Limits...
Rapidly Progressive Rhino-orbito-cerebral Mucormycosis Complicated with Unilateral Internal Carotid Artery Occlusion: A Case Report.

Bae MS, Kim EJ, Lee KM, Choi WS - Neurointervention (2012)

Bottom Line: Our patient initially presented with mild ethmoid sinusitis.However, aggravation of sinusitis with extension to the right orbit and anterior cranial fossa rapidly developed within two months.Moreover, an occlusion of the right internal carotid artery was combined.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University Hospital, Seoul National University, School of Medicine, Seoul, Korea.

ABSTRACT
Rhinocerebral mucormycosis is an acute fulminant opportunistic fungal infection usually seen in diabetic or immunocompromised patients. The fungi that cause mucormycosis inoculate the nasal mucosa and may spread to the paranasal sinuses, orbit, and brain. Our patient initially presented with mild ethmoid sinusitis. At that time, brain MRI and contrast-enhanced MR angiography were grossly normal. However, aggravation of sinusitis with extension to the right orbit and anterior cranial fossa rapidly developed within two months. Moreover, an occlusion of the right internal carotid artery was combined. We report a case of a pathologically-proven rhino-orbital-cerebral mucormycosis with serial follow-up imaging for over one year.

No MeSH data available.


Related in: MedlinePlus

A. Axial CT images on bone window setting show bone destruction of the frontal bone adjacent to the frontal sinus, anterior ethmoid sinus wall, and cribriform plate with opacification of the frontal and ethmoid sinuses.B. Coronal CT image on the soft tissue window setting shows fluid or soft tissue density lesion in the left maxillary and right anterior ethmoid sinuses, with extension of the inflammation into the superomedial portion of the right orbit, between the superior rectus and medial rectus muscles and no evidence of involvement of the optic nerve.C. T2-weighted images demonstrate heterogeneous high signal intensity in the ethmoid sinus. Note also the lack of a flow void with high signal intensity in the carvenous portion of the right internal carotid artery.D. Time-of-flight MR angiography shows occlusion of the right internal carotid artery (ICA).E. Right common carotid angiography shows occlusion of the right proximal ICA at cervical segment.F. Postoperative follow-up brain MRI obtained at 6 months after the operation. No signal void of the right cavernous ICA is suggestive of a right ICA occlusion. Note also the bulging contour of the right cavernous sinus, probably resulting from thrombophlebitis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3299950&req=5

Figure 1: A. Axial CT images on bone window setting show bone destruction of the frontal bone adjacent to the frontal sinus, anterior ethmoid sinus wall, and cribriform plate with opacification of the frontal and ethmoid sinuses.B. Coronal CT image on the soft tissue window setting shows fluid or soft tissue density lesion in the left maxillary and right anterior ethmoid sinuses, with extension of the inflammation into the superomedial portion of the right orbit, between the superior rectus and medial rectus muscles and no evidence of involvement of the optic nerve.C. T2-weighted images demonstrate heterogeneous high signal intensity in the ethmoid sinus. Note also the lack of a flow void with high signal intensity in the carvenous portion of the right internal carotid artery.D. Time-of-flight MR angiography shows occlusion of the right internal carotid artery (ICA).E. Right common carotid angiography shows occlusion of the right proximal ICA at cervical segment.F. Postoperative follow-up brain MRI obtained at 6 months after the operation. No signal void of the right cavernous ICA is suggestive of a right ICA occlusion. Note also the bulging contour of the right cavernous sinus, probably resulting from thrombophlebitis.

Mentions: After the patient had been discharged from our hospital, he was readmitted approximately two months later because of diplopia of the right eye for 3 days. He has a history of recurrent sinusitis. In addition, he has been taking diabetes mellitus and hypertension medication for 4 years. A right-eye examination revealed proptosis and restricted extraocular motility in both lateral and medial directions. The visual acuity and fundus of both eyes were completely normal. His blood sugar level was 120 mg/dL and other lab findings, such as complete blood count and urine analysis, were within normal levels. CT scan of the paranasal sinuses revealed frontal, ethmoid, and left maxillary sinusitis with associated bone destruction of the frontal bone, anterior ethmoid sinus wall, and cribriform plate. Inflammation of the right orbit was also noted (Fig. 1A, B). These findings were compatible with invasive fungal sinusitis. MRI of the paranasal sinuses showed heterogeneous enhancing lesions in the above-mentioned paranasal sinuses with extension of the inflammation into the right orbit and anterior intracranial fossa (Fig. 1C). The lesions were isointense or slightly hypointense on T1-weighted MR image (T1WI), and mostly hyperintense on T1-weighted MR image (T2WI). In addition, loss of signal void in the petrous and cavernous portion of the right ICA was noted with high signal intensity on both T1WI and T2WI. A three-dimensional time-of-flight (3D TOF) MRA of the carotid and brain (Fig. 1D) showed occlusion or severe stenosis of the right proximal ICA at the level of the carotid bifurcation. Conventional cerebral angiography (Fig. 1E) showed occlusion of the cervical segment of the right ICA with no distal flow. However, collateral circulation from the contralateral carotid artery through the anterior communicating artery was effective.


