Rare cause of intracranial hemorrhage…

March 25, 2013

CNS, CT, Head, Non-Trauma


This gentleman presented to the ED with headache that began several days prior.  He has a history of disseminated coccidioidomycosis:

IVH Coccidio 1

Disseminated Coccidioidomycosis  (DC) is rarely associated with intracerebral hemorrhage.  Not something we will see everyday!

Here is a brief discussion from the American Journal of Neuroradiology about two cases of fatal intracerebral hemorrhage from DC:

Coccidiomycosis ICH

Some highlights:

    • Coccidioides immitus resides in the topsoil of the Southwestern United States.  There are 60-80,000 new cases of coccidioidomycosis every year with disseminated disease occuring in less than 1% of the population.
    • Vasculitis may occur and usually causes ischemic CNS events but can lead to hemorrhage as well
    • Two case reports are discussed.  A 74-year-old male on chemotherapy for Waldenstrom’s macroglobinemia who had blood culture positive Coccidioidomycosis and developed signs of aphasia, confusion.  He ended up having a CT showing large parenchymal and subarachnoid hemorrhage  with a distal left middle cerebral artery aneurysm.  Second case was a 33-year-old male with a history of coccidioidal meningitis diagnosed a year earlier.  He came in with worsening headache and MR showed enlarging prepontine lesion with subtle enhancement.  He died suddenly and on autopsy had subarachnoid hemorrhage.  Numerus necrotic spherules of Coccidioides immitis were found in perivascular spaces and his basilar artery had full-thickness granulomatous changes with necrosis through the vascular wall.

Author:  Russell Jones, M.D.

References:

1.  Erly WK, Labadie E, Williams PL, Lee DM, Carmody RF, Seeger JF.  Disseminated Coccidioidomycocsis Complicated by Vasculitis:  A Cause of Fatal Subarachnoid Hemorrhage in Two Cases.  Am J Neuroradiol 20: 1605-1608, October 1999.

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  1. The LITFL Review 100 - LITFL - August 10, 2014

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