This chapter investigates the complex relationship of stroke with fungal pathogens like aspergillus, mucor, candida, cryptococcus and other fungi. Among fungal pathogens, aspergillus is most likely to present as a stroke or stroke-like syndrome. Pathologically there were multiple areas of cerebral infarction with thrombosis due to Aspergillus invasion of arteries. Like Aspergillus, Mucor species are angioinvasive and can cause stroke through, bland infarction, and vascular thrombosis. Candida is not an angioinvasive pathogen, and reports of stroke after candida infection are distinctly uncommon. Like candida species, cryptococcus is not angioinvasive. Cryptococcus neoformans is an encapsulated yeast. A variety of less common fungi that can rarely infect immunocompromised patients include fusarium (a septate mold), Trichosporon (a pathogenic yeast), paecilomyces, pseudallescheria, Scopulariopsis, and the endemic fungi (coccidioides immitis, histoplasma capsulatum). Reports of central nervous system (CNS) involvement or stroke like syndromes are limited with these less common fungi.

The childhood stroke is classified as either hemorrhagic or ischemic. Hemorrhagic infarctions are either subarachnoid or intraparenchymal. No historical feature distinguishes ischemic from hemorrhagic stroke. However, nausea, vomiting, headache, and a depressed level of consciousness are more common in hemorrhagic strokes. Subarachnoid hemorrhage (SAH) generally presents with a sudden onset of severe headache, nausea, vomiting, meningismus, and photophobia. Ischemic infarctions are thrombotic (arterial or venous) or embolic (arterial). Seizures are a presenting symptom of ischemic stroke in approximately 20% of patients. The sudden development of focal neurological deficits, headache, seizure, and altered consciousness are typical manifestations of childhood stroke. Selected historical information helps to determine the etiology of stroke. An emergent head computerized tomography (CT) scan may help to determine whether the stroke is hemorrhagic or ischemic and to guide further diagnostic evaluations. Aspirin is used especially in children who are at risk of developing recurrent stroke.