Case Report Cerebral Aspergillosis in a Diabetic Patient Leading to Cerebral Artery Occlusion and Ischemic Stroke: A Case Report and Literature Review Wentao Li, BA,* Neelofer Shafi, MD,* Ramayee Periakaruppan, MD,† Tibor Valyi-Nagy, MD, PhD,† John Groth, MD,† and Fernando D. Testai, MD, PhD, FAHA* Cerebral aspergillosis is a rare and highly fatal hematogenous infection most commonly found in immune compromised patients. From the onset of neurologic symptoms, the median reported rate of survival is between 5 and 9 days. Com- pounded with increased hemorrhagic risks and the lack of specificity in both clinical presentation and traditional imaging, a fast and noninvasive method of definitive diagnosis is necessary if there is to be any hope for positive outcomes. We describe the case of a 50-year-old female diabetic with a history of otitis media, an uncharac- terized inflammatory nasopharyngeal process, and prior ischemic strokes who presented with a new cerebral infarction in the setting of an angioinvasive fungal infection of the large cerebral arteries. We also present a literature review of aspergillosis detection and treatment in hopes that future cases will be diagnosed in a timely manner and more patients may be saved. Key Words: Cerebral aspergillosis—stroke—angioinvasive aspergillosis—carotid occlusion. Ó 2015 by National Stroke Association Cerebral aspergillosis (CA) is a relatively rare form of angioinvasive fungal infection most often seen in immune compromised individuals. 1 The angioinvasive nature of Aspergillus greatly increases the risk of intraoperative hemorrhage, rendering biopsy and direct diagnosis risky in many cases. 2 Here, we describe a 50-year-old patient with a new cerebral infarction in the setting of an angioin- vasive fungal infection of the large cerebral arteries and a literature review on contemporary diagnostic and treat- ment approaches. Case Study A 50-year-old female with a past history of diabetes, hypertension, hyperlipidemia, chronic otomastoiditis, recent left ear infection status after tympanic tube place- ment, and progressive hearing loss presented to an outside hospital with headache, mild confusion, and slurred speech. Workup revealed an acute left parieto- occipital ischemic stroke, and the patient was transferred to our institution for higher level of care. On arrival the patient had normal vital signs. The general examination was unrevealing. Neurologically the patient was fully ori- ented with normal attention and concentration and had anisocoria (right pupil: 3 mm; left pupil: 5 mm), left VI cranial neuropathy, right homonymous hemianopsia, and dysarthria. Review of magnetic resonance imaging From the *Department of Neurology, University of Illinois College of Medicine, Chicago; and †Department of Pathology, University of Illinois College of Medicine, Chicago, Illinois. Received May 6, 2014; revision received August 5, 2014; accepted August 25, 2014. This manuscript was not supported or sponsored by any grants or foundations. Address correspondence to Fernando D. Testai, MD, PhD, FAHA, Department of Neurology and Rehabilitation, University of Illinois at Chicago Medical Center, 912 S Wood Street, Rm 855N NPI (MC 796), Chicago, IL 60612-7330. E-mail: testai@uic.edu. 1052-3057/$ - see front matter Ó 2015 by National Stroke Association http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2014.08.025 Journal of Stroke and Cerebrovascular Diseases, Vol. 24, No. 1 (January), 2015: pp e39-e43 e39