APRIL 2012
48-year-old woman with right frontal headache and decreased vision right eye for nearly six months. Recent onset of right VIth nerve palsy and right hemiparesis for 4 weeks.
Atypical CNS Aspergillosis
- Atypical CNS aspergillosis occurs uncommonly in the immunocompetent patient population.
- Clinical presentation: worsening sinusitis with headaches.
- Key Diagnostic Features: Opacified sinuses are commonly seen. Often there is hyperdensity seen within the involved sinsuses. Sclerosis of the sinus walls is suggestive of chronic sinusitis but is not always seen. Associated extra-axial mass lesion extending into the middle and/or anterior cranial fossa is commonly seen. On MR the mass lesion and the opacified sinuses appear markedly hypointense on T2WI. Homogenous enhancement is seen following contrast administration. Extension into the cavernous sinus, orbit, and Meckel's cave is common.
- DDx: lymphoma, leukemia, meningioma, pseudotumor
- Rx: High mortality rate is usually associated with atypical CNS aspergillosis. Early diagnosis and prompt Rx with antifungals is helpful. Surgery can be contemplated.
