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Cerebral infarction due to Aspergillus arteritis following glioma surgery
R R Sharma1, N T Gurusinghe, P G Lynch
1Royal Preston Hospital, Lancs, UK.
Abstract:
Cerebral infarction due to fungal arteritis is an uncommon complication of neurosurgical operations and adjuvant immunosuppressive therapy, including long-term steroids. If unrecognized, the neurological deterioration which ensues may be mistreated by increasing the dose of steroids. A case of a 38-year-old Caucasian male who had no obvious immune deficiency or fungal infection prior to a craniotomy for cerebral tumour is described in whom perioperative aspergillus infection resulted in cerebral arteritis and extensive cerebral infarction with a fatal outcome. Long-term steroid therapy used in the management of cerebral tumours may carry an increased risk of systemic or cerebral fungal infection. The possibility of cerebral mycosis (arteritis) and dangers of its non-recognition are highlighted.
Insights
Fungal arteritis, a rare complication of neurosurgery and steroid therapy, can lead to fatal cerebral infarction. Early recognition of cerebral mycosis is crucial to prevent misdiagnosis and inappropriate treatment.
Area of Science:
- Neurology
- Neurosurgery
- Mycology
Background:
- Cerebral infarction is an uncommon complication of neurosurgical procedures and immunosuppressive therapy.
- Long-term steroid use, often in cancer management, can increase susceptibility to fungal infections.
- Fungal arteritis, particularly Aspergillus-related, poses a diagnostic challenge in neurosurgical patients.
Purpose of the Study:
- To highlight a fatal case of cerebral infarction secondary to Aspergillus arteritis.
- To emphasize the diagnostic challenges and risks associated with unrecognized cerebral mycosis.
- To underscore the potential link between steroid therapy for brain tumors and increased fungal infection risk.
Main Methods:
- Case report of a 38-year-old male undergoing craniotomy for a cerebral tumor.
- Detailed clinical presentation, perioperative course, and pathological findings.
- Review of literature concerning fungal arteritis and neurosurgical complications.
Main Results:
- The patient developed perioperative Aspergillus infection leading to cerebral arteritis.
- Extensive cerebral infarction occurred, resulting in a fatal outcome.
- Neurological deterioration was initially misinterpreted, potentially leading to increased steroid dosage.
Conclusions:
- Cerebral infarction due to fungal arteritis is a rare but serious complication.
- Early diagnosis of cerebral mycosis is critical to avoid mistreatment with immunosuppressants.
- Neurosurgical patients on long-term steroids require vigilance for opportunistic fungal infections.