Iihara K, Makita Y, Nabeshima S, Tei T, Keyaki A, Nioka H
Department of Neurosurgery, Tenri Hospital, Nara.
Neurol Med Chir (Tokyo). 1990 Aug;30(8):618-23. doi: 10.2176/nmc.30.618.
The authors present an extremely rare case of aspergillosis of the central nervous system (CNS) causing subarachnoid hemorrhage (SAH). A 78-year-old female developed facial pain, progressive deterioration in left visual acuity, and left total ophthalmoplegia. Computed tomography demonstrated a heterogeneously enhanced mass extending from the sphenoid sinus to the left cavernous sinus and left orbit, and angiography showed luminal narrowing and irregularity of the left internal carotid artery at its siphon. Biopsy of the left orbital and sphenoid sinus mass resulted in the diagnosis of Aspergillus granuloma. Despite combined administration of amphotericin-B and 5-FC, she became comatose from brainstem infarction and finally, suddenly died. Postmortem examination revealed massive SAH due to a ruptured mycotic aneurysm of the basilar artery. Aspergillosis of the CNS is a growing problem with the wider use of immunosuppressants and antibiotics. To the authors' knowledge, however, only 13 cases of CNS aspergillosis causing SAH have been reported. The prognosis is absolutely bad, with all patients dying from rupture of major intracranial arteries such as the internal carotid artery and basilar artery. Early diagnosis and vigorous chemotherapy are important.
作者报告了一例极为罕见的中枢神经系统（CNS）曲霉菌病导致蛛网膜下腔出血（SAH）的病例。一名78岁女性出现面部疼痛、左眼视力进行性下降及左侧完全性眼肌麻痹。计算机断层扫描显示一个不均匀强化的肿块，从蝶窦延伸至左侧海绵窦和左侧眼眶，血管造影显示左侧颈内动脉虹吸部管腔狭窄及不规则。对左侧眼眶和蝶窦肿块进行活检，诊断为曲霉菌肉芽肿。尽管联合使用了两性霉素B和5-氟胞嘧啶，但她因脑干梗死昏迷，最终突然死亡。尸检发现由于基底动脉霉菌性动脉瘤破裂导致大量蛛网膜下腔出血。随着免疫抑制剂和抗生素的广泛使用，中枢神经系统曲霉菌病问题日益突出。然而，据作者所知，仅有13例中枢神经系统曲霉菌病导致蛛网膜下腔出血的病例被报道。预后极差，所有患者均死于颈内动脉和基底动脉等主要颅内动脉破裂。早期诊断和积极化疗很重要。
