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Intracranial Fungal Aneurysms

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Fungal Infections of the Central Nervous System

Abstract

Intracranial fungal aneurysm (IFA) is a true “mycotic aneurysm” which occurs through mycotic infection of the intracranial arterial wall. This disease is among the most serious complications of central nervous system fungal infections with a high morbidity and mortality rate. Aspergillus species, Candida albicans, and Mucor species are the three most common pathogens involved. Clinical presentations cannot be categorized as being typical and may vary widely. However, the most common signs and symptoms of IFA are those related to aneurysm bleeding and their causative origin. Digital subtraction angiography continues to be the gold standard for the diagnosis, although computed tomography angiography and magnetic resonance angiography can be used. Classically, IFAs are larger than bacterial ones and located in major cerebral artery trunks. Treatment is based on administration of antifungal agents in combination with surgical or endovascular procedures according to the character and position of the aneurysm and the clinical condition of the patient. Compared to bacterial intracranial aneurysms, fungal ones lead to a poor outcome because of a mixture of difficulty in making a correct diagnosis, poor favorable response to antifungal drugs, proximal site of the aneurysms, adjacent artery thrombosis, immunocompromised status, serious medical comorbidities, and often a friable arterial wall.

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Abbreviations

CNS:

Central nervous system

CSF:

Cerebrospinal fluid

CT:

Computed tomography

ICA:

Internal carotid artery

IFA:

Intracranial fungal aneurysm

IIA:

Intracranial infectious aneurysm

MR:

Magnetic resonance

References

  • Abecassis IJ, Adel JG, Ayer A, Batjer HH. A ruptured infectious intracranial aneurysm with a combined fungal and bacterial etiology. Clin Neurol Neurosurg. 2013;115(11):2393–6. https://doi.org/10.1016/j.clineuro.2013.08.026.

    Article  PubMed  Google Scholar 

  • Ahmad FU, Mahajan H, Mahapatra AK, Suri A. Mycotic aneurysm. An unusual cause of pyrexia of unknown origin in an immunodeficient infant. Pediatr Neurosurg. 2006;42(4):237–9.

    Article  Google Scholar 

  • Ahmad RA, Hussain ST, Tan CD, Pettersson GB, Clair D, Gordon SM. Successful surgical treatment of rare Aspergillus terreus prosthetic valve endocarditis complicated by intracranial and mesenteric artery mycotic aneurysms. J Thorac Cardiovasc Surg. 2014;148(5):e221–3. https://doi.org/10.1016/j.jtcvs.2014.06.084.

    Article  PubMed  Google Scholar 

  • Ahsan H, Ajmal F, Saleem MF, Sonawala AB. Cerebral fungal infection with mycotic aneurysm of basilar artery and subarachnoid haemorrhage. Singapore Med J. 2009;50(1):e22–5.

    CAS  PubMed  Google Scholar 

  • Akhaddar A. Intracranial Infectious Aneurysms. In: Akhaddar A, editor. Atlas of infections in neurosurgery and spinal surgery. 1st ed. Cham: Springer International Publishing; 2017a. p. 143–8. https://doi.org/10.1007/978-3-319-60086-4_15.

    Chapter  Google Scholar 

  • Akhaddar A. Fungal infections of the Central Nervous System. In: Akhaddar A, editor. Atlas of infections in neurosurgery and spinal surgery. 1st ed. Cham: Springer International Publishing; 2017b. p. 317–23. https://doi.org/10.1007/978-3-319-60086-4_29.

    Chapter  Google Scholar 

  • Akhaddar A, Gazzaz M, Albouzidi A, Lmimouni B, Boucetta M. Invasive Aspergillus terreus sinusitis with orbitocranial extension: case report. Surg Neurol. 2008;69(5):490–5. discussion 495. https://doi.org/10.1016/j.surneu.2007.02.059.

    Article  PubMed  Google Scholar 

  • Azar MM, Assi R, Patel N, Malinis MF. Fungal mycotic aneurysm of the internal carotid artery associated with sphenoid sinusitis in an immunocompromised patient: a case report and review of the literature. Mycopathologia. 2016;181:425–33. https://doi.org/10.1007/s11046-015-9975-1.

    Article  PubMed  Google Scholar 

  • Brown SL, Busuttil RW, Baker JD, Machleder HI, Moore WS, Barker WF. Bacteriologic and surgical determinants of survival in patients with mycotic aneurysms. J Vasc Surg. 1984;1:541–7.

