Murthy J M, Sundaram C, Prasad V S, Purohit A K, Rammurti S, Laxmi V
Department of Neurology, Nizam's Institute of Medical Sciences, Punjgutta, Hyderabad 500 082, India.
J Assoc Physicians India. 2000 Jul;48(7):677-81.
To study the pattern of central nervous system aspergillosis in a tropical country.
Case records of patients with CNS aspergillosis seen by the authors in a university hospital in south India were reviewed.
Of the 21 patients seen during the study period, 16 (76%) patients had intracranial invasion by contiguous spread from paranasal sinuses and one had from ear. Predisposing risk factors were present in two (12.5%) patients with sinocranial aspergillosis and in both patients with disseminated form. Skull bases syndromes were the presenting features in 13 patients, six patients presented with features of intracranial space occupying lesion and two patients had stroke like presentation. CT scans showed intracranial extradural contrast enhancing mass lesions in the anterior, middle or posterior cranial fossa in addition to mass lesions in the paranasal sinuses in 13 patients with sinocranial aspergillosis and in seven orbital lesions. Intracerebral contrast enhancing mass lesion was the CT finding in both the patients with solitary cerebral aspergillus granuloma and in the patient with otocranial aspergillus granuloma. Well-formed granuloma with dense fibrosis was the histological feature in patients with sinocranial and otocranial aspergillosis. Angioinvasion was the pathological feature in both the patients with disseminated form of aspergillosis. Surgical treatment was sub-radical in our series. Survival rates were not good even after surgical and antifungal chemotherapy.
This study suggests that in this part of the world sinocranial aspergillosis is the most common form of histologically verified CNS aspergillosis. Associated predisposing factors and immune status of the host determine the clinical syndrome and type of pathology in patients with CNS aspergillosis.
研究一个热带国家中枢神经系统曲霉菌病的发病模式。
回顾了作者在印度南部一家大学医院诊治的中枢神经系统曲霉菌病患者的病例记录。
在研究期间所见的21例患者中，16例（76%）患者因鼻窦直接蔓延而发生颅内侵犯，1例因耳部蔓延所致。鼻窦颅内曲霉菌病患者中有2例（12.5%）以及播散型患者中均存在易感危险因素。颅底综合征是13例患者的首发症状，6例患者表现为颅内占位性病变的特征，2例患者有类似中风的表现。CT扫描显示，13例鼻窦颅内曲霉菌病患者除鼻窦有占位性病变外，在前颅窝、中颅窝或后颅窝有颅内硬膜外强化肿块病变，7例有眼眶病变。孤立性脑曲霉菌肉芽肿患者及耳颅曲霉菌肉芽肿患者的CT表现均为脑内强化肿块病变。鼻窦颅内及耳颅曲霉菌病患者的组织学特征为形成良好的肉芽肿伴致密纤维化。血管侵袭是播散型曲霉菌病患者的病理特征。在我们的系列研究中，手术治疗为次根治性。即使经过手术及抗真菌化疗，生存率仍不理想。
本研究表明，在世界的这一地区，鼻窦颅内曲霉菌病是经组织学证实的中枢神经系统曲霉菌病最常见的形式。相关的易感因素及宿主的免疫状态决定了中枢神经系统曲霉菌病患者的临床综合征及病理类型。
