A variant of this may be seen when patients develop bronchial obstruction due to a fungal mass in the bronchi. The central nervous system is the site next most commonly infected by aspergillosis, occurring in about 10 to 15 percent of reported cases. Patients present with symptoms and signs of a mass lesion, or with features of a stroke because of the invasion of blood vessels. Thus, seizures, hemiparesis, and focal abnormalities are common. Bony invasion is common and, since the disease may have spread from involved sinuses, the sinuses may be abnormal.
Definitive diagnosis requires a biopsy.
Often there is a history of prior sinus infection that was treated with broad-spectrum antibacterial therapy. As in other sites, Aspergillus tends to invade locally. Computed tomography of the sinuses will usually show bony erosion, and penetration into adjacent tissues such as the brain or the orbit can occur. Diagnosis is made by biopsy. Occasionally, culture from a patient with chronic sinusitis may grow Aspergillus species.