[An autopsied case of pachymeningitis associated with a ruptured, cerebral aneurysm due to Aspergillus infection].
We reported a 64-years-old woman with pachymeningitis associated with a ruptured mycotic cerebral aneurysm due to Aspergillus infection. She had suffered from diabetes mellitus and been treated since she was 49 years old. She complained of headache at the age of 62 and loss of her left visual acuity three months later. She was treated by the pulse therapy of methylprednisolone as neuritis retrobulbaris and her visual acuity recovered. But her headache continued. Three months later, her right visual acuity was lost, and the pulse therapy was not effective this time. Six months later, she died of subarachnoid hemorrhage following acute meningitis. The autopsy was granted, but limited to the cranial cavity. Macroscopically, it disclosed brownish thickened dura around sella turucica involving trigeminal ganglion and optic nerve, and fresh subarachnoid hemorrhage in the basal cisterns and a ruptured aneurysm (3 mm in diameter) between internal carotid and posterior cerebral artery on the left side. Histologically, the brownish thickened dura was infiltrated by lymphocytes, plasma cells, and multinucleated giant cells. The wall around the aneurysm was infiltrated by lymphocytes and plasma cells as well as many fungi. Immunohistochemistry demonstrated the presence of Aspergillus in the thickened dura and the arterial wall around the aneurysm. There were lymphocytes and plasma cell infiltration in the basal subarachnoid space and scattered microabcesses in the brain. Although the first entry of Aspergillus to the dura was unclear, we assume that the final intravascular dissemination of Aspergillus from the dura caused meningitis and mycotic aneurysm.
Nonaka
N
N
Department of Neurology, Niigata City General Hospital.
Yamazaki
M
M
Onishi
Y
Y
Shibuya
H
H
Okazaki
E
E
D000785:Aneurysm, Infected / Q000209:etiology* / Q000473:pathology; D017542:Aneurysm, Ruptured / Q000209:etiology* / Q000473:pathology; D001228:Aspergillosis / Q000150:complications*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000209:etiology* / Q000473:pathology; D016921:Meningitis, Fungal / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000209:etiology