Invasive Orbital Apex Aspergillosis with Mycotic Aneurysm Formation and Subarachnoid Hemorrhage in Immunocompetent Patients

World Neurosurg. 2017 Jun;102:42-48. doi: 10.1016/j.wneu.2017.02.096. Epub 2017 Feb 27.


Background: Invasive orbital apex aspergillosis (IOAA) is an aggressive form of aspergillus infection that usually affects immunocompromised patients. It can cause orbital apex syndrome and, if not treated promptly, may progress rapidly causing fatal complications. Subarachnoid hemorrhage (SAH) secondary to ruptured mycotic aneurysms is a very rare complication of invasive aspergillosis. We aim to describe our management and the outcome of six immunocompetent patients with IOAA with subsequent SAH secondary to ruptured mycotic aneurysms.

Patients and methods: A retrospective review was undertaken of charts of patients treated for orbital involvement with aspergillosis between January 2003 and December 2015 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. We identified all immunocompetent patients with IOAA who developed vascular complications.

Results: Six immunocompetent patients with IOAA complicated by SAH secondary to ruptured mycotic aneurysms were identified in the study period. Four patients were female, and patients' age ranged between 14 and 53 years (mean, 33.7 ± 13.4 years). All patients presented with progressive retro-orbital headache, visual impairment, and ophthalmoplegia; four had proptosis. Two patients had vasospasm and brain infarction. Antifungal therapy was used in all patients, and 4 underwent emergency craniotomy and clipping of an aneurysm. Five patients died as a consequence of SAH and infarction.

Conclusions: IOAA is a serious disease that commonly causes catastrophic and fatal vascular complications.

Keywords: Aspergillosis; Cerebral infarction; Fungal infections; Orbital apex syndrome; Subarachnoid hemorrhages.

MeSH terms

  • Adolescent
  • Adult
  • Aneurysm, Ruptured / complications*
  • Aneurysm, Ruptured / diagnostic imaging
  • Aspergillosis / complications*
  • Aspergillosis / diagnostic imaging
  • Female
  • Humans
  • Immunocompromised Host*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Orbital Diseases / complications*
  • Retrospective Studies
  • Subarachnoid Hemorrhage / complications*
  • Subarachnoid Hemorrhage / diagnostic imaging
  • Tomography Scanners, X-Ray Computed
  • Young Adult