Ogawa Masaki, Sakurai Keita, Kawaguchi Takatsune, Naiki-Ito Aya, Nakagawa Motoo, Okita Kenji, Matsukawa Noriyuki, Shibamoto Yuta
Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Radiology, Toyota-kai Medical Corporation Kariya Toyota General Hospital, Nagoya, Japan.
Pol J Radiol. 2015 Mar 25;80:159-63. doi: 10.12659/PJR.893050. eCollection 2015.
Blister-like aneurysm of the supraclinoid internal carotid artery (ICA) is a well-documented cause of subarachnoid hemorrhage. Generally, this type of aneurysm is associated with various conditions such as hypertension, arteriosclerosis, and ICA dissection. Although Aspergillus is the most common organism causing intracranial fungal aneurysmal formation, there is no report of a blister-like aneurysm caused by Aspergillus infection.
An 83-year-old man received corticosteroid pulse therapy followed by oral steroid therapy for an inflammatory pseudotumor of the clivus. Two months later, the patient was transported to an emergency department due to the diffuse subarachnoid hemorrhage, classified as Fisher group 4. Subsequent 3D computed tomography angiogram revealed a blister-like aneurysm at the superior wall of the left ICA. Six days later, the patient died of subarachnoid hemorrhage caused by the left ICA aneurysm rerupture. Autopsy revealed proliferation of Aspergillus hyphae in the wall of the aneurysm. Notably, that change was present more densely in the inner membrane than in the outer one. Thus, it was considered that Aspergillus hyphae caused infectious aneurysm formation in the left ICA via hematogenous seeding rather than direct invasion.
The blister-like aneurysm is a rare but important cause of subarachnoid hemorrhage. This case report documents another cause of blister-like aneurysms, that is an infectious aneurysm associated with Aspergillus infection.
鞍上颈内动脉（ICA）的水泡样动脉瘤是蛛网膜下腔出血的一个有充分文献记载的病因。一般来说，这种类型的动脉瘤与多种情况相关，如高血压、动脉硬化和ICA夹层。虽然曲霉菌是导致颅内真菌性动脉瘤形成的最常见病原体，但尚无曲霉菌感染引起水泡样动脉瘤的报道。
一名83岁男性因斜坡炎性假瘤接受了皮质类固醇脉冲治疗，随后口服类固醇治疗。两个月后，患者因弥漫性蛛网膜下腔出血被送往急诊科，分类为Fisher 4级。随后的三维计算机断层扫描血管造影显示左ICA上壁有一个水泡样动脉瘤。六天后，患者死于左ICA动脉瘤再破裂引起的蛛网膜下腔出血。尸检显示动脉瘤壁内曲霉菌丝增生。值得注意的是，这种变化在内膜比外膜更密集。因此，认为曲霉菌丝通过血行播散而非直接侵袭导致左ICA感染性动脉瘤形成。
水泡样动脉瘤是蛛网膜下腔出血的一种罕见但重要的病因。本病例报告记录了水泡样动脉瘤的另一个病因，即与曲霉菌感染相关的感染性动脉瘤。
