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58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

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Isolated leptomeningeal spreading of cerebral aspergillosis

Leptomeningeale Manifestation zerebraler Aspergillosen

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  • corresponding author F. Albers - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg
  • O. Wittkugel - Abteilung für Neuroradiologie, Universitätsklinikum Hamburg
  • M. Westphal - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg
  • P. Horn - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocP 102

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2007/07dgnc357.shtml

Published: April 11, 2007

© 2007 Albers et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Cerebral aspergillosis (CA) that is almost exclusively acquired in immune compromised patients, typically presents as multiple contrast ring-enhancing lesions in MR imaging. A rarely observed alternative presentation of CA is isolated leptomenigeal (LM) dissemination.

Methods: Three cases with diffuse LM contrast-enhancing lesions of unknown origin underwent an extensive diagnostic workup, including various MR imaging modalities, serological workup of blood samples and CSF, and finally open biopsy.

Results: Case 1: A 71-year-old male presented with a 17 month history of visual disturbances. MRI showed diffuse LM contrast enhancing frontobasal lesions including the basal cisterns. Serological studies were normal, while open biopsy revealed fungeous infection.

Case 2: A 33-year-old female suffered from focal seizures and visual disturbances over several months. MRI showed diffuse LM contrast enhancing frontobasal lesions including the basal cisterns and paranasal sinus. Serological studies were normal, finally open biopsy (6 months after presentation) revealed A. fumigatus infection treated successfully with antimycotic therapy.

Case 3: A 4-year-old boy presenting with focal seizures and transient left sided hemiparesis during a period of 15 months underwent MRI. Imaging showed multiple LM contrast enhancing lesions and a right temporal cystic lesion. Final diagnosis was obtained by means of biopsy of the cystic lesion 6 months after initial presentation.

Conclusions: CA must be considered in the differential diagnosis of diffuse LM lesions, especially in the frontobasal regions and within the basal cisterns in immune compromised patients.