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Intracranial Fungal Aneurysms

  • Ali Akhaddar
  • Sylma Diabira
Chapter

Abstract

Intracranial fungal aneurysm (IFA) is a true “mycotic aneurysm” which occurs through mycotic infection of the intracranial arterial wall. This disease is among the most serious complications of central nervous system fungal infections with a high morbidity and mortality rate. Aspergillus species, Candida albicans, and Mucor species are the three most common pathogens involved. Clinical presentations cannot be categorized as being typical and may vary widely. However, the most common signs and symptoms of IFA are those related to aneurysm bleeding and their causative origin. Digital subtraction angiography continues to be the gold standard for the diagnosis, although computed tomography angiography and magnetic resonance angiography can be used. Classically, IFAs are larger than bacterial ones and located in major cerebral artery trunks. Treatment is based on administration of antifungal agents in combination with surgical or endovascular procedures according to the character and position of the aneurysm and the clinical condition of the patient. Compared to bacterial intracranial aneurysms, fungal ones lead to a poor outcome because of a mixture of difficulty in making a correct diagnosis, poor favorable response to antifungal drugs, proximal site of the aneurysms, adjacent artery thrombosis, immunocompromised status, serious medical comorbidities, and often a friable arterial wall.

Keywords

Aspergillosis Cerebrovascular complications Fungal aneurysm Intracranial infectious aneurysm Mycotic aneurysm Stroke Subarachnoid hemorrhage 

Abbreviations

CNS

Central nervous system

CSF

Cerebrospinal fluid

CT

Computed tomography

ICA

Internal carotid artery

IFA

Intracranial fungal aneurysm

IIA

Intracranial infectious aneurysm

MR

Magnetic resonance

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ali Akhaddar
    • 1
  • Sylma Diabira
    • 1
    • 2
  1. 1.Department of Neurosurgery, Avicenne Military Hospital of MarrakechMohammed V University of RabatRabatMorocco
  2. 2.Spine Surgery UnitPrivate Hospital of Saint-GrégoireRennesFrance

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