angioinvasive cerebral aspergillosis presenting with acute ischemic stroke: a case report

Introduction: cerebral invasive aspergillosis is a rare but potentially fatal condition, predominantly affecting immunocompromised individuals. it affects 10% - 15% of patients who have disseminated aspergillosis. the distinctive ability of aspergillus to break down elastin in the vessel wall makes it highly angioinvasive, resulting in a broad range of neurological complications. case presentation: we report the case of a 57-year-old female with poorly controlled diabetes mellitus and hypertension, who presented with right-sided hemiparesis and facial paresis. initial imaging revealed small vessel disease and a midline hyperdensity extending into the paranasal sinuses (pns), prompting further evaluation with magnetic resonance imaging (mri) and paranasal computed tomography (ct), which demonstrated a mass-like lesion in the sphenoidal sinuses and an acute brainstem infarction. the patient's medical history and imaging findings led to the suspicion of an invasive fungal infection, confirmed by biopsy, which revealed aspergillosis. the patient underwent endoscopic surgical debridement to reduce the fungal burden, followed by antifungal therapy. amphotericin b was initially administered, but treatment was later switched to voriconazole, and the patient's neurological condition partially improved after treatment. conclusions: this case highlights the importance of early diagnosis and appropriate management, including antifungal therapy and surgical debridement, to reduce mortality in cerebral aspergillosis. the successful outcome highlights the importance of maintaining a high index of suspicion in immunocompromised patients presenting with neurological symptoms, even in the absence of pulmonary involvement.