Angioinvasive rhinocerebral mucormycosis with complete unilateral thrombosis of internal carotid artery—case report and review of literature

Patil, Aruna R; Mohanty, Himansu Shekhar; Kumar, Sharath; Nandikoor, Shrivalli; Meganathan, Prabhu

doi:10.1259/bjrcr.20150448

Cited by 17 publications

(24 citation statements)

References 11 publications

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“…There are many documented cases in the literature of RCM invading the skull base and neighboring vasculature leading to ophthalmic, retinal, and ICA occlusion (1, 3, 6, 28). The unique nature of our case lies in the fact that the diagnosis of RCM was made via mechanical thrombectomy and histological analysis of the embolus.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Rhinocerebral Mucormycosis by Treatment of Cavernous Right Internal Carotid Artery Occlusion With Mechanical Thrombectomy: Special Case Presentation and Literature Review

et al. 2019

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Background: Mucormycosis is a rapidly progressive, angioinvasive fungal infection that has a predilection for the paranasal sinuses and adjacent mucosa. Rhinocerebral mucormycosis (RCM) is the most common form and is known to invade the skull base and its associated blood vessels—leading to mycotic aneurysms, ischemic infarcts, and intracerebral hemorrhage. There are documented cases of mechanical thrombectomy in ischemic stroke due to RCM, however, there are no known cases that were diagnosed primarily by histological and pathological analysis of the embolus. We present a case of treatment of large vessel occlusion that led to the diagnosis and treatment of RCM. Case Presentation: A 21 year-old male inmate with history of type 1 diabetes presented with generalized weakness, abdominal pain, right eye blindness, and ophthalmoplegia after an assault in prison. He underwent treatment for diabetic ketoacidosis, but subsequently developed left hemiplegia and was found to have complete occlusion of his right internal carotid artery. He underwent successful mechanical thrombectomy and pathological analysis of the embolus revealed a diagnosis of mucormycosis. He completed a course of amphotericin B, micafungin, and posaconazole. With the aid of acute rehabilitation he achieved a modified Rankin score of 2. Discussion: We review the pathogenesis, diagnosis, and treatment of RCM. A comprehensive multidisciplinary approach is critical in the management of this often-fatal disease. Early diagnosis and treatment are essential in RCM as delaying treatment by more than 6 days significantly increases mortality. Treatment includes surgical debridement and intravenous antifungal therapy (amphotericin B + micafungin or caspofungin) for a minimum of 6–8 weeks.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of Rhinocerebral Mucormycosis by Treatment of Cavernous Right Internal Carotid Artery Occlusion With Mechanical Thrombectomy: Special Case Presentation and Literature Review

et al. 2019

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“…Enfeksiyonun oluşmasında genel durumda düşkünlük, tıkız organ nakilleri, immün yetmezlik, immün sistemin baskılanması, zeminde başka bir enfeksiyonun var olması gibi etkenler rol oynar [1,2]. Özellikle kontrol altına alınamayan diyabet olgularında görülme sıklığı bazen % 50'ye kadar çıkar ve diş çekiminden sonra görülmeleri olasıdır [1,[3][4][5]. Diyabetik ketoasidoz ya da sistemik asidozun varlığı yatkınlığı artırır.…”

Section: Discussionunclassified

“…ilgilidir [1]. Zeminde bulunan yatkınlık nedenleri arasında kontrol edilmeyen/edilemeyen diyabetli olgularda agressif ve anjiyoinvaziv rinoserebral mukormikozis gelişimi olasılığı yüksektir [1,[3][4][5].…”

Section: Discussionunclassified

“…MR erken dönemde difüzyon kısıtlamasını göstermektedir[1][2][3][4][5]. Nekrotik doku kaybı nedeni ile ve/veya sinüs duvarlarındaki kemik doku devamlılığının kaybı sonucu dokular içinde/ arasında hava kabarcıkları görülebilir.…”

