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Updated: Dec 23, 2025
Author Spotlight: A Novel Method for Comprehensive Cell Component Analysis of Cerebral Blood Clots
Published on: July 21, 2023
[A fungus in a thrombus by mechanical thrombectomy in acute cerebral infarction: a case report]
Takehiro Katano1, Yuki Sakamoto1, Shinobu Kunugi2
1Department of Neurology, Nippon Medical School Hospital.
Abstract:
A 88-year-old man suddenly presented with aphasia and right hemiparesis. The diffusion-weighted image of MRI showed ischemic lesions on the left middle cerebral artery area, and MRA showed the left intracranial artery (ICA) occlusion. Therefore, we diagnosed him as having acute ischemic stroke and treated with mechanical thrombectomy (MT). The DWI of MRI showed ischemic lesions on the left middle cerebral artery area, and MRA showed the left ICA occlusion. Therefore, we performed MT and continued best medical treatment, but ICA was reoccluded. Six day later, aspergillus was found in the thrombus from ICA. Then, we considered that ICA occlusion was caused by aspergillus. We experienced a patient specified the cause by thrombus pathology. The pathological diagnosis of the thrombus getting by MT is usefulness for stroke etiology.
Insights
This case study highlights a rare cause of acute ischemic stroke in an elderly man. Thrombus pathology revealed Aspergillus infection as the cause of intracranial artery occlusion, emphasizing its importance in determining stroke etiology.
Area of Science:
- Neurology
- Infectious Diseases
- Pathology
Background:
- Acute ischemic stroke is a leading cause of disability and mortality.
- Intracranial artery occlusion is a common cause of ischemic stroke, often treated with mechanical thrombectomy.
- Identifying the underlying etiology of stroke is crucial for effective management and prevention.
Observation:
- An 88-year-old male presented with sudden onset aphasia and right hemiparesis.
- Magnetic Resonance Imaging (MRI) revealed ischemic lesions in the left middle cerebral artery territory.
- Magnetic Resonance Angiography (MRA) demonstrated left internal carotid artery (ICA) occlusion.
Findings:
- Mechanical thrombectomy (MT) was performed for acute ischemic stroke due to left ICA occlusion.
- Despite successful MT, the ICA reoccluded, necessitating further investigation.
- Pathological examination of the thrombus retrieved during MT identified Aspergillus fungal elements.
- The patient's stroke was attributed to Aspergillus-induced intracranial artery occlusion.
Implications:
- Thrombus pathology analysis is a valuable tool for diagnosing uncommon stroke etiologies.
- Fungal infections, such as Aspergillus, should be considered in the differential diagnosis of arterial occlusions, especially in immunocompromised or elderly patients.
- This case underscores the importance of comprehensive etiological investigation in cryptogenic stroke or cases with atypical presentations.
