A.I. BURNASYAN FMBC CLINICAL BULLETIN

ISSN 2782-6430 (print)

State Research Center −Burnasyan Federal Medical Biophysical
Center of Federal Medical Biological Agency

The journal is published in Russian.
Format – A4.
The periodicity of the journal is 4 times a year.

Issue №3, 2026

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A.I. Burnasyan  FMBC clinical bulletin. 2026 № 3

I.A. Marchenko1, V.V. Borisova2, E.I. Matkevich1, E.A. Dubova1, M.M. Yusupova1, A.A. Sazhina1

The Role of Magnetic Resonance Imaging for Detecting Signs of Invasive Aspergillosis of the Central Nervous System: a Clinical Case

1International Office, State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russiа

2Department of Radiation Diagnostics and Medical Imaging, RUDN University, Moscow,  Moscow, Russia

Contact person: Borisova Valeriya Voler’evna: Valeriya.B2000@yandex.ru

 

Abstract
Introduction: invasive aspergillosis is a sapronous opportunistic mycosis with an aspiration mechanism of transmission of the pathogen, characterized by predominant lung damage, toxic-allergic reactions and severe course of the disease. It occurs more often in people with disorders in the immune system. Damage to the central nervous system is relatively rare, but it is associated with an extremely severe prognosis and high mortality, which makes the description of clinical cases especially relevant.

The purpose of the publication: to characterize the MR manifestations of aspergillosis of the central nervous system using the example of a clinical case and to trace their dynamics against the background of therapy.

Medical history data: a 63-year-old patient complains of dizziness, shakiness, impaired coordination, visual disturbances in the form of blurred vision and distant double vision, hearing loss for 4 – 5 days. He had a history of acute respiratory viral infections (according to the patient, Covid–19), with subsequent neurological manifestations. In this regard, he was hospitalized twice and discharged with a temporary improvement in his condition on the background of ongoing therapy.

Clinical, laboratory, and radiation examination data: during the first day after admission, the patient underwent a comprehensive instrumental examination, including magnetic resonance imaging (MRI) of the brain and spinal cord, computed tomography (CT) of the thoracic, abdominal, and paranasal sinuses. Extensive leptomeningial lesion was revealed at the base of the brain in the area of the major hemispheres, in the area of the anterior sections of the poles of the temporal regions. A Subependymal lesion in the area of the cervical spinal cord at the level of the C1 vertebra. Subsequently, there was an increase in hydrocephalus, PRES syndrome in the convexital sections of the right parietal lobe. The appearance of a pathological accumulation of contrast agent in the course of 7-8 pairs on the left. Pathological foci of accumulation of contrast agent at levels C7, Th1, Th10, L3 of spinal cord. The analysis of cerebrospinal fluid (CSF) determines the positive result of seeding for Aspergillus. According to the results of the molecular genetic analysis of the cerebrospinal fluid, DNA of Aspergillus fumigatus was found. This result serves as a highly specific confirmation of invasive aspergillosis of the central nervous system and, in combination with clinical data and radiation diagnostic parameters, allowed us to establish a definitive diagnosis. Despite the intensive therapy, the patient’s condition continued to deteriorate progressively. Repeated neuroimaging studies demonstrated an increase in the severity of leptomeningial lesions, focal changes in brain matter, and hydrocephalus.

Discussion: magnetic resonance imaging (MRI) is a high-tech diagnostic method that allows obtaining detailed images of brain structures and meninges. Due to its high resolution, MRI provides visualization of the smallest anatomical details, which helps to identify pathological changes in the early stages. To verify the diagnosis of invasive aspergillosis of the central nervous system, it is extremely important to carry out differential diagnosis with other diseases having a similar clinical and neuroimaging picture. In this case, it was of great importance to exclude pathologies such as neurosarcoidosis, Bing–Neal syndrome, metastatic lesions, lymphoproliferative diseases of the central nervous system, as well as autoimmune and infectious meningoencephalitis.

Conclusion: this clinical case demonstrates the importance of timely application of radiation diagnostic methods, primarily magnetic resonance imaging, in case of suspected invasive fungal lesions of the central nervous system. The MRI examination revealed typical signs of aspergillosis – leptomeningial accumulation of contrast agent, subependymal and intramedullary foci, as well as to assess the dynamics of complications, including aresorptive hydrocephalus and PRES syndrome.

Keywords: aspergillosis of the central nervous system, invasive aspergillosis, magnetic resonance imaging, computed tomography

For citation: Marchenko I.A., Borisova V.V., Matkevich E.I., Dubova E.A., Yusupova M.M., Sazhina A.A. The Role of Magnetic Resonance Imaging for Detecting Signs of Invasive Aspergillosis of the Central Nervous System: a Clinical Case. A.I. Burnasyan Federal Medical Biophysical Center Clinical Bulletin. 2026.3:115-128. (In Russian) DOI: 10.33266/2782-6430-2026-3-115-128

 

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Conflict of interest. The authors declare no conflict of interest.
Financing. The study had no sponsorship. 
Contribution. Article was prepared with equal participation of the authors.
Article received: 28.04.2026. Accepted for publication: 16.05.20226

© 2026 Scientific journal - "Clinical Bulletin of the FMBС im. A.I. Burnasyan"
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