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• Vol.42 No.8
• CLINICA NEUROL, 42: 761−765, 2002
• Vol.42 No.8 contents

Case Report

A case of CNS aspergillosis develping orbital apex syndrome and causing mycotic aneurysm and the subsequent cerebral infarction

Yoshino Ueki, M.D.¹⁾, Toshinari Kazuta, M.D.¹⁾, Eri Naitou, M.D.³⁾, Masaharu Hayashi, M.D.⁴⁾, Kozue Tanaka, M.D.⁵⁾, Toshio Mizutani, M.D.²⁾ and Shunsaku Hirai, M.D.¹⁾

¹⁾Department of Neurology, ²⁾Neuropathology and ³⁾Neurootology Tokyo Metropolitan Neurological Hospital
⁴⁾Department of Clinical Neuropathology Tokyo Metropolitan Institute for Neuroscience
⁵⁾Department of Neurology, Murayama Hospital

A 79-year-old woman, with no immune deficit, had presented progressive visual disturbance, diplopia and ptosis of her left eye over 2 weeks. T1-weighted MR images with gadolinium showed a heterogeneously enhanced lesion extending from the left orbital apex along the optic nerve to the cavernous sius. Although we could not detect fungus by a transsphenoidal biopsy, we suspected fungal infection because of high level of galactomanan antigen in serum. Despite antifungal chemotherapy, her symptoms did not improve. CT image on day 40 showed an aneurysm in the left internal carotid artery, on day 43 cerebral infarction in the left internal carotid artery distribution and on day 45 she died. Autopsy disclosed that aspergillus hyphae invaded the left sphenoid sinus, cavernous sinus and wall of the aneurysm. In this case, fungal infection in the frontal skull base including orbital apex caused mycotic aneurysm in the intracavernous portion of the left internal carotid artery. Skull base aspergillosis presenting orbital apex syndrome is itself rare and in addition, the occurrence of cerebral infarction in the mycotic aneurysm has hardly been reported. We should have cerebrovascular disease in mind as a complication of CNS aspergillosis.

(CLINICA NEUROL, 42: 761−765, 2002)
key words: orbital apex syndrome, CNS aspergillosis, mycotic aneurysm, cerebral infarction

(Received: 10-Jun-02)