Striated Enhancement Sign in Invasive Cerebral Fungal Granuloma by Aspergillus: a Case Report

Abstract

A 21-year-old man came to us from the local hospital with intermittent headache and vomiting lasting for 10 days. The patient did have no fever and immunocompromised history. Clinical examination showed that the patient suffered from superficial coma, disappearment of light reflex of the left eye, and the weakness of the right extremity. MR imaging of the brain was performed to determine the cause of headache and vomitting. Chest computed tomography (CT) was performed to check for the lung disorder. The chest CT examination was normal. MR images showed a mass lesion in the left frontal lobe involved corpus callosum and left basal ganglia region. The lesion showed slight hyperintensity on T2-weighted imaging and slight hypointensity on T1-weighted imaging, and patchy hyperintensity on diffusion weighted imaging (Fig. 1). After contrast administration, the lesion showed striated enhancement sign (radiating linear enhancement) (Fig. 2). The white blood cell count in peripheral blood was 9.67×10/L, and that in cerebrospinal fluid was negative. The patient underwent a brain operation, and the hyphae of aspergillus were observed on the pathological section (Fig. 3).