Rhinocerebral Mucormycosis with Top of Basilar Artery Syndrome
Introduction
Rhinocerebral mucormycosis is a rare opportunistic fungal infection, occasionally fatal, caused by Mucorales, and belongs to the class of Zygomycetes (Phycomycetes)1 with an incidence of approximately 1.7 cases per 1,000,000 inhabitants per year.2 The disease occurs mostly in association with diabetic ketoacidosis. Because of its rapid progression and high mortality, early recognition and aggressive treatment offer the only chance to increase the survival rate. Here, we present a case of a diabetic patient with rhinocerebral mucormycosis that was complicated by unusual modes of dissemination by vascular and bony erosions resulting in top of basilar artery syndrome.
Section snippets
Case Report
A 56-year-old male diabetic patient with poorly controlled glycemic levels despite insulin therapy presented with throbbing headache and pain in the left eye and left half of the face for 1 month, along with a history of double vision for 10 days. The patient was febrile (38.8°C), and on neurological examination there was swelling and chemosis of the left periorbital region with left third, fourth, and sixth cranial nerve palsies and decreased perception of pain on the V1 territory. There were
Discussion
Mucor occurs in soil, manure, vegetable, fruits, and as bread mold, and is acquired through airborne fungal spores, contamination of traumatized tissue, ingestion, and direct inoculation.3 Pathogens proliferate in the host tissue and infection ensues in neutropenic individuals such as in chemotherapy patients or during malignancy.4 Patients with diabetes mellitus have susceptibility to the infection by the association with altered immune function, such as diminished T-cell responses, problems
Conclusion
Rhinocerebral mucormycosis is a fatal opportunistic mycosis that predominantly occurs in patients with diabetes and usually causes ischemic arterial syndromes in the anterior circulation, but in our case there is a varied form of vascular dissemination by bony erosion from the sphenoid sinus to the clivus and to the basilar artery, resulting in top of basilar artery syndrome, which is a very unusual arterial syndrome especially in posterior circulation. Early recognition and treatment are vital
References (15)
- et al.
Mucormycosis: an emerging disease?
Clin Microbiol Infect
(2006) - et al.
Mucormycosis of the mandible after dental extractions in a patient with acute myelogenous leukemia
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(1997) - et al.
Facial swelling and palatal ulceration in a diabetic patient
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2004) - et al.
A rapidly fatal palatal ulcer: rhinocerebral mucormycosis
Oral Surg Oral Med Oral Pathol
(1989) - et al.
Palate ulcer due to mucormycosis
J Laryngol Otol
(2002) Mucormycosis
Clin Infect Dis
(1992)- et al.
Mucormycosis in immunochallenged patients
J Emerg Trauma Shock
(2008)
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COVID-19 associated rhino-orbital-cerebral mucormycosis: An observational study from Eastern India, with special emphasis on neurological spectrum
2021, Diabetes and Metabolic Syndrome: Clinical Research and ReviewsCitation Excerpt :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 [41–45]. 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.
Imaging features of rhinocerebral mucormycosis: from onset to vascular complications
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