    Article  CAS  Google Scholar 

  • Choi H, Hall WA, Deshaies EM. Infectious intracranial aneurysms. In: Hall WA, KIM PD, editors. Neurosurgical infectious disease. Surgical and nonsurgical management. New York: Thieme; 2014. p. 133–46.

    Google Scholar 

  • Corvisier N, Gray F, Gherardi R, Lebras F, Blanc CM, Nyugen JP, et al. Aspergillosis of ethmoid sinus and optic nerve, with arteritis, and rupture of the internal carotid artery. Surg Neurol. 1987;28:311–5.

    Article  CAS  Google Scholar 

  • Ducruet AF, Hickman ZL, Zacharia BE, Narula R, Grobelny BT, Gorski J, et al. Intracranial infectious aneurysms: a comprehensive review. Neurosurg Rev. 2010;33:37–46. https://doi.org/10.1007/s10143-009-0233-1.

    Article  PubMed  Google Scholar 

  • Eddleman CS, Surdell D, DiPatri A Jr, Tomita T, Shaibani A. Infectious intracranial aneurysms in the pediatric population: endovascular treatment with Onyx. Childs Nerv Syst. 2008;24(8):909–15. https://doi.org/10.1007/s00381-008-0614-8.

    Article  PubMed  Google Scholar 

  • Goldman JA, Fleischer AS, Leifer W, Parent A, Schwarzman SW, Raggio J. Candida albicans mycotic aneurysm associated with systemic lupus erythematosus. Neurosurgery. 1979;4:325–8.

    Article  CAS  Google Scholar 

  • Grandhi R, Zwagerman NT, Linares G, Monaco EA 3rd, Jovin T, Horowitz M, et al. Onyx embolization of infectious intracranial aneurysms. J Neurointerv Surg. 2014;6(5):353–6. https://doi.org/10.1136/neurintsurg-2013-010755.

    Article  PubMed  Google Scholar 

  • Gulshan KA, Neeraj J, Malini V, Subimal R. Cerebral mycotic aneurysm of fungal origin. Case report. J Neurosurg. 1978;49:107–10.

    Article  Google Scholar 

  • Ho CL, Deruytter MJ. CNS aspergillosis with mycotic aneurysm, cerebral granuloma and infarction. Acta Neurochir (Wien). 2004;146:851–6.

    Article  CAS  Google Scholar 

  • Horten BC, Abbott GF, Porro RS. Fungal aneurysms of intracranial vessels. Arch Neurol. 1976;33:577–9.

    Article  CAS  Google Scholar 

  • Hot A, Mazighi M, Lecuit M, Poirée S, Viard JP, Loulergue P, et al. Fungal internal carotid artery aneurysms: successful embolization of an Aspergillus-associated case and review. Clin Infect Dis. 2007;45(12):e156–61. https://doi.org/10.1086/523005.

    Article  PubMed  Google Scholar 

  • Hurst RW, Judkins A, Bolger W, Chu A, Loevner LA. Mycotic aneurysm and cerebral infarction resulting from fungal sinusitis: imaging and pathologic correlation. AJNR Am J Neuroradiol. 2001;22:858–63.

    CAS  PubMed  Google Scholar 

  • Kannoth S, Thomas SV. Intracranial microbial aneurysm (infectious aneurysm): current options for diagnosis and management. Neurocrit Care. 2009;11:120–9. https://doi.org/10.1007/s12028-009-9208-x.

    Article  PubMed  Google Scholar 

  • Kannoth S, Iyer R, Thomas SV, Furtado SV, Rajesh BJ, Kesavadas C, et al. Intracranial infectious aneurysm: presentation, management and outcome. J Neurol Sci. 2007;256(1-2):3–9.

    Article  Google Scholar 

  • Kasliwal MK, Reddy VS, Sinha S, Sharma BS, Das P, Suri V. Bilateral anterior cerebral artery aneurysm due to mucormycosis. J Clin Neurosci. 2009;16(1):156–9. https://doi.org/10.1016/j.jocn.2008.04.019.

    Article  PubMed  Google Scholar 

  • Kikuchi K, Watanabe K, Sugawara A, Kowada M. Multiple fungal aneurysms: report of a rare case implicating steroid as predisposing factor. Surg Neurol. 1985;24(3):253–9.

