Imaging Findings of Fungal Infections of the Cranial and Peripheral Nerves

  • Ahmet T. Turgut
  • Elif Başbay Gündoğdu
  • Can Başaloğlu
  • Mehmet Turgut


Infectious diseases of the central nervous system (CNS) are still important causes of morbidity and mortality in spite of the presence of significant progress in the prevention and treatment in recent years. Fungal pathogens rarely affect the CNS. Development of fungal infections depends on host’s immune status and fungal virulence factors. Immunocompetent individuals are usually resistant to fungal infections. These infections are particularly seen in immunocompromised persons. Microbiologically, fungal infections are caused by yeasts, molds, and dimorphic fungi in immunocompromised hosts. The most common fungal infection is cryptococcal meningitis, although the most common nosocomial infection is candidiasis. In immunocompromised patients, invasive aspergillosis and mucormycosis are associated with high morbidity and mortality. Infections due to fungal pathogens frequently present with a variety of neuroimaging features in neuroradiological techniques such as magnetic resonance imaging. In this chapter, we will review radiological characteristics of fungal diseases involving the CNS, according to morphologic features of fungal pathogens.


Antifungal agents Aspergillosis Blastomycosis Candidiasis Central nervous system Coccidioidomycosis Cryptococcal meningitis Fungal infections Histoplasmosis Zygomycosis 



