title: Fatal subarachnoid hemorrhage caused by Aspergillus arteritis without angiographic abnormalities.
abstract: No source of bleeding is detected by angiogram in 15-20% of patients with nonaneurysmal subarachnoid hemorrhage (SAH). This negative angiographic finding might suggest a benign prognosis. We describe a case of fatal SAH caused by Aspergillus arteritis without formation of fusiform dilatation or aneurysms. A 76-year-old man with a 2-month history of progressive visual loss due to pachymeningitis around the optic nerves suffered from SAH in the bilateral sylvian fissures. Repetitive serum galactomannan assay and angiography showed no abnormality. Post mortem examination revealed marked proliferation of Aspergillus in the granulomas of the frontal base dura mater. In addition, major trunks and several branches of the bilateral middle cerebral arteries were invaded by Aspergillus hyphae, which destroyed the walls in the absence of dilatation and aneurysms. Invasive aspergillosis of the CNS often forms a mycotic aneurysm. However, four autopsy cases of nonaneurysmal SAH due to invasive aspergillosis have been reported. The present case is the second autopsy case of Aspergillus arteritis without angiographic abnormality, resulting in fatal SAH. Aggressive and continuous antifungal therapy is absolutely necessary in suspected cases of invasive aspergillosis of the CNS, even if angiography is negative and therapeutic markers of aspergillosis are normal.
authors.affiliation: Department of Neurology, Aomori Prefectural Central Hospital, Aomori, Japan. yasuomiki@hotmail.com
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Miki
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tomiyama
authors.forename: Rie
authors.initials: R
authors.lastname: Haga
authors.forename: Haruo
authors.initials: H
authors.lastname: Nishijima
authors.forename: Chieko
authors.initials: C
authors.lastname: Suzuki
authors.forename: Michiharu
authors.initials: M
authors.lastname: Nishijima
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Midorikawa
authors.forename: Seiya
authors.initials: S
authors.lastname: Sannohe
authors.forename: Hidekachi
authors.initials: H
authors.lastname: Kurotaki
authors.forename: Koichi
authors.initials: K
authors.lastname: Wakabayashi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Baba
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001167:Arteritis / Q000150:complications* / Q000382:microbiology / Q000473:pathology; D001228:Aspergillosis / Q000150:complications* / Q000382:microbiology / Q000473:pathology; D001230:Aspergillus; D001344:Autopsy; D001921:Brain / Q000382:microbiology / Q000473:pathology; D002533:Cerebral Angiography; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008581:Meningitis / Q000150:complications / Q000382:microbiology; D016612:Paraffin Embedding; D013345:Subarachnoid Hemorrhage / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D016707:Tissue Fixation; D014057:Tomography, X-Ray Computed; D014786:Vision Disorders / Q000209:etiology
chemical_list: D000935:Antifungal Agents