Rhino-Orbital-Cerebral Mucormycosis With Different Cerebral Involvements: Infarct, Hemorrhage, and Ophthalmoplegia

Abstract

Rhino-orbital-cerebral mucormycosis is a rare but often fatal opportunistic necrotizing infection of the sinuses, orbit, and brain caused by saprophytic fungi. It usually develops in patients with diabetes or immune system deficiency. In this study, imaging features in 3 patients with rhino-orbital-cerebral mucormycosis who presented with various symptoms and different cerebral involvements are discussed. Headache, blurred vision, fever, painful ophthalmoplegia, and cranial nerve involvement were among the clinical findings. Computed tomography and magnetic resonance imaging are the best imaging methods for assessing the extent of this disease. Relatively typical but nonspecific characteristics are bone destruction, vascular invasion, and central hypointensity in the paranasal sinuses or an intracranial mass that is revealed by T(2)-weighted magnetic resonance imaging. Imaging findings include cavernous sinus involvement, cerebral infarct, and intracerebral hemorrhage. Because of the invasive and fulminant nature of rhino-orbital-cerebral mucormycosis, successful treatment seems to be based on early diagnosis and on the management of underlying immunologic problems.

Subcortical Intracerebral Hemorrhage Caused by Mucormycosis in a Patient with a History of Bone-marrow Transplantation

“…[2][3][4] However, there have been only two case reports of ICH in patients with RCM. 1,8 In our case, we recognized occlusion of a cortical vein around the hematoma cavity. We speculate that venous congestion arising from Mucor mycelium invasion of cortical vein is the possible reason for ICH.…”

“…5 RCM sometimes presents as a stroke. 1 Fatal cerebral infarctions caused by major artery occlusion by Mucor fungus were reported previously. [2][3][4] However, there have been only two case reports of ICH in patients with RCM.…”

Brain Zygomycosis in a Patient with High Risk Myelodysplastic Syndrome after Initiation of Chemotherapy

“…3,12,13 We present a case of disseminated zygomycosis with CNS involvement presenting clinically as stroke and radiographically as a hemorrhagic mass. Although the patient received posaconazole and amphotericin B, she succumbed to the disease in the ICU and the definitive diagnosis was made on autopsy.…”

Bir Böbrek Transplantasyon Alıcısında Orbital Apeks Sendromu ile Seyreden Mukormikoz

“…Spread may occur either via direct neighborhood or via embolus from surrounding vasculatures depending on necrosis. Rhinoorbitacerebral involvement is a rare but the most important clinical manifestation of mucormycosis with high mortality rate and usually develops in the patients with diabetes mellitus or immune system defect 8 .…”