A fungus in a thrombus by mechanical thrombectomy in acute cerebral infarction: a case report

Katano, Takehiro; Sakamoto, Yuki; Κunugi, Shinobu; Nishiyama, Yasuhiro; Shimizu, Akira; Kimura, Kazumi

doi:10.5692/clinicalneurol.cn-001400

Cited by 2 publications

(2 citation statements)

References 11 publications

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“…26 Similarly, the presence of Candida confirmed septic embolus in a case of fungal IE. 136 Observation of fungal hyphae confirmed cases of septic embolus 137 and angioinvasive mucormycosis secondary to sinusitis. 138 Identification of papillary fronds or myxomatous tissue helped diagnose embolization secondary to cardiac papillary fibroelastoma 15,16,20 and myxoma, 29 respectively.…”

Section: Relationship Between Thrombus Features and Stroke Etiologymentioning

confidence: 89%

Clot Composition Analysis as a Diagnostic Tool to Gain Insight into Ischemic Stroke Etiology: A Systematic Review

et al. 2021

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Mechanical thrombectomy renders the occluding clot available for analysis. Insights into thrombus composition could help establish the stroke cause. We aimed to investigate the value of clot composition analysis as a complementary diagnostic tool in determining the etiology of large vessel occlusion (LVO) ischemic strokes (International Prospective Register of Systematic Reviews [PROSPERO] registration # CRD42020199436). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we ran searches on Medline (using the PubMed interface) and Web of Science for studies reporting analyses of thrombi retrieved from LVO stroke patients subjected to mechanical thrombectomy (January 1, 2006 to September 21, 2020). The PubMed search was updated weekly up to February 22, 2021. Reference lists of included studies and relevant reviews were hand-searched. From 1,714 identified studies, 134 eligible studies (97 cohort studies, 31 case reports, and six case series) were included in the qualitative synthesis. Physical, histopathological, biological, and microbiological analyses provided information about the gross appearance, mechanical properties, structure, and composition of the thrombi. There were non-unanimous associations of thrombus size, structure, and composition (mainly proportions of fibrin and blood formed elements) with the Trial of Org 10172 in Acute Stroke Treatment (TOAST) etiology and underlying pathologies, and similarities between cryptogenic thrombi and those of known TOAST etiology. Individual thrombus analysis contributed to the diagnosis, mainly in atypical cases. Although cohort studies report an abundance of quantitative rates of main thrombus components, a definite clot signature for accurate diagnosis of stroke etiology is still lacking. Nevertheless, the qualitative examination of the embolus remains an invaluable tool for diagnosing individual cases, particularly regarding atypical stroke causes.

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Section: Relationship Between Thrombus Features and Stroke Etiologymentioning

confidence: 89%

Clot Composition Analysis as a Diagnostic Tool to Gain Insight into Ischemic Stroke Etiology: A Systematic Review

et al. 2021

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“…To the best of our knowledge, there is only one reported finding of a fungal mass in a thrombus that had been retrieved by thrombectomy. 10 Among several reports of cerebrovascular diseases caused by fungal infections, most of the patients had been administered steroids or immunosuppressive drugs. [11][12][13][14] The present patient was also receiving long-term steroid and immunosuppressive drugs for management of IgG4-related diseases, and we assumed that the patient was immunocompromised.…”

Section: Discussionmentioning

confidence: 99%

Acute large-vessel occlusion due to an infected thrombus formation induced by invasive sphenoid sinus aspergillosis: illustrative case

Matsumoto,

Akamatsu,

Yoshida

et al. 2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND The authors describe a rare case of acute large-vessel occlusion due to an infected thrombus formation that was induced by invasive sphenoid sinus aspergillosis. OBSERVATIONS An 82-year-old man with a history of immunoglobulin G4–related disease and long-term use of steroids and immunosuppressants was admitted to the authors’ hospital with severe right hemiparesis. Cerebral angiography revealed occlusion of the left internal carotid artery (ICA). He underwent thrombectomy, resulting in successful recanalization. However, severe stenosis was evident in the left ICA cavernous segment. Pathological analysis of the retrieved thrombus identified Aspergillus. Postoperative magnetic resonance imaging revealed sinusitis in the left sphenoid sinus as a possible source of the infection. The patient’s general condition deteriorated during the course of hospitalization due to refractory aspiration pneumonia, and he died 46 days after thrombectomy. Pathological autopsy and histopathological investigation of the left ICA and the left sphenoid sinus showed that Aspergillus had invaded the wall of the left ICA from the adjacent sphenoid sinus. These findings indicate a diagnosis of acute large-vessel occlusion due to infected thrombus formation induced by invasive sphenoid sinus aspergillosis. LESSONS Pathological analysis of a retrieved thrombus appears useful for identifying rare stroke etiologies such as fungal infection.

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A fungus in a thrombus by mechanical thrombectomy in acute cerebral infarction: a case report

Cited by 2 publications

References 11 publications

Clot Composition Analysis as a Diagnostic Tool to Gain Insight into Ischemic Stroke Etiology: A Systematic Review

Clot Composition Analysis as a Diagnostic Tool to Gain Insight into Ischemic Stroke Etiology: A Systematic Review

Acute large-vessel occlusion due to an infected thrombus formation induced by invasive sphenoid sinus aspergillosis: illustrative case

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