    Article  CAS  Google Scholar 

  • Kim YC, Lee H, Ryu HH, Beom SH, Yang Y, Kim S, et al. Aspergillus-associated cerebral aneurysm successfully treated by endovascular and surgical intervention with voriconazole in lupus nephritis patient. J Korean Med Sci. 2012;27(3):317–20. https://doi.org/10.3346/jkms.2012.27.3.317.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Knouse MC, Madeira RG, Celani VJ. Pseudomonas aeruginosa causing a right carotid artery mycotic aneurysm after a dental extraction procedure. Mayo Clin Proc. 2002;77:1125–30.

    Article  Google Scholar 

  • Kojima Y, Saito A, Kim I. The role of serial angiography in the management of bacterial and fungal intracranial aneurysms—report of two cases and review of the literature. Neurol Med Chir (Tokyo). 1989;29(3):202–16.

    Article  CAS  Google Scholar 

  • Kothary MH, Chase T Jr, Macmillan JD. Correlation of elastase production by some strains of Aspergillus fumigatus with ability to cause pulmonary invasive aspergillosis in mice. Infect Immun. 1984;43(1):320–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Kunimatsu A, Tsuji S, Saito N. Recurrent cerebral aneurysm formation and rupture within a short period due to invasive aspergillosis of the nasal sinus; pathological analysis of the catastrophic clinical course. Int J Clin Exp Pathol. 2015;8(10):13510–22.

    PubMed  PubMed Central  Google Scholar 

  • Loeys BL, Van Coster RN, Defreyne LR, Leroy JG. Fungal intracranial aneurysm in a child with familial chronic mucocutaneous candidiasis. Eur J Pediatr. 1999;158(8):650–2.

    Article  CAS  Google Scholar 

  • Marazzi MG, Bondi E, Giannattasio A, Strozzi M, Savioli C. Intracranial aneurysm associated with chronic mucocutaneous candidiasis. Eur J Pediatr. 2008;167:461–3.

    Article  CAS  Google Scholar 

  • Mennink-Kersten MA, Donnelly JP, Verweij PE. Detection of circulating galactomannan for the diagnosis and management of invasive Aspergillosis. Lancet Infect Dis. 2004;4:349–57.

    Article  CAS  Google Scholar 

  • Morriss FH Jr, Spock A. Intracranial aneurysm secondary to mycotic orbital and sinus infection: report of a case implicating penicillium as an opportunistic fungus. Am J Dis Child. 1970;119:357–62.

    Article  Google Scholar 

  • Muraoka S, Araki Y, Izumi T, Takeuchi K, Okamoto S, Wakabayashi T. Cerebral infarction and subarachnoid hemorrhage caused by central nervous system Aspergillus infection. World Neurosurg. 2016;90:705.e9–705.e13. https://doi.org/10.1016/j.wneu.2016.03.021.

    Article  Google Scholar 

  • Negoro E, Morinaga K, Taga M, Kaizaki Y, Kawai Y. Mycotic aneurysm due to Aspergillus sinusitis. Int J Hematol. 2013;98(1):4–5. https://doi.org/10.1007/s12185-013-1369-x.

    Article  PubMed  Google Scholar 

  • Ogawa M, Sakurai K, Kawaguchi T, Naiki-Ito A, Nakagawa M, Okita K, et al. Internal carotid artery blister-like aneurysm caused by Aspergillus—case report. Pol J Radiol. 2015;80:159–63. https://doi.org/10.12659/PJR.893050.

    Article  PubMed  PubMed Central  Google Scholar 

  • Okada Y, Shima T, Nishida M, Yamane K, Yoshida A. Subarachnoid hemorrhage caused by Aspergillus aneurysm as a complication of transcranial biopsy of an orbital apex lesion—case report. Neurol Med Chir (Tokyo). 1998;38(7):432–7.

    Article  CAS  Google Scholar 

  • Ong A, Blyth CC, Bency R, Vicaretti M, Harun A, Meyer W, et al. Fatal mycotic aneurysms due to Scedosporium and Pseudallescheria infection. J Clin Microbiol. 2011;49(5):2067–71. https://doi.org/10.1128/JCM.02615-10.

    Article  PubMed  PubMed Central  Google Scholar 

  • Osler W. Goulstonian lectures on malignant endocarditis. Brit Med J. 1885;1:467–70.

    Article  CAS  Google Scholar 

  • Paris S, Boisvieux-Ulrich E, Crestani B, Houcine O, Taramelli D, Lombardi L, et al. Internalization of Aspergillus fumigatus conidia by epithelial and endothelial cells. Infect Immun. 1997;65(4):1510–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Piotrowski WP, Pilz P, Chuang IH. Subarachnoid hemorrhage caused by a fungal aneurysm of the vertebral artery as a complication of intracranial aneurysm clipping. Case report. J Neurosurg. 1990;73(6):962–4.

