Superior Sagittal Sinus Thrombosis Secondary to Cerebral Aspergillosis with Ventriculitis in an Immunocompetent Patient: A Case Report

Abstract

Cerebral aspergillosis is an opportunistic fungal infection that is exceedingly rare in immunocompetent patients. The primary etiological locations for these infections typically involve the nasal cavity and hematological dissemination. A 62-year-old male, focused on wellness, presented with intermittent, nonprogressive headaches in the occipital region, generalized clonic–tonic seizures, and altered consciousness. A computed tomography scan revealed multiple small rim-enhancing lesions in both occipital lobes, with vasogenic edema in both occipital lobes adjacent to the confluence of the sinuses and the posterior superior sagittal sinus. In this case, superior sagittal sinus thrombosis secondary to cerebral aspergillosis was discovered, a condition not previously diagnosed in this specific location but manageable through surgical intervention. A combination of surgical resection and antifungal therapy resulted in favorable outcomes. The prognosis for patients depends significantly on early diagnosis and prompt, aggressive treatment.

Keywords

superior sagittal sinus thrombosis - venous sinus thrombosis - cerebral aspergillosis - brain abscess - aspergillosis

Publikationsverlauf

Artikel online veröffentlicht:
10. Oktober 2024

• References

• 1 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 (04) 1186-1189
• 2 Bokhari R, Baeesa S, Al-Maghrabi J, Madani T. Isolated cerebral aspergillosis in immunocompetent patients. World Neurosurg 2014; 82 (1-2): e325-e333
• 3 Spapen H, Spapen J, Taccone FS. et al; AspICU Study Investigators. Cerebral aspergillosis in adult critically ill patients: a descriptive report of 10 patients from the AspICU cohort. Int J Antimicrob Agents 2014; 43 (02) 165-169
• 4 Taccone FS, Van den Abeele AM, Bulpa P. et al; AspICU Study Investigators. Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes. Crit Care 2015; 19 (01) 7
• 5 Taccone FS, Van den Abeele AM, Bulpa P. et al; AspICU Study Investigators. Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes. Crit Care 2015; 19 (01) 7
• 6 Antinori S, Corbellino M, Meroni L. et al. Aspergillus meningitis: a rare clinical manifestation of central nervous system aspergillosis. Case report and review of 92 cases. J Infect 2013; 66 (03) 218-238
• 7 Miceli MH. Central nervous system infections due to Aspergillus and other hyaline molds. J Fungi (Basel) 2019; 5 (03) 79
• 8 Endo T, Numagami Y, Jokura H, Ikeda H, Shirane R, Yoshimoto T. Aspergillus parasellar abscess mimicking radiation-induced neuropathy. Case report. Surg Neurol 2001; 56 (03) 195-200
• 9 Bodey G, Bueltmann B, Duguid W. et al. Fungal infections in cancer patients: an international autopsy survey. Eur J Clin Microbiol Infect Dis 1992; 11 (02) 99-109
• 10 Stevens DA, Kan VL, Judson MA. et al; Infectious Diseases Society of America. Practice guidelines for diseases caused by Aspergillus. Clin Infect Dis 2000; 30 (04) 696-709
• 11 Zmeili OS, Soubani AO. Pulmonary aspergillosis: a clinical update. QJM 2007; 100 (06) 317-334
• 12 Dotis J, Roilides E. Immunopathogenesis of central nervous system fungal infections. Neurol India 2007; 55 (03) 216-220
• 13 Murthy JM, Sundaram C, Prasad VS, Purohit AK, Rammurti S, Laxmi V. Sinocranial aspergillosis: a form of central nervous system aspergillosis in south India. Mycoses 2001; 44 (05) 141-145
• 14 Shankar SK, Mahadevan A, Sundaram C. et al. Pathobiology of fungal infections of the central nervous system with special reference to the Indian scenario. Neurol India 2007; 55 (03) 198-215
• 15 Brenet E, Boulagnon-Rombi C, N'guyen Y, Litré CF. Cavernous sinus thrombosis secondary to aspergillus granuloma: a case report and review of the literature. Auris Nasus Larynx 2016; 43 (05) 566-569
• 16 Huang Y, Gui L. Cavernous sinus-orbital apex aspergillus infection in a diabetic patient: a case report. Medicine (Baltimore) 2019; 98 (13) e15041
• 17 Rajagopala S, Chandrasekharan S, Kumar S, Rela M. Fulminant Aspergillus related cavernous sinus thrombosis in an immunocompetent intensive care unit patient. Austin Crit Care J. 2014; 1 (01) 1-3
• 18 Sekhar LN, Dujovny M, Rao GR. Carotid-cavernous sinus thrombosis caused by Aspergillus fumigatus. Case report. J Neurosurg 1980; 52 (01) 120-125
• 19 Boutarbouch M, Arkha YA, El Ouahabi A, Derraz A, El khamlichi A. . Sphenoid aspergillosis simulating pituitary tumor in immunocompetent patient. J Clin Neurosci 2009; 16 (06) 840-841
• 20 Panda NK, Saravanan K, Chakrabarti A. Combination antifungal therapy for invasive aspergillosis: can it replace high-risk surgery at the skull base?. Am J Otolaryngol 2008; 29 (01) 24-30
• 21 Siddiqui AA, Shah AA, Bashir SH. Craniocerebral aspergillosis of sinonasal origin in immunocompetent patients: clinical spectrum and outcome in 25 cases. Neurosurgery 2004; 55 (03) 602-611 , discussion 611–613
• 22 Schwartz S, Ruhnke M, Ribaud P. et al. Improved outcome in central nervous system aspergillosis, using voriconazole treatment. Blood 2005; 106 (08) 2641-2645
• 23 Jacob MS, Gunasekaran K, Miraclin AT. et al. Clinical profile and outcome of patients with cerebral venous thrombosis secondary to bacterial infections. Ann Indian Acad Neurol 2020; 23 (04) 477-481