Related Experiment Video
Updated: Aug 11, 2026
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Aspergilloma of the brain: an overview
1Department of Neurosurgery, Seth G. S. Medical College, King Edward Memorial Hospital, Parel, Mumbai, India. tdnadkarni@hotmail.com
Abstract:
Fungal infections of the central nervous system (CNS) are almost always a clinical surprise. Their presentation is subtle, often without any diagnostic characteristics, and they are frequently mistaken for tuberculous meningitis, pyogenic abscess, or brain tumor. Granulocytopenia, cellular and humoral mediated immune dysfunction are predisposing factors to the development of CNS infections in immunosuppressed patients. Aspergillus fumigatus is the most common human pathogen in the genus Aspergillus. Maxillary sinusitis of dental origin or the lungs are the most common sites of primary Aspergillus infection. Infection reaches the brain directly from the nasal sinuses via vascular channels or is blood borne from the lungs and gastrointestinal tract. Single or multiple abscess formation with blood vessel invasion leading to thrombosis is a characteristic feature of Aspergillosis on neuropathologic examination. Aspergillosis should be considered in cases manifesting with acute onset of focal neurologic deficits resulting from a suspected vascular or space-occupying lesion especially in immunocompromised hosts. Aspergillosis is diagnosed on direct examinations and culture, however the diagnosis of aspergillosis of the CNS is difficult. Diagnosis of an intracranial mass lesion is best confirmed with a computed tomography or magnetic resonance imaging of the head with or without intravenous contrast. Aggressive neurosurgical intervention for surgical removal of Aspergillus abscesses, granulomas, and focally infracted brain; correction of underlying risk factors; Amphotericin B combined with flucytosine and treatment of the source of infection should form the mainstay of the management. Off late Liposomal Amphotericin B was found to be more effective and safe than conventional Amphotericin B in the management of Apergillus infections Only with a high index of suspicion, an aggressive approach to diagnosis, and rapid vigorous therapy may we hope to alter the clinical course in this group of patients.
Insights
Central nervous system (CNS) fungal infections, particularly Aspergillosis, are often missed due to subtle symptoms. Early suspicion and aggressive diagnosis are crucial for effective treatment in immunocompromised patients.
Area of Science:
- Neurology
- Infectious Diseases
- Mycology
Background:
- Fungal infections of the central nervous system (CNS) present subtly and are often misdiagnosed as other neurological conditions.
- Immunocompromised patients are at higher risk for CNS infections, with Aspergillus fumigatus being a common pathogen.
- Aspergillosis can reach the brain via direct extension from sinuses or hematogenously from other sites, characterized by abscess formation and vascular invasion.
Purpose of the Study:
- To highlight the diagnostic challenges and clinical presentation of CNS Aspergillosis.
- To emphasize the importance of early recognition and aggressive management strategies for CNS Aspergillosis.
- To discuss the role of neuroimaging and current therapeutic approaches in managing this rare but serious infection.
Main Methods:
- Review of clinical presentations and diagnostic difficulties associated with CNS Aspergillosis.
- Discussion of predisposing factors, routes of infection, and neuropathological findings.
- Evaluation of diagnostic tools including neuroimaging (CT, MRI) and direct examination/culture.
- Analysis of treatment modalities, including surgical intervention, antifungal therapy (Amphotericin B, flucytosine), and source control.
Main Results:
- CNS Aspergillosis is often a clinical surprise, mimicking other serious conditions like tuberculous meningitis or brain tumors.
- Neuropathological examination may reveal characteristic abscess formation with blood vessel invasion and thrombosis.
- Liposomal Amphotericin B shows promise as a safer and more effective treatment option compared to conventional Amphotericin B.
Conclusions:
- A high index of suspicion is essential for diagnosing CNS Aspergillosis, especially in immunocompromised individuals with focal neurological deficits.
- Aggressive diagnostic approaches, including advanced neuroimaging, are critical for timely confirmation.
- Prompt and vigorous multidisciplinary management, combining neurosurgery, targeted antifungal therapy, and source control, is necessary to improve patient outcomes.
Related Concept Videos
01:26Brain Abscess l: Introduction
01:26Cerebrum: Anatomical Overview I
01:11Cerebrum: Anatomical Overview II
01:20Anatomy of the Brain: Major Regions
The cerebrum is the largest section of the brain and divides into left and right hemispheres, separated by a deep fissure. The cerebral outer layer of grey matter — the cerebral cortex — comprises elevations called gyri and shallow groves called sulci. The inner portion of white matter includes long nerve fibers known as axons, which connect various areas...
01:10The Arch of Aorta
Encircling the heart, the coronary arteries form a ring-like structure before...
01:18Anatomy of the Brain: Ventricles