Rhinocerebral Mucormycosis with Top of Basilar Artery Syndrome

Kumar, N. S. Sampath; Padala, Ravi Kiran; Tirupati, Sunanda; Tatikonda, Anil Kumar

doi:10.1016/j.jstrokecerebrovasdis.2015.10.009

Cited by 5 publications

(7 citation statements)

References 14 publications

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“…In the current patient, widespread tissue necrosis was observed in the rhino-orbital region, and necrotic scarring filling the intranasal area, the orbital cavity and the sinuses, which was associated with tissue necrosis developing after vascular invasion (Figure 1C, 1D and Figure 2). Although very few cases have been reported in literature [13,14], even if there are cases of mucormycosis which developed cerebral infarct because of vascular invasion, in the current case there were no cerebral imaging findings or findings of cerebral vascular invasion which could show a reason for the acute ischaemic stroke.…”

Section: Arch Clin Med Casecontrasting

confidence: 55%

Severe Rhino-orbital Mucormycosis Infection of anIntensive Care Unit Patient: A Case Report

Tutak¹,

Fındıklı²,

Aslan³

et al. 2017

Arch Clin Med Case Rep

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Mucormycosis is an opportunistic fungal infection, which is occasionally seen in immunosuppressive patients, and has high morbidity and mortality rates despite treatment. The case is here reported of a patient admitted to our Intensive Care Unit (ICU) with diagnosis of diabetic ketoacidosis, acute kidney injury, acute cerebral infarct and rhino-orbital mucormycosis.This level of advanced rhino-orbital mucormycosis caused severe cutaneous and subcutaneous lesions has not been reported previously in literature and thus the case is evaluated in respect of the early diagnosis of mucormycosis and treatment.

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Section: Arch Clin Med Casecontrasting

confidence: 55%

Severe Rhino-orbital Mucormycosis Infection of anIntensive Care Unit Patient: A Case Report

Tutak¹,

Fındıklı²,

Aslan³

et al. 2017

Arch Clin Med Case Rep

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“… Radiological evidence of ICA involvement at the level of cavernous sinus substantiated well with imaging as evidenced by absent flow void of ICA on affected side in T2 MR imaging and decreased flow in ICA in MRA in majority cases. However in 1 subject with stroke, there was no evidence of structural involvement of ICA, thereby suggesting an intriguing relationship between stroke with microscopic invasion by fungus and vasospasm of ICA, apart from structural compression from outside and intraluminal obstructions [ [41] , [42] , [43] , [44] , [45] ]. Meningeal and invasive parenchymal involvement, seizure, and disorientation : Meningeal involvement though common in our study, was focal in all cases with primary involvement of meninges over temporal (medial and anterior) and frontal lobe.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 associated rhino-orbital-cerebral mucormycosis: An observational study from Eastern India, with special emphasis on neurological spectrum

Dubey¹,

Mukherjee²,

Sarkar³

et al. 2021

Diabetes & Metabolic Syndrome: Clinical Research & Revi

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Aims: 1 Describe the epidemiology and determine risk factors for COVID-19 associated mucormycosis. 2 Elaborate the clinical spectrum of Rhino-Orbital-Cerebral Mucormycosis (ROCM), pattern of neuroaxis involvement and it's radiological correlates. Methods Observational study. Consecutive, confirmed cases of mucormycosis (N = 55) were included. A case of mucormycosis was defined as one who had clinical and radiological features consistent with mucormycosis along with demonstration of the fungus in tissue via KOH mount/culture/histopathological examination (HPE). Data pertaining to epidemiology, risk factors, clinico-radiological features were analysed using percentage of total cases. Results Middle aged, diabetic males with recent COVID-19 infection were most affected. New onset upper jaw toothache was a striking observation in several cases. Among neurological manifestations headache, proptosis, vision loss, extraocular movement restriction; cavernous sinus, meningeal and parenchymal involvement were common. Stroke in ROCM followed a definitive pattern with watershed infarction. Conclusions New onset upper jaw toothache and loosening of teeth should prompt an immediate search for mucormycosis in backdrop of diabetic patients with recent COVID-19 disease, aiding earlier diagnosis and treatment initiation. Neuroaxis involvement was characterized by a multitude of features pertaining to involvement of optic nerve, extraocular muscles, meninges, brain parenchyma and internal carotid artery.

