FATAL HEMORRHAGE FROM RUPTURE OF THE INTRACRANIAL INTERNAL CAROTID-ARTERY CAUSED BY ASPERGILLUS ARTERITIS

To the best of our knowledge, this is the first reported case of combi ned intracranial and extracranial hemorrhage due to aspergillus cerebr al arteritis. Knowledge of the imaging and the importance of early dia gnosis and treatment ale emphasized. A 78 year old man develop ed prog ressive right-sided visual impairment and diplopia. Magnetic resonance imaging demonstrated a mass lesion located in the right orbital apex, with extension to the cavernous sinus and the right middle cranial fo ssa. Cerebral angiography showed no aneurysmal dilatation. He was sche duled for transnasal biopsy. However, the patient died of massive epis taxis and intracranial hemorrhage. Postmortem examination revealed an aspergillus granuloma of the orbit and the skull base involving the in tracranial and extracranial internal carotid artery. Aspergillus fumig atus was identified by culture. The characteristic feature of the fung al infection is a low-intensity signal on T2-weighted magnetic resonan ce images. This finding may be useful in diagnosing fungal infection.