著者

中村 克己 粟 博志 朝倉 哲彦

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.23, no.3, pp.239-244, 1983 (Released:2006-11-10)

参考文献数

41

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This 66-year-old farmer had a one year history of headache and visual disturbance. On admission, he was severely emaciated and blood examination showed leukocytosis. Precontrast CT showed a low density area in the right frontal lobe. Postcontrast CT demonstrated a high density area in the right frontal base and a multilobular ring-like enhancement in the right frontal lobe. The lesion was diagnosed as brain abscess and was treated by antibiotics. The patient's general condition, however, became worse and signs of cerebral herniation appeared. A large right fronto-temporal decompressive craniotomy was done and the pus in the cavity was aspirated with a needle through the dura. The pus was cultured in Sabouraud's dextrose agar and Aspergillus was identified. Amphotericin B was administered, but the patient expired on the 12th day after operation. Autopsy revealed a fistula formation between the sphenoidal sinus and the frontal base, and the sphenoidal sinus was filled with pus. A large brain abscess with multiple cavities existed in the right frontal lobe, and from it numerous Aspergillus were microscopically recognized. Aspergillus was not found in other organs including the lungs. It was assumed that the primary lesion of aspergillosis was in the sphenoidal sinus which then invaded the frontal base via the fistula to form a multilobular abscess in the frontal lobe.