Intracranial manifestations of rhinocerebral mucormycosis: a pictorial essay

Agrawal, Alka; Tripathi, Prem Siddharth; Shukla, Prachi; Nigam, Prakhar; Kheti, Pramita

doi:10.1186/s43055-022-00765-5

Egypt J Radiol Nucl Med

2022

DOI: 10.1186/s43055-022-00765-5

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Intracranial manifestations of rhinocerebral mucormycosis: a pictorial essay

Alka Agrawal

Prem Siddharth Tripathi

Prachi Shukla

et al.

Abstract: Rhinocerebral mucormycosis has emerged as a common coinfection in coronavirus disease 2019 (COVID-19) patients during the convalescence period. Frequent spread of disease from sinonasal mucosa to bone, neck spaces, orbit, and brain occurs along the perivascular/perineural routes or through direct invasion. Brain involvement represents severe manifestation and is often associated with poor functional outcomes and high mortality rates. Magnetic resonance imaging (MRI) is the modality of choice for the intracrani… Show more

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Cited by 3 publications

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Radiological differentiation between bacterial orbital cellulitis and invasive fungal sino-orbital infections

Ang,

Lim,

Chaggar

et al. 2024

Int Ophthalmol

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Purpose Invasive fungal orbital infections (IFOI) may be difficult to differentiate from sinogenic bacterial orbital cellulitis (OC). This study investigates the features differentiating OC from IFOI on magnetic resonance imaging (MRI). Methods Retrospective study of adult patients with sinogenic OC and IFOI with pre-intervention MRI. Patients without post-septal involvement, non-sinogenic OC (e.g.: secondary to trauma) and poor-quality scans were excluded. Independent Sample’s t test and Fisher’s exact test were conducted with p < 0.05 deemed statistically significant. Results Eleven cases each of OC (Mean age: 41.6 ± 18.4 years-old, Male: 10) and IFOI (Mean age: 65.0 ± 16.6 years-old, Male: 9) between 2006 and 2023. IFOI patients were older, more likely immunocompromised and had a lower mean white-cell count (p value = 0.005, 0.035 and 0.017, respectively). The ethmoid and maxillary sinuses were most commonly involved in both entities. Pre-septal and lacrimal gland involvement were more common in OC (p = 0.001 and 0.008, respectively). Infiltrative OC orbital lesions were poorly demarcated, whilst those in IFOI were expansile/mass-like invading the orbit from the adjacent paranasal sinuses. Specific IFOI features included loss-of-contrast-enhancement (LoCE) of paranasal sinus tissues with orbital extension. Extra-orbital and -sinonasal extension indicative of IFOI included contiguous skull base or pterygopalatine fossa involvement, retro-antral and masticator space stranding and vasculitis. Conclusion This study describes the key MRI features of IFOI including differentiating markers from OC. These specific features, such as LoCE of the paranasal and orbital soft tissues, the location and pattern of contiguous soft-tissue involvement, provide expedient identification of IFOI which necessitate early surgical intervention for microbiological confirmation of an invasive fungal pathology.

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Radiological differentiation between bacterial orbital cellulitis and invasive fungal sino-orbital infections

Ang,

Lim,

Chaggar

et al. 2024

Int Ophthalmol

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Predictors of disease severity in COVID-19 associated mucormycosis: impact of HbA1C levels, time lag to mucormycosis onset, and radiologic patterns of paranasal sinuses and spaces involvement

Rao

Rangankar

Rohatgi

et al. 2023

Infectious Diseases

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Magnetic resonance imaging manifestations of vascular complications in patients with acute invasive fungal rhinosinusitis

Abokoura

Youssef

Nada

et al. 2023

Egypt J Radiol Nucl Med

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Background Owing to significant morbidity and mortality with the development of vascular complications in patients with acute invasive fungal rhinosinusitis (AIFRS), early identification, and rapid medical or surgical interventions that are essential for improving patients’ outcomes. For the purpose of presurgical mapping and management planning, magnetic resonance imaging (MRI) is essential for the early identification and improved delineation of disease extent. Objective To evaluate variable MRI manifestations in the detection of the vascular complications in patients with AIFRS and its impact on patients’ survival. Methods A retrospective study, included 24 patients with histopathological proven AIFRS to review the para nasal sinus MRI findings. MRI were evaluated for the sinus involvement and the extrasinus extension into the orbit and/or the brain. Vascular structures were assessed for the development of vascular complications, like ICA for thrombosis, attenuation or pseudoaneurysm, cavernous sinus and superior ophthalmic veins for thrombosis. Results Of the reviewed 24 patients, 16 had cavernous sinus thrombosis, 15 had ICA thrombosis, 10 had ophthalmic vein thrombosis, 4 had ICA attenuation and only two cases had pseudoaneurysm of the ICA. Vascular thrombosis was more common with mucormycosis with cavernous sinus and ophthalmic vein thrombosis which were significantly increased among non survivor patients (90%, 70%), as compared to the survivor patients (50%, 14.29%), with P = 0.04 and 0.005 respectively. Conclusions Vascular complications are common in patients with AIFRS. MRI is helpful in accurate detection of vascular complications in patients with AIFRS.

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Intracranial manifestations of rhinocerebral mucormycosis: a pictorial essay

Cited by 3 publications

References 37 publications

Radiological differentiation between bacterial orbital cellulitis and invasive fungal sino-orbital infections

Radiological differentiation between bacterial orbital cellulitis and invasive fungal sino-orbital infections

Predictors of disease severity in COVID-19 associated mucormycosis: impact of HbA1C levels, time lag to mucormycosis onset, and radiologic patterns of paranasal sinuses and spaces involvement

Magnetic resonance imaging manifestations of vascular complications in patients with acute invasive fungal rhinosinusitis

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