Rapidly Progressive Rhino-orbito-cerebral Mucormycosis Complicated with Unilateral Internal Carotid Artery Occlusion: A Case Report.

Bae MS, Kim EJ, Lee KM, Choi WS - Neurointervention (2012)

A. Axial CT images on bone window setting show bone destruction of the frontal bone adjacent to the frontal sinus, anterior ethmoid sinus wall, and cribriform plate with opacification of the frontal and ethmoid sinuses.B. Coronal CT image on the soft tissue window setting shows fluid or soft tissue density lesion in the left maxillary and right anterior ethmoid sinuses, with extension of the inflammation into the superomedial portion of the right orbit, between the superior rectus and medial rectus muscles and no evidence of involvement of the optic nerve.C. T2-weighted images demonstrate heterogeneous high signal intensity in the ethmoid sinus. Note also the lack of a flow void with high signal intensity in the carvenous portion of the right internal carotid artery.D. Time-of-flight MR angiography shows occlusion of the right internal carotid artery (ICA).E. Right common carotid angiography shows occlusion of the right proximal ICA at cervical segment.F. Postoperative follow-up brain MRI obtained at 6 months after the operation. No signal void of the right cavernous ICA is suggestive of a right ICA occlusion. Note also the bulging contour of the right cavernous sinus, probably resulting from thrombophlebitis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3299950&req=5

Figure 1: A. Axial CT images on bone window setting show bone destruction of the frontal bone adjacent to the frontal sinus, anterior ethmoid sinus wall, and cribriform plate with opacification of the frontal and ethmoid sinuses.B. Coronal CT image on the soft tissue window setting shows fluid or soft tissue density lesion in the left maxillary and right anterior ethmoid sinuses, with extension of the inflammation into the superomedial portion of the right orbit, between the superior rectus and medial rectus muscles and no evidence of involvement of the optic nerve.C. T2-weighted images demonstrate heterogeneous high signal intensity in the ethmoid sinus. Note also the lack of a flow void with high signal intensity in the carvenous portion of the right internal carotid artery.D. Time-of-flight MR angiography shows occlusion of the right internal carotid artery (ICA).E. Right common carotid angiography shows occlusion of the right proximal ICA at cervical segment.F. Postoperative follow-up brain MRI obtained at 6 months after the operation. No signal void of the right cavernous ICA is suggestive of a right ICA occlusion. Note also the bulging contour of the right cavernous sinus, probably resulting from thrombophlebitis.
Mentions: After the patient had been discharged from our hospital, he was readmitted approximately two months later because of diplopia of the right eye for 3 days. He has a history of recurrent sinusitis. In addition, he has been taking diabetes mellitus and hypertension medication for 4 years. A right-eye examination revealed proptosis and restricted extraocular motility in both lateral and medial directions. The visual acuity and fundus of both eyes were completely normal. His blood sugar level was 120 mg/dL and other lab findings, such as complete blood count and urine analysis, were within normal levels. CT scan of the paranasal sinuses revealed frontal, ethmoid, and left maxillary sinusitis with associated bone destruction of the frontal bone, anterior ethmoid sinus wall, and cribriform plate. Inflammation of the right orbit was also noted (Fig. 1A, B). These findings were compatible with invasive fungal sinusitis. MRI of the paranasal sinuses showed heterogeneous enhancing lesions in the above-mentioned paranasal sinuses with extension of the inflammation into the right orbit and anterior intracranial fossa (Fig. 1C). The lesions were isointense or slightly hypointense on T1-weighted MR image (T1WI), and mostly hyperintense on T1-weighted MR image (T2WI). In addition, loss of signal void in the petrous and cavernous portion of the right ICA was noted with high signal intensity on both T1WI and T2WI. A three-dimensional time-of-flight (3D TOF) MRA of the carotid and brain (Fig. 1D) showed occlusion or severe stenosis of the right proximal ICA at the level of the carotid bifurcation. Conventional cerebral angiography (Fig. 1E) showed occlusion of the cervical segment of the right ICA with no distal flow. However, collateral circulation from the contralateral carotid artery through the anterior communicating artery was effective.

Bottom Line: Our patient initially presented with mild ethmoid sinusitis.However, aggravation of sinusitis with extension to the right orbit and anterior cranial fossa rapidly developed within two months.Moreover, an occlusion of the right internal carotid artery was combined.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University Hospital, Seoul National University, School of Medicine, Seoul, Korea.

ABSTRACT
Rhinocerebral mucormycosis is an acute fulminant opportunistic fungal infection usually seen in diabetic or immunocompromised patients. The fungi that cause mucormycosis inoculate the nasal mucosa and may spread to the paranasal sinuses, orbit, and brain. Our patient initially presented with mild ethmoid sinusitis. At that time, brain MRI and contrast-enhanced MR angiography were grossly normal. However, aggravation of sinusitis with extension to the right orbit and anterior cranial fossa rapidly developed within two months. Moreover, an occlusion of the right internal carotid artery was combined. We report a case of a pathologically-proven rhino-orbital-cerebral mucormycosis with serial follow-up imaging for over one year.

No MeSH data available.


Related in: MedlinePlus