[A case of intracerebral epidermoid associated with aspergillosis].

A case of intracerebral epidermoid associated with aspergillosis, which spread from the middle ear to the left temporal lobe, is reported. A 58-year-old woman was admitted on 6 June 1988, complaining of left temporalgia and motor aphasia. She had suffered from lt. chronic otitis media with cholesteatoma and had undergone a radical operation 11 years previously. CT scan revealed low density area with a mass effect in lt. temporal lobe. Bone image coronal CT scan revealed destruction of the roof of the pyramidal bone had resulted in communication between abscess cavity and external auditory meatus. On MRI scan lt. temporal lobe showed low signal intensity on T1WI, and high signal intensity on T2WI. In spite of strong antibiotic chemotherapy, mass effect on CT scan showed no sign of improvement. We performed total removal of the abscess on 15 July 1987. A number of characteristic aspergillus hyphae were recognized in the resected cyst. As the cyst wall consisted of keratinising squamous epithelium intermingled with granulation tissue, we had a diagnosis of epidermoid cyst. The diagnosis of epidermoid associated with aspergillosis was difficult. CT findings of epidermoid in general, show homogeneous low density without enhancement, but, in our case, CT scan showed heterogeneous low density area with capsular high dense. MRI of epidermoid usually shows a low signal intensity on T1WI, but our case showed iso-low signal intensity on T1WI. In spite of a poor prognosis of aspergillosis of the CNS, our patient has recovered well due to receiving prompt surgical treatment.