title: Fatal subarachnoid hemorrhage, with brainstem and cerebellar infarction, caused by Aspergillus infection after cerebral aneurysm surgery: case report.
abstract: OBJECTIVE
  Intracranial aspergillosis has been reported to cause subarachnoid hemorrhage (SAH) attributable to ruptured mycotic aneurysms. We describe a case of Aspergillus arteritis that caused SAH without aneurysm formation, followed by successive brainstem and cerebellar infarction.
  
  
  METHODS
  A 50-year-old woman experienced a sudden onset of headache. Computed tomography demonstrated SAH. After angiography revealed an aneurysm of the anterior communicating artery, a complete neck-clipping operation was performed, without neurological deterioration. However, the patient experienced another episode of SAH on the 26th postoperative day.
  
  
  METHODS
  We repeated the craniotomy and confirmed that the clip was still intact. A second angiographic evaluation did not reveal an aneurysm or any other cause of hemorrhage. On the 30th postoperative day, magnetic resonance imaging demonstrated cerebellar infarction in the territory of the anteroinferior cerebellar artery. The patient died on the 40th postoperative day, after another episode of SAH and progressive cerebellar and brainstem infarction. The postmortem examination revealed destruction of the basilar artery and occlusion of the basilar and vertebral arteries attributable to Aspergillus arteritis.
  
  
  CONCLUSIONS
  When a patient presents with SAH of unknown origin followed by cerebral infarction, Aspergillus arteritis should be included in the differential diagnosis. Earlier recognition of this fungal infection improves the prognosis.
authors.affiliation: Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Endo
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Konno
authors.forename: Takashi
authors.initials: T
authors.lastname: Yoshimoto
mesh_terms: D001167:Arteritis / Q000382:microbiology*; D001933:Brain Stem / Q000098:blood supply; D002531:Cerebellum / Q000098:blood supply; D002533:Cerebral Angiography; D002536:Cerebral Arteries; D002544:Cerebral Infarction / Q000175:diagnosis / Q000382:microbiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D020953:Neuroaspergillosis / Q000150:complications* / Q000473:pathology; D011183:Postoperative Complications; D012086:Reoperation; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000382:microbiology*; D014057:Tomography, X-Ray Computed