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“…Hava, orbital kavite içinde ve pterigopalatin fossaya kadar ulaşarak bu yolla da intrakraniyal bölgeye geçme eğilimi sergiler. Kontrastlı MR anjiyografi ya da BT anjiyografilerde tromboze olan arterlerde kontrast madde yokluğu ya da kontrastsız MR anjiyografilerde akım yokluğu saptanır[1][2][3][4][5].…”

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Taniniz Nedir?/Cevap

Pabuşçu¹,

Universitesi²

2018

Türk Radyoloji Derg

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Tanı: Rinoserebral (anjiyoinvaziv) mukormikozisHastanemize geliş tarihinde elde edilmiş paranazal sinüs, maksillofasiyal ve beyin BT'lerinde çekilmiş diş köküne ait alveolar çıkıntıdaki kemik defekti ve yumuşak doku ile sağ tarafta sinüzit bulguları ve yüz sağ yarısında cilt, cilt-altı yağlı doku ve kas gruplarında inflamatuar yumuşak doku değişiklikleri ve kalınlaşma saptandı. Geliş tarihinden iki gün sonra elde edilen BT ve Diffüzyon ağırlıklı MR görüntülerinde, nekroza bağlı cilt ve cilt-altı dokularda kayıplar ve ülsere görünüm ile inflamatuvar/infektif sürecin ilerlemesine ait sağ gözde propitozis gelişimi, optik sinirde kalınlaşma, sinüzit bulgularında artış, pterigopalatin fossa ve orbital kavitede amfizem alanlarının gelişimi ve yüzde cilt-altı amfizem bulgularında artış ile sağ serebellar ve serebral hemisferde enfarkt ile sağ orta serebral arterde hiperdens arter işaretinin varlığı ve serebellar ve serebral iskemi ile ilgili MR difüzyon kısıtlanmaları mevcuttu. Hasta gelişinin onuncu gününde çekilen Kraniyal MR incelemesine ek olarak elde edilen beyin MR anjiyografisinde intrakraniyal kan akımının olmayışı ve diğer gerekli test ve klinik bulgular ile beyin ölümü tanısı kesinleşti. Planlanan ancak yapılamayan endoskopik sinüs cerrahisi operasyonu öncesinde alınan nazal kavite biyopsisinde Mukormikozis tanısı aldı.

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Spectrum of intracranial complications of rhino-orbito-cerebral mucormycosis — resurgence in the era of COVID-19 pandemic: a pictorial essay

et al. 2021

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Rhino-orbito-cerebral mucormycosis (ROCM) has regained significance following its resurgence in the second wave of the COVID-19 pandemic in India. Rapid and progressive intracranial spread occurs either by direct extension across the neural foraminae, cribriform plate/ethmoid, walls of sinuses, or angioinvasion. Having known to have a high mortality rate, especially with intracranial extension of disease, it becomes imperative to familiarise oneself with its imaging features. MRI is the imaging modality of choice. This pictorial essay aims to depict and detail the various intracranial complications of mucormycosis and to serve as a broad checklist of structures and pathologies that must be looked for in a known or suspected case of ROCM.

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Angioinvasive rhinocerebral mucormycosis with complete unilateral thrombosis of internal carotid artery—case report and review of literature

Cited by 17 publications

References 11 publications

Diagnosis of Rhinocerebral Mucormycosis by Treatment of Cavernous Right Internal Carotid Artery Occlusion With Mechanical Thrombectomy: Special Case Presentation and Literature Review

Diagnosis of Rhinocerebral Mucormycosis by Treatment of Cavernous Right Internal Carotid Artery Occlusion With Mechanical Thrombectomy: Special Case Presentation and Literature Review

Taniniz Nedir?/Cevap

Spectrum of intracranial complications of rhino-orbito-cerebral mucormycosis — resurgence in the era of COVID-19 pandemic: a pictorial essay

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