Frontal intra-axial mass lesion in an adult

Abstract

Invasive aspergillosis has been reported increasingly following intensive chemotherapy, or immunosuppressive therapy for solid organ or bone marrow transplantation. However, invasive aspergillosis of the cerebrum in an immunocompetent patient is unusual. Cerebral aspergillosis was previously almost uniformly fatal, but development of new antifungal therapies, including voriconazole, have resulted in effective treatment, with markedly improved survival rates of up to 30%. Survival may be higher in immunocompetent patients. Consequently, early and accurate diagnosis of this infection, with initiation of antifungal agents prior to surgery, has become essential for the management of affected patients. Although evidence of co-existing extracranial infection may facilitate the diagnosis in many patients, its presence is not the rule. The most common neuroimaging pattern in patients with cerebral aspergillosis includes ring enhancement on MRI, central hyperintensity with reduced apparent diffusion coefficient values consistent with restricted diffusion as described recently, and enhancing soft-tissue abnormalities of the adjacent paranasal sinuses or orbit. However, the enhancement pattern may vary markedly depending on the immune status of the host and stage