Iida J, Takemura K, Makita Y
Department of Neurosurgery, Ishinkai Yao Hospital, Osaka, Japan.
No Shinkei Geka. 1994 May;22(5):491-4.
The authors report a rare case of intracranial aspergillosis presenting marked granulomatous pachymeningitis. A 58-year-old male who had a three-year history of diabetes and chronic bronchitis was referred to us because of progressive left hemiparesis and dysarthria. Postcontrast CT scan showed a ring-enhancing lesion with marked perifocal edema in the right parietal lobe, and right subdural enhancing mass. MR image revealed hypertrophic dura mater in the right convexity. On June 9, 1992, partial removal of the intra-axial cystic mass and granulomatous dura mater was performed. A number of characteristic aspergillus hyphae were recognized in the resected cyst and granulomatous dura mater. Postoperatively, the patient was treated with amphotericin-B and fluconazole. But granulomatous pachymeningitis became progressively enlarged and eventually created a large mass effect again. On January 23, 1993, the patient died of pneumonia. Cerebral aspergillosis is getting common but preoperative diagnosis is still difficult because of its causing several clinical features such as brain abscess, granuloma, intracerebral hemorrhage, cerebral infarction, meningitis, and encephalitis. Several comments were made about the pathogenesis of these features, and the necessity of early diagnosis and treatment was emphasized.
作者报告了一例罕见的颅内曲霉病，表现为显著的肉芽肿性硬脑膜炎。一名有三年糖尿病和慢性支气管炎病史的58岁男性因进行性左侧偏瘫和构音障碍被转诊至我院。增强CT扫描显示右顶叶有一个环形强化病灶，周围有明显水肿，右侧硬膜下有强化肿块。磁共振图像显示右侧脑凸面硬脑膜肥厚。1992年6月9日，对轴内囊性肿块和肉芽肿性硬脑膜进行了部分切除。在切除的囊肿和肉芽肿性硬脑膜中发现了许多特征性的曲霉菌丝。术后，患者接受了两性霉素B和氟康唑治疗。但肉芽肿性硬脑膜炎逐渐增大，最终再次产生巨大的占位效应。1993年1月23日，患者死于肺炎。脑曲霉病越来越常见，但由于其可导致多种临床特征，如脑脓肿、肉芽肿、脑出血、脑梗死、脑膜炎和脑炎，术前诊断仍然困难。对这些特征的发病机制进行了一些讨论，并强调了早期诊断和治疗的必要性。
