Invasive aspergillosis and thrombosis of carotid artery.

Acta Neurologica Taiwanica Vol 15 No 1 March 2006 From the Department of Neurology, Taipei Municipal Wan Fang Hospital, Taipei Medical University; Taiwan Miners General Hospital Consulting Neurologist. Received June 8, 2005. Revised July 8, 2005. Accepted August 5, 2005. Reprint requests and correspondence to: Chin-I Chen, MD. Department of Neurology, Taipei Municipal Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, XingLong Road, Taipei, Taiwan. E-mail: [email protected] A 67-years-old woman with diabetes mellitus was admitted because of having difficulty in opening her left eye for two days following a left frontal pain of two months duration. Neurological examination revealed a left trochlear nerve palsy and a left oculomotor nerve palsy with preserved light reflex. Tendon reflexes in the limbs were equally depressed. All sensation was impaired in a stocking and glove fashion. Magnetic resonance images (MRI) of the brain with gadolinium showed a mass lesion in the left sphenoid sinus (Figs. 1A-B), and two brain abscesses in the left medial temporal and right temporal-occipital regions (Fig. 1C). The mass was removed surgically and pathological examination revealed clumps of aspergillus with septated hyphae and focal purulent exudate. Cerebrospinal fluid analysis was unremarkable. The patient received a 2-month course of combined intravenous amphotericin-B and oral itraconazole. Oral itraconazole alone was continued for 10 more months. The functions of left oculomotor and trochlear nerve recovered after above treatment. Two months after admission, slight right hemiparesis was observed. MRI of the brain showed thrombotic change of the siphon portion of the left internal carotid artery (ICA) (Figs. 2A-B) along with a low-flow infarcInvasive Aspergillosis and Thrombosis of Carotid Artery