PMC7495157_01
One month before admission: imaging included CT (a), T1-(b), and T2-weighted (c) images, fluid attenuated inversion recovery images (d), and MRA (e).
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There was no abnormality in the fundus, and computed tomography (CT) of the head revealed no abnormal findings, except sinusitis on the right side (Figure 1(a)). On brain magnetic resonance imaging (MRI), mass lesions in the right maxillary sinus were seen with a high signal intensity on T1-weighted images and with a low signal intensity on T2-weighted and fluid-attenuated inversion recovery images (Figures 1(b)-1(d)). No aneurysm was found on magnetic resonance angiography (MRA) (Figure 1(e)).
On admission: brain MRI showing no abnormalities in the cerebraand parenchyma on T2-weighted images (a). MRI shows a 3 mm aneurysm in the siphon of the internal carotid (arrow head) (b).
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Brain MRI showed no abnormalities in the cerebral parenchyma (Figure 2(a)). An aneurysm (3 mm diameter) was found in the siphon of the right internal carotid artery on MRA (Figure 2(b)).
Day 6: head CT showing a subarachnoid hemorrhage (a), (b). Day 8: brain MRI showing a right middle cerebral artery infarction on DWI (c) and MRI showing right internal carotid artery occlusion (d).
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Repeated head CT revealed a subarachnoid hemorrhage, likely due to the rupture of the aneurysm in the right internal carotid artery (Figures 3(a) and 3(b)). Brain MRI revealed a cerebral infarction in the middle cerebral artery territory and right internal carotid artery occlusion (Figures 3(c) and 3(d)).
Sinus mucosal biopsy hematoxylin and eosin staining (magnification 400). CT: compound tomography, MRA: magnetic resonance angiography, MRI: magnetic resonance imaging, DWI: diffusion weighted imaging.
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Pathological examination of this mass showed numerous spores and mycelium with septae (Figure 4).