Acquired immunodeficiency syndrome


Central nervous system


Cerebrospinal fluid


Diffusion weighted imaging


Human immunodeficiency virus


Magnetic resonance imaging


  1. Almutairi BM, Nguyen TB, Jansen GH, Asseri AH. Invasive aspergillosis of the brain: radiologic-pathologic correlation. Radiographics. 2009;29:375–9.CrossRefGoogle Scholar
  2. Ashdown BC, Tien RD, Felsberg GJ. Aspergillosis of the brain and paranasal sinuses in immunocompromised patients: CT and MR imaging findings. AJR Am J Roentgenol. 1994;162:155–9.CrossRefGoogle Scholar
  3. Bakshi SS. An unusual cause for facial nerve palsy: mucormycosis. Int J Diabetes Dev Ctries. 2016;36:385–8.CrossRefGoogle Scholar
  4. Berkefeld J, Enzensberger W, Lanfermann H. Cryptococcus meningoencephalitis in AIDS: parenchymal and meningeal forms. Neuroradiology. 1999;41:129–33.CrossRefGoogle Scholar
  5. Bhatia A, Pruthi S. Imaging of pediatric infection within the central nervous system. Curr Radiol Reports. 2016;4:1–11.CrossRefGoogle Scholar
  6. Borges A. Trigeminal neuralgia and facial nerve paralysis. Eur Radiol. 2005;15:511–33.CrossRefGoogle Scholar
  7. Chakrabarti A. Epidemiology of central nervous system mycoses. Neurol India. 2007;55:191–7.CrossRefGoogle Scholar
  8. Dhirawani R, Asrani S, Pathak S, Sharma A. Facial translocation approach for management of invasive sinonasal aspergillosis. J Maxillofac Oral Surg. 2015;14:482–7.CrossRefGoogle Scholar
  9. Erly WK, Bellon RJ, Seeger JF, Carmody RF. MR imaging of acute coccidioidal meningitis. AJNR Am J Neuroradiol. 1999a;20:509–14.PubMedGoogle Scholar
  10. Fockaert N, D’Hooghe L, Casselman J, Dycke AV. Sixth cranial nerve palsy in isolated sphenoid sinusitis: a case report. Acta Neurol Belg. 2014;114:335–7.CrossRefGoogle Scholar
  11. Galgiani JN, Ampel NM, Blair JE. Coccidioidomycosis. Clin Infect Dis. 2005;41:1217–23.CrossRefGoogle Scholar
  12. George R, Andronikou S, Plessis J, Plessis A, Toorn RV, Maydell A. Central nervous system manifestations of HIV infection in children. Pediatr Radiol. 2009;39:575–85.CrossRefGoogle Scholar
  13. Hassler A, Porto L, Lehrnbecher T. Cerebral fungal infection in pediatric cancer patients. Curr Fungal Infect Rep. 2015;9:6–14.CrossRefGoogle Scholar
  14. Hirschmann JV. The early history of coccidioidomycosis: 1892-1945. Clin Infect Dis. 2007;44:1202–7.CrossRefGoogle Scholar
  15. Hughes AD, Lorusso GD, Greer DL. Cost-effective method for identification of dimorphic fungi. J Clin Microbiol. 2004;42:4408–9.CrossRefGoogle Scholar
  16. Hurst RW, Judkins A, Bolger W, Chu A, Loevner LA. Mycotic aneurysm and cerebral infarction resulting from fungal sinusitis: imaging and pathologic correlation. AJNR Am J Neuroradiol. 2001;22:858–63.PubMedGoogle Scholar
  17. Igel HJ, Bolande RP. Humoral defense mechanisms in cryptococcosis: substances in normal human serum, saliva, and cerebrospinal fluid affecting the growth of Cryptococcus neoformans. J Infect Dis. 1966;116:75–83.CrossRefGoogle Scholar
  18. Jiang N, Zhao G, Yang S, Lin J, Hu L, Che C, Wang Q, Xu Q. A retrospective analysis of eleven cases of invasive rhino-orbito-cerebral mucormycosis presented with orbital apex syndrome initially. BMC Ophthalmol. 2016;16:10. Scholar
  19. Khandelwal N, Gupta V, Singh P. Central nervous system fungal infections in tropics. Neuroimaging Clin N Am. 2011;21:859–66.CrossRefGoogle Scholar
  20. Kovoor JM, Mahadevan A, Narayan JP, Govindappa SS, Satishchandra P, Taly AV, Shankar SK. Cryptococcal choroid plexitis as a mass lesion: MR imaging and histopathologic correlation. AJNR Am J Neuroradiol. 2002;23:273–6.PubMedGoogle Scholar
  21. Lai PH, Lin SM, Pan HB, Yang CF. Disseminated miliary cerebral candidiasis. AJNR Am J Neuroradiol. 1997;18:1303–6.PubMedGoogle Scholar
  22. Liyanage DS, Pathberiya LPS, Gooneratne IK, Caldera MHPC, Perera PWS. Cryptococcal meningitis presenting with bilateral complete ophthalmoplegia: a case report. BMC Res Notes. 2014;7:328.CrossRefGoogle Scholar
  23. Luthra G, Parihar A, Nath K, Jaiswal S, Prasad KN, Husain N, Husain M, Singh S, Behari S, Gupta RK. Comparative evaluation of fungal, tubercular, and pyogenic brain abscesses with conventional and diffusion MR imaging and proton MR spectroscopy. AJNR Am J Neuroradiol. 2007;28:1332–8.CrossRefGoogle Scholar
  24. Maschio M, Mengarelli A, Girmenia C, Vidiri A, Kayal R, Gallo MT, Prignano G, Dessanti ML, D’Andrea M, Petti MC. Trigeminal neuralgia as unusual isolated symptom of fungal paranasal sinusitis in patients with haematological malignancies. Neurol Sci. 2012;33:647–52.CrossRefGoogle Scholar
  25. Mathur M, Johnson CE, Sze G. Fungal infections of the central nervous system. Neuroimaging Clin N Am. 2012;22:609–32.CrossRefGoogle Scholar
  26. McLean FM, Ginsberg LE, Stanton CA. Perineural spread of rhinocerebral mucormycosis. AJNR Am J Neuroradiol. 1996;17:114–6.PubMedGoogle Scholar
  27. Murthy JM. Fungal infections of the central nervous system: the clinical syndromes. Neurol India. 2007;55:221–5.CrossRefGoogle Scholar
  28. Murthy JM, Sundaram C. Fungal infections of the central nervous system. Handb Clin Neurol. 2014;121:1383–401.CrossRefGoogle Scholar
  29. Negoro E, Morinaga K, Taga M, Kaizaki Y, Kawai Y. Mycotic aneurysm due to Aspergillus sinusitis. Int J Hematol. 2013;98:4–5.CrossRefGoogle Scholar
  30. Ridder GJ, Breunig C, Kaminsky J, Pfeiffer J. Central skull base osteomyelitis: new insights and implications for diagnosis and treatment. Eur Arch Otorhinolaryngol. 2015;272:1269–76.CrossRefGoogle Scholar
  31. Scully EP, Baden LR, Katz JT. Fungal brain infections. Curr Opin Neurol. 2008;21:347–52.CrossRefGoogle Scholar
  32. Shankar SK, Mahadevan A, Sundaram C, Sarkar C, Chacko G, Lanjewar DN, Santosh V, Yasha TC, Radhakrishnan VV. Pathobiology of fungal infections of the central nervous system with special reference to the Indian scenario. Neurol India. 2007;55:198–215.CrossRefGoogle Scholar
  33. Shih RY, Koeller KK. Bacterial, fungal, and parasitic infections of the central nervous system: radiologic-Pathologic correlation and historical perspectives. Radiographics. 2015;35:1141–69.CrossRefGoogle Scholar
  34. Starkey J, Moritani T, Kirby P. MRI of CNS fungal infections: review of Aspergillosis to Histoplasmosis and everything in between. Clin Neuroradiol. 2014;24:217–30.CrossRefGoogle Scholar
  35. Suchitha S, Sheeladevi CS, Sunila R, Manjunath GV. Disseminated cryptococcosis in an immunocompetent patient: a case report. Case Rep Pathol. 2012;2012:652351.PubMedPubMedCentralGoogle Scholar
  36. Tyc KM, Kühn C, Wilson D, Klipp E. Assessing the advantage of morphological changes in Candida albicans: a game theoretical study. Front Microbiol. 2014;5:41.PubMedPubMedCentralGoogle Scholar
  37. Zalduondo FM, Provenzale JM, Hulette C, Gorecki JP. Meningitis, vasculitis, and cerebritis caused by CNS histoplasmosis: radiologic-pathologic correlation. AJR Am J Roentgenol. 1996;166:194–6.CrossRefGoogle Scholar
  38. Zhong Y, Zhou Z, Fang X, Peng F, Zhang W. Magnetic resonance imaging study of cryptococcal neuroradiological lesions in HIV-negative cryptococcal meningitis. Eur J Clin Microbiol Infect Dis. 2017;36:1367–72.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ahmet T. Turgut
    • 1
  • Elif Başbay Gündoğdu
    • 2
  • Can Başaloğlu
    • 3
  • Mehmet Turgut
    • 4
  1. 1.Department of RadiologyIstinye University Faculty of MedicineİstanbulTurkey
  2. 2.Department of RadiologyOsmangazi UniversityEskişehirTurkey
  3. 3.Department of Radiologyİzmir Dr. Suat Eren Chest Diseases and Surgery Training and Research HospitalİzmirTurkey
  4. 4.Department of NeurosurgeryAydın Adnan Menderes University School of MedicineAydınTurkey

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