Aspergillus is a saprophytic, opportunistic fungus that can infect humans, especially immunocompromised hosts [1]. The primary portal of entry for aspergillus is the respiratory tract. From there, it secondarily infects the brain via hematogenous spread. In some cases, it can also result from penetrating trauma or extension of infection from the mastoid air sinuses [2].
CNS aspergillosis should be considered in patients presenting with the acute onset of focal neurologic deficits, especially in immunocompromised hosts. The most frequent symptoms are headache, vomiting, convulsion, hemiparesis, fever, cranial nerve deficits, paralysis and sensory impairment of varying degrees. Since aspergillus can form mycotic aneurysms, it can lead to subarachnoid hemorrhage and meningeal signs. The propensity of the fungus to invade blood vessels may lead to extensive necrosis or intracranial bleeding [3].
The MRI in CNS aspergillosis typically shows infarction or abscesses in multiple brain areas, including the basal ganglia and thalami [4]. Although the mortality rate in CNS aspergillosis approaches 95% [5], recent reports suggest that early initiation of antifungal therapy with neurosurgical intervention can improve outcomes [6].