J Korean Neurol Assoc.  2000 Mar;18(2):235-239.

Rhino-orbito-cerebral Mucormycosis Complicated with Intracranial Hemorrhage

• Baek KH
• Whang SH
• Choi HC
• Shin JH
• Lee BC

Abstract

Rhino-orbito-cerebral mucormycosis is an uncommon fulminant fungal infection that occurs usually in debilitated or immune suppressed patients. Intracranial lesions such as cerebral ischemia mostly develop secondary to vascular injuries like thrombosis of cavernous sinus or internal carotid artery and also from arteritis. However, intracranial hemorrhage complicated by mucormycosis is very rare. We report a patient with a fatal complicaton of intracranial hemorrhage presumably due to arteritis by mucormycosis. A 66-year-old female patient with uncontrolled diabetes mellitus developed complete ophthalmoplegia in her left eye for two days. Rhinoscopic examination revealed black necrotic turbinate. Orbital CT scan and Brain MRI showed soft tissue material at the left orbital apex and mild deformities in the left lateral cavernous sinus. On the basis of radiological evidence and biopsy, a diagnosis of mucormycosis was established, and the patient underwent surgical debridement followed by an Amphotericin B infusion. On the following day, she suddenly developed a right hemiparesis and stupor. An immediate brain CT scan revealed a large intracranial hemorrhage in the left frontal head region. Removal of the hematoma and a biopsy was performed immediately. A pathological examination revealed a fungal invasion of the small arterial wall and an acute inflammatory reaction of the surounding tissues.

Keyword

Rhino-orbito-cerebral mucormycosis; Diabetes mellitus; Arteritis; Intracranial hemorrhage

MeSH Terms

Aged
Amphotericin B
Arteritis
Biopsy
Brain
Brain Ischemia
Carotid Artery, Internal
Cavernous Sinus
Congenital Abnormalities
Debridement
Diabetes Mellitus
Diagnosis
Female
Head
Hematoma
Humans
Intracranial Hemorrhages*
Magnetic Resonance Imaging
Mucormycosis*
Ophthalmoplegia
Orbit
Paresis
Stupor
Thrombosis
Tomography, X-Ray Computed
Turbinates
Vascular System Injuries
Amphotericin B