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Bilateral optic nerve infarction in rhino-cerebral mucormycosis: A rare magnetic resonance imaging finding.

Ghuman MS, Kaur S, Bhandal SK, Ahluwalia A, Saggar K - J Neurosci Rural Pract (2015 Jul-Sep)

Bottom Line: Mucormycosis is an emerging disease in diabetes and immunocompromised patients.Mucormycosis leading to ischemic optic neuropathy is a rare complication.We report an unusual case of mucormycosis in which MRI revealed bilateral optic nerve infarction, in addition to perineural extension of the fungus along the trigeminal nerve, another uncommon imaging finding.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Dayanand Medical College and Hospital, Ludhiana, India.

ABSTRACT
Mucormycosis is an emerging disease in diabetes and immunocompromised patients. Rhino-orbito-cerebral mucormycosis is one of the common forms of the disease. Mucormycosis leading to ischemic optic neuropathy is a rare complication. The role of magnetic resonance imaging (MRI) in the diagnosis of ischemic optic neuropathy is limited and uncommonly reported. We report an unusual case of mucormycosis in which MRI revealed bilateral optic nerve infarction, in addition to perineural extension of the fungus along the trigeminal nerve, another uncommon imaging finding.

No MeSH data available.


Related in: MedlinePlus

Axial diffusion-weighted image (a) and fluid-attenuated inversion recovery image (b) showing abnormal high signal and thickening of the cisternal segment of the left trigeminal nerve (thin arrows) extending to involve the left side of the pons (chevron)
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Figure 2: Axial diffusion-weighted image (a) and fluid-attenuated inversion recovery image (b) showing abnormal high signal and thickening of the cisternal segment of the left trigeminal nerve (thin arrows) extending to involve the left side of the pons (chevron)

Mentions: A 33-year-old female, known type-1 diabetes mellitus with ketoacidosis, presented with nasal bleeding with blackish nasal crusts, periorbital swelling, proptosis and left hemifacial pain. She further developed decreased vision in both eyes and altered sensorium. Examination showed bilateral ophthalmoplegia, left corneal and left hemifacial sensory loss. Visual acuity was limited to detecting hand movements at one foot bilaterally. Magnetic resonance imaging (MRI) revealed intensely hypointense signal, involving medial orbits bilaterally, orbital apices, and left cavernous sinus suggesting a fungal pathology. Diffusion-weighted (DW) MRI and corresponding ADC maps [Figure 1b and c] demonstrated bilateral optic nerve infarction. Abnormal signal intensity was also noted along the left trigeminal nerve in left side of the ambient cistern extending into the left side of pons [Figures 1a and 2a and b]. Smear of sinonasal aspirate and histopathology of nasal crusts confirmed mucormycosis.


Bilateral optic nerve infarction in rhino-cerebral mucormycosis: A rare magnetic resonance imaging finding.

Ghuman MS, Kaur S, Bhandal SK, Ahluwalia A, Saggar K - J Neurosci Rural Pract (2015 Jul-Sep)

Axial diffusion-weighted image (a) and fluid-attenuated inversion recovery image (b) showing abnormal high signal and thickening of the cisternal segment of the left trigeminal nerve (thin arrows) extending to involve the left side of the pons (chevron)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4481798&req=5

Figure 2: Axial diffusion-weighted image (a) and fluid-attenuated inversion recovery image (b) showing abnormal high signal and thickening of the cisternal segment of the left trigeminal nerve (thin arrows) extending to involve the left side of the pons (chevron)
Mentions: A 33-year-old female, known type-1 diabetes mellitus with ketoacidosis, presented with nasal bleeding with blackish nasal crusts, periorbital swelling, proptosis and left hemifacial pain. She further developed decreased vision in both eyes and altered sensorium. Examination showed bilateral ophthalmoplegia, left corneal and left hemifacial sensory loss. Visual acuity was limited to detecting hand movements at one foot bilaterally. Magnetic resonance imaging (MRI) revealed intensely hypointense signal, involving medial orbits bilaterally, orbital apices, and left cavernous sinus suggesting a fungal pathology. Diffusion-weighted (DW) MRI and corresponding ADC maps [Figure 1b and c] demonstrated bilateral optic nerve infarction. Abnormal signal intensity was also noted along the left trigeminal nerve in left side of the ambient cistern extending into the left side of pons [Figures 1a and 2a and b]. Smear of sinonasal aspirate and histopathology of nasal crusts confirmed mucormycosis.

Bottom Line: Mucormycosis is an emerging disease in diabetes and immunocompromised patients.Mucormycosis leading to ischemic optic neuropathy is a rare complication.We report an unusual case of mucormycosis in which MRI revealed bilateral optic nerve infarction, in addition to perineural extension of the fungus along the trigeminal nerve, another uncommon imaging finding.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Dayanand Medical College and Hospital, Ludhiana, India.

ABSTRACT
Mucormycosis is an emerging disease in diabetes and immunocompromised patients. Rhino-orbito-cerebral mucormycosis is one of the common forms of the disease. Mucormycosis leading to ischemic optic neuropathy is a rare complication. The role of magnetic resonance imaging (MRI) in the diagnosis of ischemic optic neuropathy is limited and uncommonly reported. We report an unusual case of mucormycosis in which MRI revealed bilateral optic nerve infarction, in addition to perineural extension of the fungus along the trigeminal nerve, another uncommon imaging finding.

No MeSH data available.


Related in: MedlinePlus