Lethal subarachnoid bleeding under immunosuppressive therapy due to mycotic arteritis.

A subarachnoid haemorrhage (SAH) occurred 67 days after cardiac transplantation in a 10-year-old girl with consecutive immunocompromising therapy. Neither digital subtraction angiography (DSA) nor computed tomographic angiography showed signs of intracranial vascular malformations. One month before the lethal SAH occurred, she had developed arterial hypertension and attacks of severe headache with cerebrospinal fluid (CSF) pleocytosis while CT scans showed an infarct of the left thalamus. Pathologic findings established the rare diagnosis of SAH due to aspergillosis-related mycotic arteritis. Imaging characteristics are presented.

Middle cerebral artery aneurysm due to Nocardia asteroides: case report of aneurysm excision and extracranial-intracranial bypass.

Nocardia asteroides is an uncommon human pathogen typically encountered in immunocompromised patients. Primary central nervous system (CNS) nocardiosis is rare and usually manifests as cerebritis or abscesses. The case of a young woman who presented with CNS Nocardia abscesses complicated by an infective middle cerebral artery aneurysm is reported. Treatment, which included abscess aspiration, aneurysm excision, and end-to-end extracranial to intracranial bypass and prolonged antibiotic therapy, resulted in an excellent outcome. This case and the management of CNS nocardiosis are reviewed.

Cerebral granulomatous angiitis associated with isolation of human T-lymphotropic virus type III from the central nervous system.

A 42-year-old homosexual man without evidence of immune deficiency developed cerebral granulomatous angiitis in association with the isolation of human T-lymphotropic virus type III (HTLV-III) from brain tissue and cerebrospinal fluid. This syndrome may be an additional neurological sequela of HTLV-III infection.

Mycoplasma-like structures in granulomatous angiitis of the central nervous system. Case reports with light and electron microscopic studies.

Two patients had granulomatous angiitis of the central nervous system. The typical vasculitis involved the small branches of the cerebral arteries in both patients and resulted in thrombosis of the left middle cerebral artery in one. Electron microscopy demonstrated structures resembling Mycoplasma organisms. These were present in small numbers in the wall and in the granulomatous reaction within the lumen. Giant cells were observed cintaining particles suggestive of Mycoplasma within the perinuclear cisternae. Virus-like particles were not observed.

Acute hemiphegia of childhood associated with Coxsackie A9 viral infection.

A 16-mo-old girl is described with acute hemiplegia associated with virologic and serologic evidence of Coxsackie A9 infection. Possibilities of pathogenesis are discussed. It is suggested that the present hemiplegia may have been the result of a focal vasculitis due to Coxsachie A9 viral infection in the region of the middle cerebral artery.