A case of multiple cerebral aneurysms associated with Aspergillus infection and recurrence of subarachnoid hemorrhage determined at autopsy

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  • くも膜下出血再発を繰り返したアスペルギルス性多発脳動脈瘤の1 剖検例

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Abstract

<p>This report describes a case of multiple cerebral mycotic aneurysms causing subarachnoid hemorrhage (SAH) that were confirmed at autopsy. An 83-year-old male was admitted with a durable headache that was treated with corticosteroid. Findings on MRI were normal throughout the hospital stay. A suffused sudden consciousness disturbance (JCS 200) occurred on hospital day 58. Head CT showed a SAH and digital subtraction angiography (DSA) revealed an aneurysm at the internal carotid artery (ICA; C2) that was treated by coil embolization. Although we suspected a mycotic cerebral aneurysm, fungal antibodies, blood cultures, and cerebral spinal fluid cultures were negative. Left hemiparesis appeared on postoperative day (POD) 5 and MRI revealed a new infarction in the right basal ganglia and several new aneurysms in the ICA. Despite a repeat coil embolization to prevent aneurysm rupture, the patient fell into a coma on the following morning, and CT confirmed the recurrence of SAH. He died on POD 7, and a pathological autopsy was performed with the written, informed consent of his family. The results showed significant fungal infection and inflammation in the aneurysmal wall and dura mater of the skull base.</p>

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