located deep in the Sylvian fissure and are small in size, intraoperative identification and safe clip occlusion of these aneurysms are challenging. Thus, the use of intraoperative imaging and navigation can be beneficial. We describe the use of intraoperative real-time 3D ultrasound “angiography” (3D-iUS) in localizing and occlusion control of a ruptured MCA M3 segment mycotic aneurysm. To our knowledge, its application in the surgery of a ruptured mycotic distal MCA aneurysm is not yet reported. Clinical Presentation A 54-year-old woman with a history of septic thrombophlebitis treated with long-term antibiotic therapy presented with sudden onset of headaches, dysphasia, and seizures. Computed tomography (CT) revealed subarachnoid hemorrhage in the distal portion of the left Sylvian fissure. Digital subtraction angiography (DSA) showed an aneurysm at the peripheral branch of the M3 segment of the MCA with characteristics of an infectious aneurysm. A microsurgical treatment was decided. 3D-iUS scan showed an aneurysm within the Sylvian fissure at a depth of 5 cm. The aneurysm was clipped and a repeated 3D-iUS scan showed total occlusion of the aneurysm and patency of the parent artery. The intraoperative findings were confirmed with a postoperative DSA. Conclusion Our case report shows that real-time 3D-iUS, despite its limitations, is an important tool to locate and ascertain the successful clip occlusion of an aneurysm, especially when intraoperative angiography (IA) and indocyanine green (ICG) videoangiography are not available due to low-income settings.

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Fungal aneurism of the right posterior inferior cerebellar artery (PICA)

Cited by 9 publications

References 21 publications

Confirmed Invasive Pulmonary Aspergillosis and COVID-19: the value of postmortem findings to support antemortem management

Confirmed Invasive Pulmonary Aspergillosis and COVID-19: the value of postmortem findings to support antemortem management

Surgical treatment of ruptured right middle cerebral artery mycotic aneurysm and central nervous system aspergillosis: Clinical case and literature review

The Use of Real-Time 3D Intraoperative Ultrasound “Angiography” in Localization and Occlusion Control of a Ruptured Mycotic Aneurysm: A Case Report

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