    Article  CAS  Google Scholar 

  • Radotra BD, Salunke P, Parthan G, Dutta P, Vyas S, Mukherjee KK. True mycotic aneurysm in a patient with gonadotropinoma after trans-sphenoidal surgery. Surg Neurol Int. 2015;6:193. https://doi.org/10.4103/2152-7806.172697.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shinya Y, Miyawaki S, Nakatomi H, Okano A, Imai H, Shin M, et al. Recurrent cerebral aneurysm formation and rupture within a short period due to invasive aspergillosis of the nasal sinus; pathological analysis of the catastrophic clinical course. Int J Clin Exp Pathol. 2015;8(10):13510–22.

    PubMed  PubMed Central  Google Scholar 

  • Stehbens WE. Atypical cerebral aneurysms. Med J Aust. 1965;1(21):765–6.

    CAS  PubMed  Google Scholar 

  • Takeda S, Wakabayashi K, Yamazaki K, Miyakawa T, Arai H. Intracranial fungal aneurysm caused by Candida endocarditis. Clin Neuropathol. 1998;17:199–203.

    CAS  PubMed  Google Scholar 

  • Takeshita M, Izawa M, Kubo O, Tanikawa T, Onda H, Wanifuchi H, Tamura Y, Kagawa M. Aspergillotic aneurysm formation of cerebral artery following neurosurgical operation. Surg Neurol. 1992;38:146–51.

    Article  CAS  Google Scholar 

  • Verweij PE, Brinkman K, Kremer HP, Kullberg BJ, Meis JF. Aspergillus meningitis: diagnosis by non-culture-based microbiological methods and management. J Clin Microbiol. 1999;37:1186–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Visudhiphan P, Bunyaratavej S, Khantanaphar S. Cerebral aspergillosis. Report of three cases. J Neurosurg. 1973;38:472–6.

    Article  CAS  Google Scholar 

  • Watson JC, Myseros JS, Bullock MS. True fungal mycotic aneurysm of the basilar artery: a clinical and surgical dilemma. Cerebrovasc Dis. 1999;9:50–3.

    Article  CAS  Google Scholar 

  • Yamaguchi J, Kawabata T, Motomura A, Hatano N, Seki Y. Fungal internal carotid artery aneurysm treated by trapping and high-flow bypass: a case report and literature review. Neurol Med Chir (Tokyo). 2016;56(2):89–94. https://doi.org/10.2176/nmc.cr.2015-0206.

    Article  PubMed  PubMed Central  Google Scholar 

  • Yip CM, Hsu SS, Liao WC, Chen JY, Liu SH, Chen CH. Orbital apex syndrome due to aspergillosis with subsequent fatal subarachnoid hemorrhage. Surg Neurol Int. 2012;3:124. https://doi.org/10.4103/2152-7806.102349.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zanaty M, Chalouhi N, Starke RM, Tjoumakaris S, Gonzalez LF, Hasan D, et al. Endovascular treatment of cerebral mycotic aneurysm: a review of the literature and single center experience. Biomed Res Int. 2013;2013:151643. https://doi.org/10.1155/2013/151643.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Avicenne Military Hospital of Marrakech, Mohammed V University of Rabat, Rabat, Morocco

    Ali Akhaddar & Sylma Diabira

  2. Spine Surgery Unit, Private Hospital of Saint-Grégoire, Rennes, France

    Sylma Diabira

Authors
  1. Ali Akhaddar
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  2. Sylma Diabira
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Editors and Affiliations

  1. Department of Neurosurgery, Aydın Adnan Menderes University, School of Medicine, Aydın, Turkey

    Mehmet Turgut

  2. Department of Pathology, Basavatarakam Indo-American Hospital & Research Institute, Hyderabad, Telangana, India

    Sundaram Challa

  3. Department of Neurosurgery, Avicenne Military Hospital, Mohammed V University in Rabat, Marrakech, Morocco

    Ali Akhaddar

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Akhaddar, A., Diabira, S. (2019). Intracranial Fungal Aneurysms. In: Turgut, M., Challa, S., Akhaddar, A. (eds) Fungal Infections of the Central Nervous System. Springer, Cham. https://doi.org/10.1007/978-3-030-06088-6_25

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  • DOI: https://doi.org/10.1007/978-3-030-06088-6_25

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