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“…However, in many cases (42%), despite the use of surgery, death occurred (Table 1), which could be due to rapid Mucorales invasion into the brain, delayed surgical treatment, progressive infection and high‐risk patients like those with diabetic ketoacidosis or renal failure 8,37 . Furthermore, some factors such as brain involvement, intracranial abscesses, hydrocephalus, hemiparesis, bilateral sinus involvement and facial necrosis can contribute to the poor prognosis for a patient, whose survival is not ensured despite the proper use of medication and surgery 35,67 . Besides, surgery provides very valuable samples for the diagnosis of mucormycosis but, often, repeated debridement sessions are required to control the disease and, at this stage, the patient is left with a large bony and soft tissue defect, which lead to the patient not accepting surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, although treatment can sometimes control CM in patients, bacterial infections can cause death due to the patient's physiological condition, multiple surgeries, metabolic disorders caused by diabetes and the long hospital stay 17,67 . Therefore, the survivors of mucormycosis are high‐risk patients who are highly susceptible to disease recurrence and exhibit predisposition to more conventional bacterial infection and sepsis by the insertion of a foreign body; therefore, it is recommended that one consult an infectious disease expert from the outset of the treatment process.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology, clinical features, diagnosis and treatment of cerebral mucormycosis in diabetic patients: A systematic review of case reports and case series

Chegini

Didehdar

Khoshbayan

et al. 2020

Mycoses

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Summary Background Patients with diabetes are known as an important high‐risk group for cerebral mucormycosis (CM). Method We conducted a structured search using PubMed/MEDLINE to collect both case reports and case series case (ie including at least two patients) onto CM in diabetic patient published between 2000 and March 2020. Results Forty‐five reports of individual cases and eighteen case series articles were included. India accounted for the largest share of reports with 37.7% and 38.8% of individual cases and case series, respectively. Mortality ranged from 0% to 100% in the case series. The overall mortality in the individual cases was 46.3%, and 64.2% of deaths were reported in patients with ketoacidosis diabetes. Facial swelling (53.3%), headache (44.4%), loss of vision (35.5%) and ophthalmoplegia (35.5%) were the most frequently reported clinical symptoms. In all patients except 4 (91.1%), CM was treated surgically; however, in many cases (42%), despite the use of surgery, death occurred. Amphotericin B deoxycholate (AMB) and lipid‐based AMB (LAMB) were used as the first lines of treatment for all patients; however, posaconazole, echinocandins, hyperbaric oxygen therapy (HBOT) and deferasirox were used in combination for a number of patients. Posaconazole has been shown to have positive therapeutic effect; however, posaconazole, LAMB and HBOT are not commonly used in low‐income and health‐challenged countries. Conclusion Cerebral mucormycosis is a rapidly progressive infection in diabetic patients and carries immense morbidity despite early diagnosis and treatment. Low‐income countries have had the highest number of reports of the disease in recent years, indicating the need to control diabetes in these countries.

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Rhinocerebral Mucormycosis with Top of Basilar Artery Syndrome

Cited by 5 publications

References 14 publications

Severe Rhino-orbital Mucormycosis Infection of anIntensive Care Unit Patient: A Case Report

Severe Rhino-orbital Mucormycosis Infection of anIntensive Care Unit Patient: A Case Report

COVID-19 associated rhino-orbital-cerebral mucormycosis: An observational study from Eastern India, with special emphasis on neurological spectrum

Epidemiology, clinical features, diagnosis and treatment of cerebral mucormycosis in diabetic patients: A systematic review of case reports and case series

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