Ayala DDT, Barba RM, Reséndiz MM, Aguirre QD, Velázquez GG, Gómez AÉ, Chablé MF, Amezcua HMC, Aristi UG, Lazos OM, Chávez ML, Olvera RJE

Language: Spanish
References: 16
Page: 178-187
PDF size: 672.90 Kb.

ABSTRACT

True mycotic aneurysms are secondary to septic emboli from lungs or heart and occasionally nasal sinuses, presenting with inflammation and weakness of the vascular wall in the presence of the fungus, most frequently Aspergillus. These are less common than other aneurysms, which may be called “mycotic”, that are actually produced by bacteria. The five cases reported occurred in a wide range of ages, from a newborn to a man of 64, with an average of 42 years; there were three males and two females, with the associated illnesses of diabetes mellitus, alcoholism, chronic idiopathic ulcerative colitis, hypophyseal adenoma and hypoxic-ischemic perinatal damage. Clinically the disease was generally of sudden onset, with headache, drowsiness or hemiplegia, followed by meningeal and pyramidal signs. Tomography in two patients demonstrated subarachnoid hemorrhage, and in a third showed an infarct affecting the territory of the internal carotid. At autopsy subarachnoid hemorrhage was demonstrated in a third case; of the three with subarachnoid hemorrhage, in two it occurred in the interhemispheric fissure, and in the other was ventral, in the area of resection of the hypophyseal adenoma. The arteries of origin, in four cases large, were the right anterior cerebral, the left anterior cerebral, basilar and internal carotid; and in one was a small artery. The causal agents were Aspergillus sp. (two), Candida sp. (two) and Mucor (one case).

REFERENCES

1. Graham D, Lantos P. Greenfield’s neuropathology. 7th ed. London: Arnold; 2002:135-141.

2. Salaki JS, Louria DB, Chmel H. Fungal and yeast infections of the central nervous system. A clinical review. Medicine (Baltimore)1984;63:108-132.

3. Hot A, Mazighi M, Lecuit M, Poirée S, et al. Fungal internal carotid aneurysms. Clin Infect Dis 2007;45:e156-161.

4. Sundaram C, Goel D, Uppin SG, Seethajayalakshmi S, Borgohain R. Intracranial mycotic aneurysm due to Aspergillus species. J Clin Neurosc 2007;14:882-886.

5. Ducruet AF, Hickman ZL, Zacharia BE, Grobelny BT, et al. Intracranial infectious aneurysms: a comprehensive review. Neurosurg Rev 2010;33:37-46.

6. Ho C, Deruytter M. CNS aspergillosis with mycotic aneurysm, cerebral granuloma end infarction. Acta Neurochir 2004;146:851-856.

7. Wilson WR, Hawrych A, Olan W. Rapid development of bilateral internal carotid artery aneurysm from sphenoid sinus aspergillosis. Skull Base Surgery 1998;50(1):211-214.

8. Masago A, Fukuoka H, Yoshida T, Majima K, et al. Intracranial mycotic aneurysm caused by Aspergillus. Case Report. Neurol Med Chir 1992;32:904-907.

9. Azarpira N, Esfandiari M, Bagheri MH, Rakei S, Salari S. Cerebral aspergillosis presenting as a mass lesion. Braz J Infect Dis 2008;12(4):349-351.

10. Ahsan H, Ajmal F, Saleem MF, Sonawala AB. Cerebral fungal infection with mycotic aneurysm of basilar artery and subarachnoid haemorrhage. Singapore Med J 2009;50(1):22-25.

11. Ruhnke M, Kofla G, Otto K, Schwartz S. CNS aspergillosis: recognition, diagnosis and management. CNS Drugs 2007;21(8):659-676.

12. Jafari HS, Saez-Llorens X, Grimprel E, Argyle JC, et al. Characteristics of experimental Candida albicans infection of the central nervous system. J Infect Dis 1992;164:389-395.

13. Parker JC, McCloskey JJ, Lee RS. Human cerebral candidosis. A post mortem evaluation of 19 patients. Hum Pathol 1981;12:23-28.

14. Ellis CKJ, Daniel SE, Kennedy PG, Oppenheimer SM, Scaravelli F. Rhino-orbital zygomycosis. J Neurol Neurosurg Psychiatry 1985;48:455-458.

15. Rangel-Guerra R, Martínez HR, Saenz C. Mucormycosis. Report of 11 cases. Arch Neurol 1985;42:578-781.

16. Espinell-Ingroff A, Oakley LA, Kerkering TM. Opportunistic zygomycotic infections. Mycopathologia 1987;97:33-41.