Mucormycose rhinocérébrale : étude anatomoclinique de sept cas

Rhino-orbito-cerebral mucormycosis: Five cases

“…The physical examination may reveal hemiparesis or hemiplegia contralateral to the lesion with homolateral facial palsy, brachial monoplegia, auditory hallucinations, meningeal signs, or involvement of cranial pairs (VI, VII, VIII, IX, X, XI, XII). Other complications may be observed such as meningoencephalitis, brain abscess, thrombosis of the cavernous sinus or of the carotid, intracranial hypertension, or subdural or intracerebral hemorrhages [10,13,20,21]. In our patients, the cerebral involvement was peripheral for four patients, with involvement of cranial nerves, and central in three patients with consciousness disorders ( Table 1).…”

“…CT scan of the brain and of facial bones reveals, besides signs of sinus involvement, an infiltration of retro-orbital tissues or orbit abscess, and exophthalmia. A the cerebral level, we may observe hypodense lesions with a ring edema, cerebral abscess, obstructive hydrocephalus, multiple zones of infarct, or thrombosis of the cavernous sinus [5,8,18,20]. We observed radiological signs of sinus involvement in all patients, as well as radiological images of exophthalmia (patients 1 and 2) and images of cerebral extension such as thrombosis of the right lateral sinus (patient 4) or ventricular dilatation, or dilated cortical grooves (patient 3).…”

“…Eye fundus is a key examination for the diagnosis of naso-orbital-cerebral mucormycosis. It may reveal a venous congestion or a thrombosis of the artery or of the central vein of the retina, optic atrophy or panophthalmia [2,5,20]. 3 FE were performed for our patients, revealing anomalies in only one patient, hemorrhagic and exudative lesions without papillary involvement.…”

“…The sinus extension always concerns the homolateral ethmoidal sinus. Involvement of the frontal and sphenoidal sinus is less frequent [18][19][20]. We observed pansinusitis in four patients and maxillo-ethmoidal sinusitis in one patient.…”

“…These filaments have a vascular tropism creating aneurysmal distensions, thrombosis, and parietal rupture responsible for hemorrhagic tissular necrosis. The special stains used are Gomori-Grocott and PAS [2,11,12,20].…”