Abstract.
A subarachnoid haemorrhage (SAH) occurred 67 days after cardiac transplantation in a 10-year-old girl with consecutive immunocompromising therapy. Neither digital subtraction angiography (DSA) nor computed tomographic angiography showed signs of intracranial vascular malformations. One month before the lethal SAH occurred, she had developed arterial hypertension and attacks of severe headache with cerebrospinal fluid (CSF) pleocytosis while CT scans showed an infarct of the left thalamus. Pathologic findings established the rare diagnosis of SAH due to aspergillosis-related mycotic arteritis. Imaging characteristics are presented.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Van Gijn J, Rinkel GJE (2001) Subarachnoid haemorrhage: diagnosis, causes and management. Brain 124: 249–278
Lau AHC, Takeshita M, Ishii N (1991) Mycotic arteritis resulting in fatal subarachnoid hemorrhage: a case report. Angiology 42:251–255
Masuda J, Yutani C, Waki R (1992) Histopathological analysis of the mechanisms of intracranial hemorrhage complicating infective endocarditis. Stroke 23:843–850
Brust JCM, Dickinson PCT, Hughes JEO (1990) The diagnosis and treatment of cerebral mycotic aneurysms. Ann Neurol 27:238–246
O'Donohue JM, Enzmann DR (1987) Mycotic aneurysm in angiitis associated with herpes zoster ophthalmicus. Am J Neuroradiol 8:615–619
Martinez AJ, Sotelo-Avila C, Alcala H (1980) Granulomatous encephalitis, intracranial arteritis, and mycotic aneurysm due to a free-living ameba. Acta Neuropathol 49:7–12
Erly WK, Labadie E, Williams PL (1999) Disseminated coccidioidomycosis complicated by vasculitis: a cause of fatal subarachnoid hemorrhage in two cases. Am J Neuroradiol 20:1605–1608
Fernando SS, Lauer CS (1982) Aspergillus fumigatus infection of the optic nerve with mycotic arteritis of cerebral vessels. Histopathology 6:227–234
Nenoff P, Kellermann S, Horn LC (2001) Case report. Mycotic arteritis due to Aspergillus fumigatus in a diabetic with retrobulbar aspergillosis and mycotic meningitis. Mycoses 44:407–414
Horten BC, Abbott GF, Porro RS (1976) Fungal aneurysms of intracranial vessels. Arch Neurol 33:577–579
Tietz HJ, Martin H, Koch S (2001) Incidence of endomycoses in autopsy material. Mycoses 44:450–454
Matsumura S, Sato S, Fujiwara H (1988) Cerebral aspergillosis as a cerebral vascular accident. No To Shinkei 40:225–232
Jamjoom AB, Al-Hedaithy SAS, Jamjoom ZAB et al. (1995) Intracranial mycotic infections in neurosurgical practice. Acta Neurochir 137:78–84
Takahashi Y, Sugita Y, Maruiwa H et al. (1998) Fatal hemorrhage from rupture of the intracranial internal carotid artery caused by Aspergillus arteritis. Neurosurg Rev 21:198–201
Yamada K, Zoarski GH, Rothman MI et al. (2001) An intracranial aspergilloma with low signal on T2-weighted images corresponding to iron accumulation. Neuroradiology 43:559–561
Dietrich U, Hettmann M, Maschke M et al. (2001) Cerebral aspergillosis: comparison of radiological and neuropathologic findings in patients with bone marrow transplantation. Eur Radiol 11:1242–1249
Yamada K, Shrier DA, Rubio A et al. (2002) Imaging findings in intracranial aspergillosis. Acad Radiol 9:163–171
Corvisier N, Gray F, Gherardi R et al. (1987) Aspergillosis of ethmoid sinus and optic nerve, with arteritis and rupture of the internal carotid artery. Surg Neurol 28:311–315
Christophe C, Azzi N, Bouche B (1999) Magnetic resonance imaging and angiography in cerebral fungal vasculitis. Neuropediatrics 30:218–220
Endo T, Tominaga T, Konno H et al. (2002) Fatal subarachnoid hemorrhage, with brainstem and cerebellar infarction, caused by Aspergillus infection after cerebral aneurysm surgery: case report. Neurosurgery 50:1147–1150
Nagashima T, Miyanoshita A, Sakiyama Y et al. (2000) Cerebral vasculitis in chronic mucocutaneous candidiasis: autopsy case report. Neuropathology 20:309–314
Sakaki T, Kikuchi H, Furuse S et al. (1975) False aneurysm due to mycotic angitis: case report. No Shinkei Geka 3:495–499
Venger BH, Aldama AE (1988) Mycotic vasculitis with repeated intracranial aneurysmal hemorrhage. J Neurosurg 69:775–779
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Weigel, S., Kloska, S., Kehl, H.G. et al. Lethal subarachnoid bleeding under immunosuppressive therapy due to mycotic arteritis. Eur Radiol 13 (Suppl 6), L215–L218 (2003). https://doi.org/10.1007/s00330-002-1741-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-002-1741-3