Invasive craniocerebral aspergillosis, often encountered in an immunocompromised 
setting, is almost uniformly fatal despite radical surgical and medical 
management, and is frequently a necropsy finding. The authors report a unique, 
self-resolving clinical course of this aggressive infection in a 10-month-old 
infant. The infant was brought to the emergency services in altered sensorium 
with a 1-week history of left-sided hemiparesis, excessive irritability, and 
vomiting. An MRI study of the brain revealed multiple, heterogeneously enhancing 
lesions in the right cerebral hemisphere with mass effect. The largest lesion in 
the frontotemporal cortical and subcortical regions was decompressed on an 
emergent basis. Histopathological findings were suggestive of invasive 
aspergillosis, although there was no evidence of the infection in the lungs or 
paranasal sinuses. Computed tomography-guided aspiration of the remaining 
lesions and follow-up antifungal therapy were recommended. The parents, however, 
requested discharge without further treatment. The child was seen at a follow-up 
visit 3 years later without having received any antifungal treatment. Imaging 
showed resolution of the infection and features of Dyke-Davidoff-Masson syndrome 
(cerebral hemiatrophy). This report of invasive cerebral aspergillosis resolving 
without medical therapy is the first of its kind. Its clinicoradiological 
aspects are discussed in light of previously reported cases.