Rapidly progressive intracranial infection consistent with aspergillosis, mimicking acute ischemic stroke.

Intracranial aspergillosis is a rare but highly fatal opportunistic infection that predominantly affects immunocompromised patients and frequently presents with nonspecific neurologic symptoms. Radiologic findings may closely resemble acute ischemic stroke, leading to diagnostic delay in the emergency department. We report a case of rapidly progressive intracranial aspergillosis in a neutropenic patient who presented with acute neurologic deterioration. Diffusion-weighted magnetic resonance imaging demonstrated multifocal cortical and subcortical diffusion restriction with leptomeningeal involvement. Despite early recognition and initiation of antifungal therapy, the patient experienced rapid clinical decline and died shortly after admission. This case highlights the importance of considering invasive fungal infections in immunocompromised patients presenting with stroke-like imaging findings.