Rhinocerebral Mucormycosis with Top of Basilar Artery Syndrome

https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.10.009Get rights and content

Aim

Our objective is to highlight the varied forms of vascular dissemination of rhinocerebral mucormycosis resulting in ischemic arterial syndromes, especially rare posterior ischemic circulatory strokes, through dissemination of mucormycosis from sphenoid bone to clivus by bony erosion and to the basilar artery, thus causing the top of basilar artery syndrome.

Materials and Methods

We have reported a case of rhinocerebral mucormycosis in an uncontrolled diabetic patient presented to the neurointensive care unit, department of neurology.

Findings

A 56-year-old male diabetic patient with poorly controlled glycemic levels presented with pansinusitis resulting in rhinocerebral mucormycosis with basilar artery erosion through clivus bone erosion from sphenoid sinus. Mucormycosis is caused by fungi. Mucormycosis is commonly reported in immunocompromised patients such as poorly controlled diabetes mellitus, blood dyscrasias, malnutrition, neutropenia, iron overload, organ transplant, and immunosuppressive therapy. Mucormycosis rises with an increase in incidence of diabetes mellitus and HIV infection leading to immunocompromised status of the patient. In our case, there is invasion to the sphenoid bone and to clivus by bony erosion and to the basilar artery, thus causing the top of basilar artery syndrome, which is very unusual.

Conclusion

Mucormycosis has a very fatal rapid progression with varied forms of cerebral dissemination with high mortality; hence early recognition and aggressive treatment are needed to increase the survival rate.

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)

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